Ophthalmic Research最新文献

Introduction: Various methods of conjunctival closure have been described, with no consensus of preference. We designed this study to compare continuous versus interrupted sutures for closure of scleral pocket and conjunctiva after evisceration and acrylic ocular implant installation.

Methods: This study was a retrospective comparative observational study conducted at South Valley University Hospital on all ocular evisceration cases with acrylic implants from 1 March 2019 to 31 March 2024. For each patient, clinical data were perused, including demographics, indications, clinical history, operative details, and postoperative follow-up data.

Results: Forty-seven patients were included in this study. Twenty-seven were allocated to group A (continuous sutures) and 20 patients to group B (interrupted sutures). The mean age of patients was 38.52 ± 12.8 and 39.35 ± 14.5 in groups A and B, respectively (p value = 0.839). Males represented 51.9% (14/27) and 50% (10/20) of groups A and B, respectively (p value = 0.901). Absolute glaucoma was the indication in 5 (18.5%) and 3 (15%) patients in groups A and B, respectively; anterior staphyloma was the indication in 7 (25.9%) and 5 (25%) patients, respectively; and atrophia/phthisis was the indication in 6 (22.2%) and 5 (25%) patients, respectively, while old trauma was the indication in 9 (33.3%) and 7 (35%) patients, respectively, with p value = 0.769. The median size of the acrylic implant used was 20 mm in both groups. Patients were followed up on average in group A for 20.19 ± 3.2 months and in group B for 19.95 ± 3.4 months (p value = 0.812). No cases of infection or implant extrusion were observed in both groups. But in group B, there were 3 cases (15%) of wound dehiscence and implant exposure, while no reported cases in group A (0%) with clinically significant p value (0.029).

Conclusion: Continuous suturing for closure, as opposed to interrupted sutures, produces better wound outcomes when closing the scleral pocket and conjunctiva post evisceration and acrylic ocular implant installation.

Introduction: The aim of the study was to compare the effects of 1-month versus routine-duration silicone oil (SO) tamponade on intraocular inflammatory cytokine levels and clinical outcomes in patients undergoing vitrectomy for rhegmatogenous retinal detachment.

Methods: A prospective study from May 2019 to March 2022 divided patients undergoing vitrectomy into routine and early groups. Aqueous humor was sampled before SO removal to measure cytokine levels, including granulocyte-macrophage colony-stimulating factor, interferon (IFN)-γ, interleukin (IL)-4, IL-8, IL-10, IL-13, IL-17, macrophage inflammatory protein (MIP)-1α, tumor necrosis factor (TNF)-α, and IL-1α. Clinical outcomes such as SO emulsification, cataract formation, recurrent retinal detachment, corneal endothelial cell (CEC) density, and intraocular pressure were assessed. Statistical analyses were performed to evaluate differences and correlations between cytokine levels and clinical characteristics.

Results: The study analyzed 48 eyes, with 28 in the routine group and 20 in the early group. The early group had significantly lower IL-8 and TNF-α levels (p = 0.006 and p = 0.013) and reduced SO emulsification (p = 0.01). A significant trend toward fewer cataract cases and higher CEC density was observed in the early group (p = 0.019 and p = 0.015). IL-8 and TNF-α levels showed positive correlations with IL-10, MIP-1α.

Conclusion: One-month SO tamponade significantly reduces intraocular inflammatory cytokine levels and associated complications by decreasing the recruitment and activation of leukocytes. These findings suggest that shorter SO placement durations can effectively minimize inflammation-related complications while maintaining therapeutic efficacy. Future research should focus on optimizing SO tamponade protocols and exploring the underlying mechanisms of inflammation and emulsification to enhance the safety and efficacy of vitreoretinal surgeries.

Background: Stargardt disease (STGD1) due to biallelic mutations in the ABCA4 gene is the most frequent single-gene retinal disease with a genetic prevalence of about 1 in 7,000. Pathology in STGD1 is due to dysfunction of a retina-specific vitamin A transporter which causes accumulation of cytotoxic vitamin A byproducts known as bisretinoids. Bisretinoids produce a distinct autofluorescent emission within affected cells that is seen to precede atrophy of the retinal pigment epithelium (RPE), photoreceptor cell death, and vision loss. This sequence of pathogenesis, and the fact that formation and accumulation of bisretinoids begin within photoreceptors, suggests early pathology may occur within photoreceptor cells. Here, relevant literature is reviewed to explore the relationship between bisretinoids, fundus autofluorescence, and photoreceptor function/integrity in STGD1 with a focus on early-stage disease and potential biomarkers for clinical investigation.

Summary: Currently accepted primary endpoints in STGD1 clinical trials include quantification of areas where the autofluorescence signal is lacking due to the death of RPE and photoreceptor cells. Importantly, many patients with early-stage STGD1 cannot be monitored in this way as they present clinically prior to RPE or photoreceptor loss at a pre-atrophic stage and without significant visual impairment. Imaging analyses of patients with early-stage disease have shown increased fundus autofluorescence and compromised photoreceptor integrity and/or visual function deficits in the absence of atrophic retinal lesions. These findings implicate early accumulation of bisretinoid toxins within the retina as an underlying causative factor and provide an impetus to determine the relevance of these measures as surrogate endpoints or biomarkers for disease progression in STGD1 clinical trials.

