Ophthalmic Research最新文献

Introduction: The aim of study was to investigate postoperative outcomes in patients who underwent rhegmatogenous retinal detachment (RRD) surgery.

Methods: This was a multicenter retrospective study involving 263 patients who underwent silicone oil (SiO) tamponade for RRD. Patients were divided into three groups based on the SiO tamponade: 1 month (group 1, n = 55), 3 months (group 2, n = 176), and 6 months (group 3, n = 32). The main outcomes were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and retinal structure 1 month after silicone oil removal (SOR).

Results: In the analysis of retinal structure in post-SOR, the median central macular thickness (CMT) in groups 1, 2, and 3 was 182.5 μm (IQR: 156.0-214.0), 170.0 μm (IQR: 140.3-211.5), and 152.0 μm (IQR: 92.3-195.3), and the median ganglion cell layer-inner plexiform layer (GCL-IPL) in groups 1, 2, and 3 was 80.5 μm (IQR: 70.0-92.3), 73.0 μm (IQR: 65.0-81.3), and 65.0 μm (IQR: 56.3-79.0), respectively. Both CMT and GCL-IPL differed significantly with the group 1 exhibiting the thickest retinal structure (p = 0.03 and p = 0.006). IOP differed significantly across groups, with group 3 showing the highest IOP in post-SOR (p = 0.015). However, there were no significant differences in BCVA, inner retinal layer thickness, outer retinal layer thickness, or submacular fluid among the groups.

Conclusions: Prolonged SiO tamponade is correlated with increased IOP and the thinning of the CMT and GCL-IPL over time, with favorable postoperative outcomes for 1-month SiO tamponade. Given the potential risks of extended tamponade, it is advisable to remove SiO as soon as anatomically feasible.

Background: Polypoidal choroidal vasculopathy (PCV) causes severe visual impairment in patients with neovascular age-related macular degeneration (nAMD). Currently, PCV is classified as a subtype or variant of type 1 macular neovascularization. Effective treatments for PCV remain limited, despite the variable efficacy of anti-vascular endothelial growth factor (VEGF) drugs in regressing polypoidal lesion(s) (PLs). A key contributing factor is the incomplete understanding of the disease mechanisms, which highlights the necessity for reliable animal models and a comprehensive understanding from multiple perspectives. Summary: This review elucidates the complexities of PCV through an integrated analysis of its clinical characteristics, pathological features, and molecular mechanisms. Both PLs and the branching neovascular network (BNN) are neovascular lesions located beneath the retinal pigment epithelium (RPE), as evidenced by optical coherence tomography angiography (OCTA) and clinicopathological studies. Key distinctions between PLs and BNN include lesion location, cellular component, and vascular maturity. Three-dimensional OCTA reconstruction demonstrated an anteroposterior separation between PLs and BNN, and revealed an internal microvascular architecture within PLs. Clinicopathological analysis demonstrated markedly incomplete coverage of mural cells - specifically, a lack of pericytes in PLs and relatively reduced coverage of vascular smooth muscle cells in BNN. This incomplete coverage might be attributed to increased expression of angiopoietin-2 (Ang-2), leading to mural cell loss via the integrin-mediated signaling pathway. Key Messages: Regressing PLs and promoting BNN maturity through various approaches might provide an optimal treatment strategy for PCV management. However, a comprehensive understanding of the complex mechanisms of PCV merits further investigation for better management of this refractory disease.

Introduction: Age-related macular degeneration (AMD) is a leading cause of vision loss among older adults in the USA. Understanding its prevalence and demographic distribution is critical for developing targeted public health strategies. This study aimed to assess the prevalence of AMD and its clinical stages among US Medicare beneficiaries aged 65 years and older.

Methods: We conducted a retrospective cohort study using the Vision and Eye Health Surveillance System (VEHSS) database of Medicare beneficiaries diagnosed with AMD between 2014 and 2021. Crude prevalence rates for overall AMD, early AMD, intermediate AMD, wet AMD, and geographic atrophy (GA) were calculated at national and state levels. Prevalence was stratified by age, sex, and race/ethnicity. Statistical analyses included the Mann-Whitney U test for age and sex comparisons, the Brown-Forsythe one-way ANOVA for racial/ethnic comparisons, and the Dunnett T3 test for post hoc analyses.

