Ophthalmic Research最新文献

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.

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 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.

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.