Key messages: Early recognition and treatment of patients with STGD1 who have relatively healthy retinal tissue will likely yield a more favorable visual prognosis. Accordingly, there is a need to identify early disease initiators and progression patterns. The reviewed data support the hypothesis that bisretinoid accumulation within photoreceptors may be responsible for the observed early retinal pathology and vision loss. Clinical evaluation of therapeutics intended to reduce bisretinoid accumulation in early-stage STGD1 patients will likely provide a greater understanding of the role of bisretinoids in disease progression and potential for vision preservation.

Introduction: The aim of the study was to evaluate the effect of modified posterior scleral reinforcement (PSR) surgery integrated with comprehensive amblyopia rehabilitation in children with high myopia-related anisometropic amblyopia.

Methods: A retrospective cohort analysis was conducted, including 24 eyes treated with the modified PSR intervention and 20 nonsurgical controls. Baseline and 3-year postoperative assessments included best-corrected visual acuity (BCVA), cycloplegic spherical equivalent (SE), and axial length (AL).

Results: At the 3-year follow-up, the PSR cohort exhibited significant BCVA enhancement (p < 0.001) alongside suppressed myopic progression, as evidenced by reduced SE deterioration (p < 0.001) and AL elongation (p < 0.001), compared to controls. Amblyopia treatment success rates were markedly higher in the surgical group (p < 0.001). Stratified analyses revealed greater BCVA gains in the PSR group across all amblyopia severities, with pronounced improvements in severe amblyopia cases. Age-specific outcomes demonstrated attenuated AL growth in both preschoolers (<6 years, p < 0.01) and school-aged children (≥6 years, p < 0.05). Notably, younger preschoolers in the PSR group achieved superior BCVA gains (p < 0.05), whereas older controls showed limited responsiveness.

Conclusion: The combination of modified PSR surgery and multidisciplinary amblyopia rehabilitation represents a promising therapeutic approach for mitigating refractive error progression and enhancing visual outcomes in children with high myopia-associated anisometropic amblyopia.

Introduction: Diabetic retinopathy (DR) is a severe complication of diabetes, and lipid imbalances play a key role in its progression. The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has been identified as a predictor of cardiovascular diseases, but its link to DR remains unclear. This study aimed to assess the association between NHHR and DR risk in diabetic patients.

Methods: Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Multivariate logistic regression models were used to evaluate the relationship between NHHR and DR. Nonlinear associations were assessed using restricted cubic spline analysis.

Results: Of the 4,935 participants, 1,193 had DR. Higher NHHR was strongly associated with increased DR risk. Each unit rise in NHHR increased the risk by 19% (OR = 1.19, 95% CI: 1.07-1.31, p < 0.05). In quartile analysis, participants in the highest NHHR quartile had nearly double the risk of DR compared to those in the lowest quartile (OR = 1.84, 95% CI: 1.62-2.06, p < 0.001). Subgroup analysis showed this association was consistent across different demographic groups, including age, gender, BMI, and smoking status.

Conclusion: NHHR is significantly linked to DR risk in diabetic patients and may be a valuable biomarker for early detection and prevention strategies in clinical settings.

Introduction: The purpose of this systematic review and meta-analysis was to compare optical coherence tomography (OCT) retinal measurements between patients with autism spectrum disorder (ASD) and the neurotypical controls, exploring the potential of OCT as a noninvasive biomarker for ASD-related neurodevelopmental alterations.

Methods: PubMed, Embase, and Scopus databases were explored to determine eligible articles reporting OCT measurements of the retina and choroid in patients with ASD compared to healthy controls. Statistical analysis of OCT metrics was performed if reported in at least three discrete studies. In the process, fixed- and random-effects models were utilized, depending on the heterogeneity level between studies. Subgroup analysis based on the age group of cases, the method of eye selection, age and sex matching of cases and controls, and the OCT device used was also conducted.

Results: Ten studies with 373 ASD cases (with a total of 640 eyes) and 443 controls (with a total of 760 eyes) were included in this study. No significant alteration was observed in the average total macular layer, macular inner nuclear layer (INL), macular inner plexiform layer (IPL), macular ganglion cell layer (GCL), and macular retinal nerve fiber layer (RNFL) thickness. There was also no significant difference in the peripapillary retinal nerve fiber layer (pRNFL) thickness of the eyes of cases with ASD compared to healthy controls, except for the inferonasal portion of the pRNFL, which was significantly thicker in ASD subjects when compared to controls (p = 0.02).

Conclusion: The findings of the present meta-analysis indicate a localized thickening of the inferonasal pRNFL with no alteration of other portions of pRNFL and macular layers (IPL, INL, GCL, RNFL). Although OCT may reflect subtle neurodevelopmental differences in ASD, current evidence is limited by small sample sizes, methodological heterogeneity, and potential confounders.

