Ophthalmic Research最新文献

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.

Introduction: The aim of the study was to investigate the specificity of Clarus 500™, an ultra-wide-field (UWF) fundus camera, for detecting peripheral retinal lesions in myopic eyes.

Methods: This diagnostic test included 436 eyes from 221 patients with myopia before refractive surgery. The mean age was 28.9 ± 6.0 years (18 to 49 years), with the average spherical equivalent refraction being -8.33 ± 2.81 diopters (D) (-20.63 D to -0.50 D). Images were captured using Clarus 500™ from the posterior pole and four UWF directions, including the superior temporal, superior nasal, inferior temporal, and inferior nasal gaze. A slit-lamp non-contact +120 D lens was used as the control. Sensitivity and specificity in detecting fundus lesions were compared between the images obtained by Clarus 500™ and slit-lamp examination. Statistical analysis was performed using version 4.3.0 of R software, and significance was set at p < 0.05.

Results: Of the 436 eyes, 13 (2.98%) underwent slit-lamp examination, and 5 (1.15%) underwent Clarus 500™ examination, revealing retinal lesions. The sensitivity of Clarus 500™ for detecting peripheral retinal holes/tears was 50% (95% confidence interval [95% CI]: 1.26%, 98.74%). The specificity for peripheral lattice degeneration was 99.77% (95% CI: 98.70%, 99.99%). The agreement between the two methods for detecting peripheral reticular degeneration and retinal holes was moderate (kappa value: 0.42, 95% CI: 0.10-0.75, p < 0.01) and substantial (kappa value: 0.67, 95% CI: 0.05-1, p < 0.01), respectively.

Conclusion: Clarus 500™ showed high specificity for detecting peripheral retinal holes and substantial agreement with the slit-lamp in identifying peripheral retinal degeneration and retinal holes.

Introduction: Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery. But it may lead to temporary dry eye due to reversible damage to the corneal subbasal nerve plexus. However, evidence on chronic ocular surface changes are unclear. This study reports the ocular surface changes, partial blinking rates, and meibomian gland statuses in eyes that underwent LASIK for at least 48 months.

Methods: Cross-sectional, matched case-control comparison study, including 48 post-LASIK patients and 48 sex-, age-, smoking-, and axial length-matched healthy controls, recruited from a community eye screening program. Outcome measures include anterior segment clinical findings, keratographic and meibographic imaging.

Results: Totally, 48 right eyes of 48 post-LASIK Chinese patients (39 females, 2 smokers) were analyzed with 48 right eyes of 48 matched healthy controls. The mean age at the time of ocular surface examination was 50 ± 11 years, and the axial length 26±1 mm. Post-LASIK eyes had a lower quality of meibum (p = 0.008) compared to healthy controls. Post-LASIK eyes were associated with a shorter Schirmer's test (p = 0.03). The ocular surface disease index (OSDI) score was higher in post-LASIK patients (p = 0.00001). Other anterior segment examination parameters, partial blinking rate, meibomian gland dropout, lipid layer thickness, noninvasive tear break-up time, and tear meniscus height were comparable between the 2 groups.

Conclusions: Up to 75% of post-LASIK patients complained of on-going, chronic dry eye symptoms. Post-LASIK eyes were associated with a reduced aqueous tear production. Post-LASIK patients with chronic dry eye symptoms are advised to have periodic ocular surface evaluation. Treatments might be considered in patients with poor tear film stability.

Introduction: Schlemm's canal-based minimally invasive glaucoma surgeries (MIGSs) are gaining increasing recognition and acceptance, but majority of these MIGSs are recommended in eyes with open angle. Bleb-independent penetrating canaloplasty (PCP) restores physiological aqueous outflow in eyes with both open and closed angles. We aimed to compare the efficacy, safety, and postoperative management of PCP versus trabeculectomy (TRAB) in patients with bilateral primary glaucoma.

Methods: This study is prospective self-control case series in a tertiary hospital in China. A total of 54 eyes from 27 patients with bilateral primary open angle glaucoma (n = 18) or primary angle-closure glaucoma (n = 9) were included. TRAB with mitomycin C was performed in one eye, while PCP was performed in the contralateral fellow eye. Intraocular pressure (IOP), number of glaucoma medications, surgery-related complications, and postoperative interventions were compared between groups. Complete (without medication) and qualified success (with/without medication) were defined as IOP ≤21 mm Hg and ≥20% IOP reduction.

