Ophthalmic Research最新文献

Introduction: The outcomes and prognosis of pars plana vitrectomy (PPV) for high myopia-epiretinal membrane (HM-ERM) patients with retinoschisis remains unclear. The aim of this study was to analyze the impact of retinoschisis on the recovery of macular configuration and visual acuity following ERM removal in eyes with HM and to explore the prognostic factors.

Methods: A retrospective study of 73 consecutive patients with HM-ERM who underwent PPV with ERM peeling. According to the optical coherence tomography images, eyes were classified into 4 groups: group A without retinoschisis, group B with outer retinoschisis, group C with inner retinoschisis, and group D with both inner and outer retinoschisis.

Results: In groups A, B, C, and D, there were 17, 21, 22, and 16 eyes, respectively. Retinoschisis of 44 eyes (74.6%) disappeared postoperatively, including 11 eyes in group B, 20 in group C, and 8 in group D. No correlation was found between retinoschisis resolution and baseline factors. The mean best corrected visual acuity (BCVA) significantly improved at the final follow-up (p < 0.001). The final BCVA was associated with baseline BCVA (p = 0.001), the presence of epiretinal proliferation preoperatively (p = 0.014), and the postoperative integrity of the ellipsoid zone (EZ) (p = 0.001) and interdigitation zone (IZ) (p = 0.008).

Conclusions: After surgery, the inner retinoschisis usually resolved completely. Retinoschisis was not the main factor influencing final BCVA. Preoperative BCVA and disruption of EZ and IZ were associated with good visual recovery in long-term follow-up.

Introduction: This study aimed to evaluate the iris vessel density within a 15 mm × 12 mm area in primary glaucoma using anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA).

Methods: The study involved 30 normal eyes and 31 eyes with primary glaucoma, comprising 15 with primary open-angle glaucoma and 16 with primary angle-closure glaucoma. OCT/OCTA images of the iris obtained were evaluated and a univariate logistic regression model was used to assess the correlation between the iris vessel density and primary glaucoma, area under the receiver operating characteristic (AUROC), and clinically relevant performance metrics of different regions (superior, inferior, temporal, and nasal regions) were compared. Additionally, the trabecular iris angle (TIA) in both the nasal and temporal regions to elaborate the mechanism of using iris vessel density for primary glaucoma detection.

Results: Across all regions, the vessel density in the glaucoma group was significantly lower than in the normal eyes. The nasal 6-12 mm annular region of the iris demonstrated the highest diagnostic ability (AUROC = 0.870, p < 0.001), followed by the temporal 3-6 mm annular region (AUROC = 0.837, p < 0.001). All AUROC exceeded 0.8, with p values below 0.01, indicating strong diagnostic accuracy. Furthermore, TIA in primary glaucoma was smaller than normal individuals. Compared with the nasal region, the temporal region exhibited higher correlation with TIA, where TIA500 demonstrated the largest diagnostic value in the temporal region (AUROC = 0.995, p < 0.001). Moreover, a strong correlation was observed between iris vessel density and TIA in the 6-12 mm region. Based on the clinical parameter metrics, the detection ability of iris vessel density in the nasal region and TIA in the temporal region are more significant.

Conclusion: Iris vessel density is significantly reduced in primary glaucoma. The wide-field AS-OCTA of iris provides a comprehensive perspective of microvascular structures, facilitating precise comparison and evaluation of vessel changes in different regions associated with glaucoma. Specifically, the vessel density in the larger annular region on the nasal region has significant diagnostic value, enhancing understanding of disease mechanisms and progression.

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.

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: Intrableb structures are hallmark features of the filtering bleb. This study aimed to compare the characteristics of functioning blebs using anterior segment optical coherence tomography (AS-OCT) according to amniotic membrane transplantation (AMT).

Methods: Forty eyes from 40 patients diagnosed with primary open-angle glaucoma who underwent trabeculectomy, either with AMT (20 eyes) or without AMT (control group, 20 eyes), were included. Parameters including bleb height, bleb wall thickness, striping layer thickness, striping to bleb wall ratio, bleb wall reflectivity, fluid-filled space score/height/area, and presence of microcysts were assessed using AS-OCT. Surgical success was defined at the time of AS-OCT as an intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥30% without medication. In these patients, if the bleb had a clinically diffuse and healthy without any signs of an encapsulated bleb, the bleb was then defined as functioning bleb.

Results: Except for bleb height (p = 0.352) and microcyst formation (p = 0.266), significant differences were observed between the two groups. The functioning blebs of the AMT group exhibited greater fluid-filled space score, area, and height than those of the control group, following adjustment for AS-OCT time (all p < 0.001). Conversely, the functioning bleb of the control group demonstrated thicker bleb wall and striping layer, higher striping to bleb wall ratio, and lower bleb wall reflectivity than those of the AMT group, following adjustment for AS-OCT time (all p ≤ 0.001).

Conclusion: Distinct intrableb structures were identified in functioning blebs according to AMT. The reflectivity and thickness of the bleb wall structures were more pronounced in the functioning bleb after trabeculectomy alone. In contrast, the extent of the fluid-filled space emerged as a more distinctive feature of the intrableb structures in the functioning bleb after trabeculectomy with AMT.

Introduction: Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disorder. Ocular involvement in patients with MMD has increasingly been recognized and reported in recent years. This study aimed to investigate the changes of optic disc morphology and the peripapillary retinal and choroidal thickness in patients with MMD.

