Ophthalmic Research最新文献

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.

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.

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: 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: The aim of the study was to systematically review the evidence from randomized controlled trials that evaluate the efficacy and safety of perfluorohexyloctane in the treatment of dry eye disease.

Methods: Literature search was conducted on PubMed and Scopus in April 2024 with the search strategy ("perfluorohexyloctane" or "NOV03" or "semifluorinated alkane") and "dry eye." Extension and paired-eyes study were excluded. The risk of bias was assessed using the Cochrane risk-of-bias tool. Forest plots and a summary of findings were prepared for total corneal fluorescein staining (tCFS), tear film break-up time (TFBUT), eye dryness score (EDS), and Ocular Surface Disease Index (OSDI).

Results: The pooled standardized mean difference (SMD) for tCFS after 8 weeks of treatment was -0.53 (95% CI: -0.68 to -0.38; p < 0.001), indicating a significant improvement in patients treated with perfluorohexyloctane. The between-study heterogeneity was moderately high (I2 = 52.0%). No significant differences in TFBUT were observed (SMD = 0.05; 95% CI: -0.16 to 0.25; p = 0.654). Regarding symptoms, patients treated with NOV03 had significantly lower EDS compared to controls (SMD = -0.49; 95% CI: -0.66 to -0.32; p < 0.001), with moderately high heterogeneity (I2 = 71.1%). Conversely, the pooled SMD of OSDI was -0.13 (95% CI: -0.43 to 0.17; p = 0.412), indicating no significant difference.

Conclusion: Perfluorohexyloctane is an effective and safe alternative for the treatment of evaporative dry eye disease due to MGD that can significantly reduce tCFS and eye dryness symptoms. More well-designed non-sponsored randomized clinical trials are required to investigate the impact on other ocular surface parameters.