Introduction: The aim of the study was to investigate the anterior segment anatomical parameters associated with the scleral spur and cornea for risk profiling of primary angle closure glaucoma (PACG).

Methods: A retrospective study was conducted, collecting parametric measurements obtained using CASIA 2 and IOLMaster 700. Univariate and multivariate logistic regression models were utilized to compare ocular parameters between the narrow angle (NA) group and PACG group, as well as identify risk factors for PACG. The predictive performance of each parameter was evaluated using the area under the receiver operating characteristic (AUROC) curve.

Results: A total of 84 patients with PACG (48 with PACG and 36 with chronic PACG) and 84 patients with NA were included in this study. In the multivariable model, it was demonstrated that individuals with a smaller trabecular scleral-spur angle (TSA: OR = 0.810, per 1° increase, p < 0.001, AUROC = 0.738) and larger relative lens vault (rLV: OR = 1.112, per 1 percent increase, p < 0.001, AUROC = 0.720) had an increased risk of developing PACG. Furthermore, combining TSA with rLV yielded an improved AUROC value of 0.807 (p < 0.001).

Conclusion: AS-OCT is a valuable tool for early assessment of progression risk in NA patients at risk for developing PACG. Our findings suggest that both TSA and rLV are significant risk factors for PACG. Moreover, the novel parameter TSA demonstrates promising potential as a predictive tool for early PACG screening.

Introduction: The aim of this study was to investigate the effect of different levels of early intraocular pressure (IOP) on long-term outcomes of patients with primary open-angle glaucoma (POAG) who were treated with primary trabeculectomy.

Methods: This was a retrospective cohort study, with a total of 74 patients (90 eyes) with POAG who were treated with trabeculectomy surgery at a single center from 2021 to 2022. Based on IOP at 1 day after surgery, they were divided into the high IOP group (≥15 mm Hg) and the low IOP group (<15 mm Hg). The Student's t test and a chi-square test were used to compare the differences between the two groups. The generalized estimating equation model compared the included binocular data to adjust for internal correlations between the two eyes of the same subject. The Kaplan-Meier method compared the surgical success rates of the two groups. Besides, to identify the relationship between IOP at different postoperative time points and IOP at 1-year follow-up, the Spearman correlation analysis was established.

Results: A total of 90 eyes (74 patients) with POAG were included in this investigation. After a 1-year follow-up, both the qualified surgical success rates in the high IOP group and the low IOP group were 92.3% and 92.2%, respectively, and there was no statistically significant difference between them (p = 0.890). The rate of bleb massage in the high IOP group was 82.1% (32 eyes) which was significantly higher than in the low IOP group (19.6%, 10 eyes) (p < 0.001). In the Spearman correlation analysis, it was observed that in the high IOP group, the significant correlation with IOP at 1 year emerged at 1 week after surgery (r = 0.496, p = 0.002) and a higher correlation at 1 month after surgery (r = 0.515, p = 0.002). In the low IOP group, the significant correlation with IOP at 1 year emerged at 3 month after surgery (r = 0.314, p = 0.038) and a higher correlation at 6 month after surgery (r = 0.592, p < 0.001).

Conclusion: In the POAG patients with primary trabeculectomy, we demonstrated that compared with the low IOP group, the high IOP group could provide a similar surgical success rate while requiring a higher frequency of bleb massage. In addition, in the high IOP group, IOP at 1 month after surgery predicted long-term IOP control outcomes.

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: The aim of this study was to characterized fundus autofluorescence (AF) changes that occur in the macula of patients with retinitis pigmentosa (RP).

Methods: We conducted a case series on 99 patients with RP. Features seen on fundus AF images were evaluated, organized into a grading scheme, and correlated with ellipsoid zone (EZ) width. Patterns of AF changes occurring in the macula and correlation with EZ width.

Results: Four primary fundus AF phenotypes were identified: (1) hyperAF arc, (2) hyperAF ring, (3) hyperAF ring with abnormal hyperAF within the ring, and (4) central hyperAF. The second phenotype was most common and had 3 subgroups, hyperAF rings within the macula, those extending outside the macula, and incomplete rings. HyperAF rings were also characterized as narrow or wide with wide rings having a greater amount of hyperAF. Linear Mixed-Effects Model showed mean measured EZ width was significantly greater for phenotype 1 versus each of the other 3 phenotypes (p < 0.01) and for phenotype 2 versus phenotypes 3 and 4 (p < 0.05), and also differed among phenotype 2 subgroups (p < 0.05). Other AF characteristics identified were focal posterior distinct or indistinct hypoAF which sometimes formed complete or incomplete hypoAF rings surrounding a hyperAF ring, diffuse or focal hyperAF outside hyperAF rings, and the amount of encroachment of peripheral hypoAF.

Conclusions: A grading scheme for macular AF features in patients with RP identified phenotypes that correlate with stage of disease based upon EZ width. Longitudinal studies are needed to test whether presumed early AF phenotypes evolve into later phenotypes. Use of the grading scheme for patient populations in interventional trials could help determine if any of the defined AF features provide predictive value for therapeutic responses.