Ophthalmic Research最新文献

Purpose: Previous studies have demonstrated the efficacy of Faricimab where the intervention in treatment-resistant neovascular age-related macular degeneration (nAMD) had been switched from Aflibercept to Faricimab. This exploratory study aimed to assess the clinical anatomical and functional outcomes of a single intravitreal Faricimab (IVF) injection in those with treatment-resistant nAMD who switched from Aflibercept, in a single tertiary ophthalmology centre.

Methods: This retrospective, observational real-world study assessed 20 patients (21 eyes) with treatment-resistant nAMD who were switched from intravitreal Aflibercept (IVA) to Faricimab due to persistent subretinal fluid (SRF) despite frequent Aflibercept injections. Patients were switched to a regimen of Faricimab consisting of three loading doses administered at 4-weekly injections. Anatomical and functional measures were assessed at two time points: immediately before the initial Faricimab injection and approximately 4 weeks later, before the second Faricimab injection. The outcome measures were: visual acuity, central macular thickness (CMT), macular volume, and the presence of SRF were evaluated pre- and post-switch.

Results: Twenty-one eyes from 20 patients were analyzed. Statistically significant reductions in CMT (from 570.2 to 482.7 μm; p < 0.01) and macular volume (from 8.57 to 7.87 mm³; p = 0.02) were observed post-switch, while the change in visual acuity did not reach statistical significance (p = 0.051). The number of eyes with SRF decreased from 21 pre-switch to 9 post-switch.

Conclusion: The findings from this exploratory study suggests that switching from Aflibercept to Faricimab demonstrated significant physiological improvements among patients with treatment-resistant nAMD. Faricimab may serve as an effective and safe option in this patient population. The exploratory study also identifies changes in CMT and macular volume as outcome measure candidates for future large-scale investigations.

Purpose: This study aimed to characterize the differential indications and compare anatomical and visual outcomes between pars plana vitrectomy (PPV) and posterior scleral contraction (PSC) in eyes with myopic traction maculopathy (MTM).

Methods: One hundred seventy-five eyes with MTM from 157 patients who were treated with PSC or PPV and had at least 6 months of follow-up were retrospectively analysed. Best-corrected visual acuity (BCVA) was used to assess visual outcomes. Anatomical outcomes were assessed using optical coherence tomography.

Results: The PPV and PSC groups included 87 and 88 eyes, respectively. Eyes in the PPV group presented with higher presence of epiretinal membrane (93.1% vs. 69.3%, P<0.001), larger macular hole (MH) diameter (128.0 μm vs. 0 μm, P=0.01), and more severe pattern of MH (e.g., full thickness MH 18.4% vs. 10.2%, P<0.001), whereas achieved better anatomical outcomes (MH recovery rate: 89.9% vs. 50.0%, P <0.001; incidence of complete or essential recovery: 82.8% vs. 61.4%, P <0.001; the median time to recovery: 90 days vs. 307 days. P<0.001). Additionally, better recovery of retinal profile in PPV group tended to be more significant in eyes with axial length (AL) ≤30 mm. Conversely, eyes in the PSC group presented with more advanced MTM Staging System (e.g., stage 4 13.6% vs. 4.6%, P=0.003) and larger highest cavity of maculoschisis or macular detachment (389.3 ± 229.8 μm vs. 322.2 ± 216.4 μm, P=0.048), resulting in significant reduction in AL postoperatively (29.9 ± 1.6 mm before surgery vs. 28.2 ± 1.6 mm at last follow-up, P <0.001). In multivariate linear regression analysis, type of operation did not have a significant impact on BCVA at last follow-up or on change in BCVA after surgery.

Conclusions: PPV was typically performed for eyes with severer vitreoretinal interface abnormalities and achieved better outcomes, particularly in eyes with AL ≤ 30mm. PSC was performed for eyes with advanced MTM Staging System, providing better axial stabilization despite slower anatomical improvement. Both approaches improved visual acuity to a similar extent, irrespective of the surgical technique employed.

Introduction: This study aimed to assess visual and refractive outcomes and cost utility of toric intraocular lens (IOLs) implantation in cataract patients over 80 with corneal astigmatism.

Methods: Patients >= 80 years with corneal astigmatism >= 1.50 diopters (D) who underwent cataract surgery with toric or monofocal IOLs were enrolled. Uncorrected distance visual acuity (UDVA) and residual refractive astigmatism at the 3-month postoperative follow-up were compared between the toric and non-toric groups. Cost data were gathered, long-term quality-adjusted life years (QALYs) were calculated, and the incremental cost-effectiveness ratio (ICER) was determined.

Results: The study included 50 eyes from 50 patients, with 25 eyes receiving toric IOLs and the remaining 25 receiving non-toric IOLs. Three months after surgery, both the mean UDVA (P < 0.0001) and the mean residual refractive astigmatism (P < 0.0001) in the toric group significantly outperformed those in the non-toric group. An average of 4.04 ± 0.25 QALYs were obtained in the toric group through cataract surgery, while 3.78 ± 0.26 QALYs were obtained in the non-toric group. The median ICER stood at 11,222 CNY (1,753 USD) per QALY [95% CI: 5,840 ~ 25,295 CNY (913 ~ 3,952 USD) per QALY], which is lower than the threshold of cost-effectiveness in China (80,976 CNY (12,653 USD) per QALY).

Conclusion: In cataract patients aged over 80 with corneal astigmatism and no complicating vision-threatening conditions, toric IOL implantation not only improved UDVA and reduced residual astigmatism but also emerged as a cost-effective intervention compared with non-toric IOL implantation.

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.