Ophthalmic Research最新文献

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 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 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.

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: 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: This systematic review and meta-analysis aimed to evaluate the effects of hemodialysis (HD) on ocular parameters in patients with the end-stage renal disease (ESRD) using optical coherence tomography (OCT).

Methods: Adhering to PRISMA guidelines, we conducted a comprehensive search of PubMed, Scopus, and Embase databases up to June 26, 2023. Eligible studies included original research investigating retinal and choroidal OCT measurements before and after HD in human subjects. Meta-analyses were conducted using Stata 16, calculating weighted mean differences and standardized mean differences (SMDs) with 95% confidence. Meta-regression and subgroup meta-analysis were carried out for suitable parameters.

Results: Twenty-six studies on 1,430 participants were included. Meta-analysis revealed a significant reduction in subfoveal choroidal thickness post-HD in diabetic and mixed patient groups (SMD = -0.24, p < 0.0001) but not in nondiabetic patients. No significant changes were observed in average choroidal thickness, foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, or macular volume across all groups. Subgroup analyses based on OCT models, eye selection, etc., largely mirrored overall findings, with some variations. Sensitivity analyses were generally consistent, and quality assessment indicated satisfactory to excellent study quality.

Conclusion: HD generally exerts minimal effects on various ocular parameters. However, a notable reduction in subfoveal choroidal thickness was observed in diabetic and mixed ESRD populations, suggesting increased vulnerability of choroidal tissues in these groups. These findings underscore the importance of regular ophthalmologic monitoring for ESRD patients undergoing HD, particularly those with diabetes. Future research should address existing heterogeneities and explore the long-term ocular implications of repeated HD sessions.

Introduction: Cataract surgery has been reported to have a reducing effect on intraocular pressure (IOP) in glaucomatous and non-glaucomatous eyes. This effect seems to be more noticeable in eyes with narrow angles (NAs) than in eyes with open angles (OAs). Decrease in IOP may be a result of the increase in anterior chamber angle and Schlemm canal (SC) after cataract surgery. The purpose of this paper was to evaluate the relationship between Schlemm canal-cross-sectional area (SC-CSA) changes and trabecular meshwork, ciliary muscle changes after cataract surgery and the difference in non-glaucomatous eyes with NAs and OAs.

Methods: IOP, SC-CSA, Schlemm canal diameter (SCD), trabecular meshwork width (TMW) and thickness (TMT), trabecular-iris angle at 500 µm from the scleral spur (TIA500), and the distance between the inner apex of the ciliary muscle and scleral spur (IA-SS) were measured by swept-source-optical coherence tomography preoperatively and 1-week post-surgery. Patients were divided into NA and OA groups according to the degree of TIA500, and SC-CSA-related parameters were compared.

Results: Seventy-five patients (89 eyes) were included. IOP significantly decreased, SC-CSA, SCD, TMW, TMT, and TIA500 significantly increased post-surgery (p < 0.001). Changes in nasal SC-CSA were associated with TMW (p = 0.003) and TIA500 (p < 0.001) changes; changes in temporal SC-CSA were associated with TMW (p = 0.001) and TMT (p < 0.001) changes. SC-CSA expansion was correlated with changes in TMW (β3.726 ± 1.085, p = 0.001 nasally; β3.405 ± 0.945, p = 0.001 temporally), TMT (β5.224 ± 2.033, p = 0.012 nasally; β11.853 ± 3.059, p < 0.001 temporally), and TIA500 (β40.330 ± 15.100, p = 0.009 nasally; β35.453 ± 17.527, p = 0.047 temporally). There was no association between SC-CSA expansion and IA-SS changes. SC-CSA expansion was greater in the NAs than in the OAs group (p < 0.001).

Conclusion: Cataract surgery results in IOP reduction and SC-CSA expansion. Increased SC-CSA correlates with increases in TMW, TMT, and TIA500. SC-CSA increased more in NAs than in OAs group post-surgery, which may explain the greater decrease in IOP in eyes with NAs.