Results: In 2021, the VEHSS-Medicare dataset included 24,129,807 individuals aged 65 and older, among whom the national prevalence of AMD was 10.40%. Prevalence rates for early AMD, intermediate AMD, wet AMD, and GA were 2.87%, 6.91%, 2.14%, and 0.73%, respectively. The number of AMD cases increased from 2.33 million in 2014 to 2.51 million in 2021. Prevalence was significantly higher in individuals aged ≥85 years compared to those aged 65-84 years, and in females compared to males. Post hoc analyses demonstrated that White individuals had a significantly higher prevalence of AMD compared with all other racial/ethnic groups.

Conclusions: The prevalence of AMD among US adults aged 65 years and older was 10.4%, with higher rates observed in the oldest age groups, females, and White individuals. These findings highlight the importance of addressing disparities in AMD prevention and care, particularly in populations at greatest risk.

Introduction: The purpose of this study was to compare the accuracy of seven formulas for intraocular lens power calculation in patients with microspherophakia (MSP).

Methods: A retrospective case series included 44 eyes from 28 patients with MSP. The mean prediction error (PE) was calculated, and the accuracy was determined by formula performance index (FPI), median absolute error (MedAE), and percentage of eyes with a PE within ±0.25 diopters (D), ±0.50 D, ±0.75 D, and ±1.00 D. Depending on whether the patients had Marfan syndrome (MFS), MSP patients 36 were sub-divided into MFS and non-MFS group.

Results: In the non-MFS subgroup, the performance of formulas ranked by FPI from highest to lowest was BUII, Emmetropia Verifying Optical (EVO), Kane, Haigis, Sanders-Retzlaff-Kraff/Theoretical (SRK/T), Holladay 1, and Hoffer Q. In the MFS subgroup, Kane achieved the best accuracy regarding the lowest MedAE and the largest percentage of PE in the range of ±0.50 D. Similar results were obtained in eyes with shallow anterior chamber depth (ACD). In the regular ACD subgroup, the EVO provided the highest prediction accuracy and SRK/T took the second place. In the deep ACD subgroup, Holladay 1 performed superiorly presenting the lowest standard deviation values, mean absolute error and MedAE.

Conclusions: Overall, new generation formulas showed a better trend of refractive outcomes in MSP patients. The Holladay 1 formula was suggested for eyes with deep ACD, while Haigis was not recommended.

Introduction: This study investigated microperimetry-derived retinal sensitivity and optical coherence tomography (OCT)-based macular morphologic data in eyes with early and intermediate age-related macular degeneration (AMD). The respective metrics were compared between macular subfields and their associations were determined. Detailed knowledge of functional associations with morphology is an asset to future therapeutic trial design.

Methods: This is a cross-sectional analysis of microperimetry and spectral-domain OCT baseline data. OCT data were segmented automatically within the HEYEX software (Heidelberg Engineering). Data were assessed for Gaussian normal distribution by the D'Agostino and Pearson tests, and appropriate comparison tests were performed for parametric and nonparametric data. The association of retinal sensitivity metrics with OCT morphologic data was tested with mixed-effects models.

Results: In total, 19 eyes of 19 participants (75 ± 6.4 years) with early and intermediate AMD were included in the analysis. Both in mesopic (p < 0.05) and in scotopic red (p < 0.001) microperimetry, retinal sensitivities differed significantly between macular subfields in ANOVA. Nasal and temporal subfields showed the highest retinal sensitivities, also compared to the central subfield. Generally, subfields within the 1 mm-2 mm diameter ring showed higher retinal sensitivities than subfields within the 2 mm-3 mm diameter ring. Superior subfields demonstrated higher retinal sensitivity than inferior subfields in mesopic microperimetry. RPE thickness was mostly negatively associated with retinal sensitivity, which was pronounced in the ETDRS inner ring inferior subfield and for mesopic retinal sensitivity (t value, p value: -3.7, <0.01). In the center position, inner retinal thickness was negatively associated with mesopic retinal sensitivity (t value, p value: -2.2, <0.05).