Results: Mean IOP decreased from 32.5 ± 8.87 mm Hg on 2.3 ± 1.43 medications at baseline to 15.5 ± 5.02 mm Hg on 0.12 ± 0.33 medications at 24 months in TRAB group (both p < 0.0001) and from 30.0 ± 9.61 mm Hg on 2.7 ± 1.10 medications to 15.5 ± 4.36 mm Hg on 0.40 ± 0.82 medications in PCP group (both p < 0.0001). Equal complete success (12 months: 84.0%, p > 0.999; 24 months: 72.0%, p > 0.999) was achieved at both 12 and 24 months in two groups. Although not statistically significant, higher qualified success was observed in PCP (88.0%) than in TRAB group (80.0%, p = 0.702) at 24 months. However, 63.0% eyes (n = 17) in TRAB group needed bleb managements to maintain a lower IOP. Transient IOP spike (>25 mm Hg, 22.2%) and microhyphema (22.2%) were the most common complications for PCP, while hypotony (14.8%) and wound leakage (11.1%) were frequently seen after TRAB.

Conclusion: PCP demonstrates comparable IOP-lowering effect with TRAB in eyes with primary glaucoma, but with less postoperative complications and interventions.

Introduction: Optical coherence tomography angiography (OCTA) is an emerging technique to investigate retinal and choroidal microvascular alterations in patients with systemic sclerosis (SSc). This systematic review and meta-analysis aimed to evaluate the features of retinal and choroidal microvasculature using OCTA among SSc patients.

Methods: The methodology of the study was based on PRISMA guidelines. PubMed, Scopus, Web of Science, and Embase were searched systematically on November 25, 2023, for relevant studies utilizing OCTA as the main diagnostic tool to assess the retinal and choroidal microvasculature in SSc patients versus healthy controls. Random-effect or fixed model meta-analysis was used based on the heterogeneity of studies.

Results: Eleven observational comparative studies, including 366 patients with SSc and 350 healthy controls, conducted between 2020 and 2023, were included in this review. Meta-analysis findings revealed a significant decrease in vessel densities in both the superficial and deep capillary plexuses among SSc patients compared to controls. However, there were no significant differences observed in the foveal avascular zone area and choriocapillaris flow area between SSc patients and controls. Moreover, central macular thickness (CMT) consistently exhibited a decrease in SSc patients, while retinal nerve fiber layer thickness showed no significant differences. Although radial peripapillary capillary vessel density, subfoveal choroidal thickness, and cup/disk ratio yielded mixed results, with some studies indicating significant changes in the SSc group, meta-analysis could not be performed due to variations in the OCTA machines used across the included studies.

Conclusion: This systematic review demonstrates retinal and choroidal microvascular abnormalities in SSc using OCTA. Longitudinal studies are needed to understand how these abnormalities evolve over time in patients with SSc and whether these abnormalities correlate with the clinical features of SSc.

Introduction: Dry eye disease (DED) is a prevalent ocular condition that significantly impacts quality of life. Umbilical cord serum (UCS) has emerged as a promising therapeutic option, but its efficacy requires further investigation. This systemic review and meta-analysis aimed to evaluate the therapeutic effects of UCS eye drops in the treatment of DED.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of science, Embase, Science Direct, Cochrane Library, and China National Knowledge Network, to identify relevant clinical trials. The efficacy of UCS was assessed based on key outcome measures, such as the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer I test, and corneal fluorescein staining scores. Meta-analyses were performed to pool the results, and the findings were presented in a forest plot.

Results: Eight studies were included in the meta-analysis, with two relevant randomized controlled trials (RCTs) involving a total of 204 patients. Most of the included studies had a follow-up time of less than 2 months. The pooled results showed that UCS treatment significantly improved the OSDI, with a mean difference (MD) of -9.16 (95% confidence interval [CI], -12.0, -6.36) compared to baseline. Additionally, the TBUT values were higher in the UCS group, with an MD of 2.65 (95% CI, 0.93, 4.36). The Schirmer I test results showed an improvement, with an MD of 1.18 (95% CI, 0.30, 2.06). The fluorescein staining score were also lower in the UCS treatment group, with an MD of -4.71 (95% CI, -5.72, -3.69).

Conclusion: This meta-analysis suggested that UCS eye drops had a beneficial therapeutic effect on DED, significantly improving the OSDI, TBUT, Schirmer I test, and corneal fluorescein staining scores. However, larger RCTs with longer follow-up periods were needed to further evaluate the long-term efficacy and safety of UCS in the management of DED.

Introduction: Pars plana vitrectomy (PPV) is a primary surgical method for rhegmatogenous retinal detachment (RRD). The introduction of the 3D head-up system has provided ophthalmologists with a new surgical experience. This study aimed to compare the surgical outcomes between 3D low-light intensity-assisted and traditional eyepiece-assisted PPV for RRD.

Methods: A prospective randomized controlled design was employed to compare the surgical outcomes of 3D low-light intensity-assisted and traditional eyepiece-assisted PPV for RRD. The optical intensity parameters of optical fibers and chandeliers were set according to the minimum lighting standard for 25-G PPV. Surgery duration and intraoperative conditions were documented. Post-surgery, the light intensity of the optical fiber and chandeliers during surgery was measured using a photometer. Patients were followed up for six months to assess their postoperative recovery. Statistical analysis was performed using SPSS 26.0 software, with p < 0.05 indicating statistically significant differences.

Results: There was no statistically significant difference between the two groups in baseline data (p > 0.05). PPV was completed in all patients, and there was no statistically significant difference in surgery time between the two groups (p > 0.05). The optical fiber and chandelier light intensity in the 3D group were significantly lower than those in the eyepiece group and the difference being statistically significant (p < 0.001). Six months after surgery, the retinal attachment rate was 100%. Post-surgery, both best corrected visual acuity (BCVA) and intraocular pressure (IOP) were significantly higher than presurgery levels. There were no significant differences between the two groups in terms of retinal attachment rate, BCVA, IOP, and flash electroretinogram (p > 0.05).

Conclusion: Compared to the traditional eyepiece, the 3D head-up system can effectively complete surgery under lower illumination intensity. The anatomical restoration and functional success of the retina after surgery are equivalent.

Introduction: This study is a population-based investigation into the prevalence and causes of blindness and vision impairment (VI) among people aged 50 years and older living in the State of Qatar.

Methods: A Rapid Assessment of Avoidable Blindness (RAAB) methodology, applied from May 2022 to June 2023, utilized stratified two-stage cluster random sampling to select 5,060 persons aged 50 years and older resident in Qatar from 145 communities chosen by probability proportional to size. Communities were stratified by Qatari and non-Qatari nationality. Participants were examined by ophthalmologists in primary health centers. Data collection was through the RAAB7 Android application and supervised by a trainer using secure, encrypted cloud storage.

Results: Of the 3,206 participants examined, 14 (0.4%) had blindness and 10 (0.3%) had severe VI. Compared to a previous RAAB study in 2009, the prevalence of blindness (presenting visual acuity [VA] <3/60) decreased from 1.28% to 0.4% (95% confidence interval (CI): 0.2-0.7%). The age-sex-adjusted prevalence of all VI (presenting VA <6/12-NPL) was 9.7% (95% CI: 8.3-11.1), higher among females 12.6% (95% CI: 10.5-14.6), and Qataris 16.7% (95% CI: 14.4-19.1), compared to males 7.6% (95% CI: 6.3-9.0), and non-Qataris 6.3% (95% CI: 5.1-7.5). The principal causes of blindness included diabetic retinopathy (DR) (33.3%), cataract (20%), glaucoma (13%), and other posterior segment diseases (13%). All VI was mainly attributed to uncorrected refractive errors at 58% and cataract at 17%, with the former being more common among non-Qataris and cataract more prevalent among Qataris.

Conclusion: Our findings show a low prevalence of VI compared with many countries that have published VI data. VI was mainly caused by DR, cataract, and uncorrected refractive error. Further reduction in vision loss can be achieved with early detection and improved access using innovation and technology.

Introduction: Peripapillary optical coherence tomography angiography (OCT-A) scans are a challenge for vessel density (VD) analysis, being dependent on demarcation of the optic disc. Longitudinal VD analysis requires that each pixel of the OCT-A scan must be at the exact same location during follow-up scans in order to see inter-visit differences. The aim of the present study was to investigate reliability of Bruch's membrane opening (BMO)-based peripapillary OCT-A analysis with and without the implementation of the anatomical positioning system (APS) compared to manual analysis.

Methods: Thirty-seven eyes were measured twice by OCT-A (Heidelberg OCT II Spectralis) and analyzed by the Erlangen-Angio-Tool (EA-Tool) with an APS- and BMO-based analysis of the macula and peripapillary region. APS allows alignment of OCT-A scans according to each individual FoBMOC (fovea-to-Bruch's membrane opening center). Peripapillary OCT-A scans were analyzed: (1) manually (by the shortest distance of the vertical or horizontal diameter of the optic disc), (2) BMO-based, and (3) BMO-based with APS information. Coefficients of variation (CVs) were calculated.

Results: Peripapillary mean VD was 42.52 ± 4 and 41.69 ± 4 (manually), 50.29 ± 4 and 48.8 ± 4 (BMO-based), and 44.73 ± 3 and 44.39 ± 4 (BMO-based and APSified) for 1st and 2nd scan, respectively. Peripapillary mean VD yielded a significant difference between the 1st and 2nd scan for manual (p = 0.04), but not for BMO-based (p > 0.05) and BMO-based and APSified analysis (p > 0.05). CVs were 10.0% (manually), 8.0% (BMO-based), and 8.0% (BMO-based and APSified).

Conclusion: The integration of BMO and APS information into the EA-Tool allows a BMO-based peripapillary VD analysis for long-term OCT-A analysis.