Conclusion: Retinal layer thicknesses and their associations with retinal sensitivity show localized differences between macular subfields in early and intermediated AMD. An analysis including more subjects is necessary to confirm these trends. This knowledge is of importance since therapeutic trial design requires detailed morphologic but also functional conception in order to detect therapeutic effects and pass regulatory hurdles.

Introduction: The aims of the study were to evaluate the structure-function relationship between steady-state pattern electroretinogram (ssPERG), optical coherence tomography (OCT), and visual field (VF) tests and to investigate indicators that enhance the detection of preperimetric and early-stage primary open-angle glaucoma (POAG).

Methods: In this retrospective cohort study, patients with POAG and normal subjects who underwent ssPERG, OCT, and VF tests were included. We defined the ratio of the amplitudes from 0.8° checks to 16° checks as the pattern electroretinogram ratio (PERGratio). The thickness of the macular ganglion cell inner plexiform layer and the circumpapillary retinal nerve fiber layer (cpRNFL) were measured using spectral-domain OCT. We compared the areas under the receiver operating characteristic curves (AUCs) for ssPERG, OCT, and VF test parameters. A combined index using structural and functional measures was generated using logistic regression models to improve diagnostic accuracy.

Results: Four parameters had AUCs higher than 0.8; PERGratio (AUC = 0.890), average cpRNFL thickness (AUC = 0.827), 7 o'clock cpRNFL thickness (AUC = 0.844), and inferior quadrant cpRNFL thickness (AUC = 0.830). The new index, which combines the PERGratio and 7 o'clock cpRNFL thickness, significantly improved diagnostic accuracy (AUC = 0.951), outperforming the best four parameters (all p ≤ 0.004). Furthermore, the combined index of PERGratio and 7 o'clock cpRNFL thickness showed significantly higher diagnostic accuracy compared to those combining the 7 o'clock cpRNFL thickness with VF mean deviation, pattern standard deviation, and VF index.

Conclusion: The combined index of ssPERG, indicative of retinal ganglion cell dysfunction, and the OCT test, indicative of focal structural damage, improved the detection of patients with POAG in its early stage.

Introduction: The aim of the study was to investigate the correlation between systemic inflammation biomarkers and morphological changes of retinal neurovascular unit (RNVU) under optical coherence tomography (OCT) and OCT angiography (OCTA) in type 2 diabetic patients with early signs of diabetic retinopathy (DR).

Methods: This cross-sectional study was carried out among 93 type 2 diabetic patients with early signs of DR (170 eyes), ranging from level 10 to level 35 based on ETDRS DR severity scale score. Age-, sex-, and axial length-matched normal subjects were enrolled as controls. Systemic inflammation biomarkers including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammatory index (SII) were calculated based on peripheral blood results. Retinal neuronal changes of RNVU were identified by accessing the thickness of macular retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) using OCT. Retinal microvascular alterations of RNVU were evaluated by measuring macular vessel density (VD) and size of foveal avascular zone (FAZ) using OCTA.

Results: GCL thickness was significantly correlated with NLR (r = -0.183, p = 0.017) and MLR (r = -0.235, p = 0.002), RNFL thickness was significantly associated with MLR (r = -0.210, p = 0.008), FAZp was positively correlated with NLR (r = 0.153, p = 0.046) and MLR (r = 0.187, p = 0.014), FAZa was positively correlated with MLR (r = 0.189, p = 0.014), and VD was significantly correlated with NLR (r = -0.188, p = 0.014) on spearman correlation analysis. Additionally, VD was independently associated with SII in both univariable and multivariable GLM analysis (p < 0.05). This difference still remained statistically significant during subgroup analysis after controlling DM duration.

Conclusion: Systemic inflammation biomarkers including NLR, MLR, and SII are significantly associated with not only retinal microvascular alterations but also retinal neuronal changes, providing evidence that systemic inflammation may play a crucial role on the early morphological changes of RNVU and early DR pathogenesis. SII is independently associated with VD, which supports SII may serve as a potential biomarker for monitoring early microvascular changes of DR.

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 optimize 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: The aim of this study was 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 pretreatment 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 of 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 of PMA were labeled as middle-term re-treated group.

Results: Thirty-six percentage 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 of 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 pretreatment 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 pretreatment 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, extraretinal new vessels, and prophylactic purposes were the main re-treatment indications.