Methods: This cross-sectional study included 56 patients diagnosed with idiopathic MMD and 56 healthy controls matched by age and gender. All participants underwent swept-source optical coherence tomography to capture the optic disc morphology as well as the peripapillary retinal and choroidal thickness. Optic disc parameters, including cup area, rim area, cup volume, rim volume, cup-disc area ratio (CDR), linear CDR, and vertical CDR were measured and compared between the two groups. Additionally, the thickness of the whole peripapillary retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and choroid were evaluated and analyzed across 12 clock-hour segments around the peripapillary region.

Results: The rim area in MMD patients was significantly less than in controls, while the CDR in MMD patients was significantly larger than that in the control group. There was no statistically significant difference between the two groups regarding disc area, cup area, cup volume, rim volume, vertical and horizontal diameter of disc. The retinal thickness at the 7 o'clock position was significantly thinner in the MMD group compared to the control group and the temporal RNFL thickness, particularly at the 7 o'clock and 9 o'clock positions, was significantly reduced in the MMD group (p < 0.05). The GCL layer at the 7 o'clock position was thinner in the MMD group than in the control group (p < 0.05). The MMD group showed a notably reduced average choroidal thickness, particularly in the inferior-temporal region (p < 0.05). There was a correlation between peripapillary choroidal and GCL layer thickness in the MMD group, but no significant correlations were found with rim area, CDR, or RNFL.

Conclusions: In patients with MMD, there is an increase in the CDR accompanied by a decrease in the rim area. Additionally, there is thinning of the temporal RNFL, GCL, and choroidal thickness, notably in the inferotemporal quadrant of the optic disc.

Introduction: The aim of the study was to quantitatively characterize the longitudinal changes in macular vessel density (VD) in eyes with high myopia using swept source-optical coherence tomography angiography (SS-OCTA).

Methods: A total of 108 high myopic subjects (axial length [AL] ≥26.0 mm) and 180 age-matched normal subjects were recruited and followed up for at least 1 year. Here, 6 × 6 mm SS-OCTA scans centered at the fovea were used to obtain measurements of macular VD in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Linear regression analyses were performed to determine the independent factors associated with the change rates of parafoveal VD over time.

Results: High myopia group presented a great loss of VD in both SCP and DCP, whereas control group only showed a significant reduction of VD in the SCP (all p < 0.05). The decrease of VD in the parafoveal region of high myopia group was faster than that of control group (SCP, -2.81%/year vs. -1.05%/year, p = 0.002; DCP, -1.06%/year vs. -0.01%/year, p = 0.004), as well as in the inner and outer ring (all p < 0.05). Longer baseline AL was demonstrated to be significantly associated with faster reduction of parafoveal VD in both SCP (estimate, -0.49; 95% CI: -0.79 to -0.18; p = 0.002) and DCP (estimate, -0.22; 95% CI: -0.42 to -0.03; p = 0.025) in high myopia group.

Conclusions: High myopes exhibited a faster reduction of VD in parafoveal region and in the inner and outer ring in comparison with healthy controls. Longer baseline AL was associated with greater loss of parafoveal VD in patients with high myopia.

Introduction: The use of posterior chamber phakic intraocular lenses (PCPIOLs) is a reasonable option in the armamentarium to treat refractive error in patients with keratoconus. We present our experience with the use of PCPIOL for the management of ametropia in patients with keratoconus.

Methods: Patients included those with stable keratoconus treated in the Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK, with PCPIOL (ICL Staar Surgical and IPCL Care Group) to improve their visual acuity. Data were obtained from preoperative visit and 1, 3, 6, and 12 months after surgery. Clinical characteristics, pre- and postoperative uncorrected (UDVA) and best corrected (CDVA) logMAR visual acuities, and perioperative complications were analysed.

Results: A total of 23 eyes of 21 patients were included. UDVA changed from 0.75 preoperatively to 0.18 post-surgery (p = <0.001) and CDVA from 0.07 to 0.12 (p = 0.12). Seventy percent of the cases increased 3 or more lines of UDVA while none of the eyes lost more than 2 lines of CDVA. No significant difference in final UDVA was found between patients with and without previous keratoplasty (0.27 and 0.18, p = 0.38), previous corneal collagen crosslinking (0.16 and 0.3, p = 0.24), intracorneal ring segments (0.2 and 0.2, p = 0.94), or type of lens implanted (0.2 implantable collamer lens and implantable phakic contact lens. p = 0.94). One intraoperative complication reported was an inverted PCPIOL insertion and postoperatively 4 axis rotations and 1 cataract were observed.

Conclusions: The use of PCPIOL in patients with stable keratoconus is effective in improving their UDVA, even in cases with previous corneal procedures such as keratoplasty, crosslinking, and intracorneal rings. Rotation is the most common postoperative complication.

Introduction: Cataracts are the leading cause of blindness worldwide, with a notably high incidence rate. Endophthalmitis is the most severe complication following cataract surgery, often resulting in profound vision loss. This study evaluates the impact of risk factors such as age, sex, diabetes mellitus (DM), hypertension, posterior capsule rupture (PCR), type of surgery, and use of intraocular lens (IOL) material on the risk of endophthalmitis after cataract surgery.

Methods: English and Chinese public databases were searched from inception to March 1, 2024. We included studies reporting the number of occurrences of endophthalmitis after cataract surgery on potential risk factors, including age, sex, DM status, hypertension status, intraoperative PCR, type of surgery and use of IOL material. The quality of the included studies was assessed using the Newcastle-Ottawa Scale.

Results: A total of 57 studies were included and critically evaluated in the meta-analysis. The results showed that female sex was associated with a lower risk of endophthalmitis (odds ratio [OR]: 0.81; 95% CI: 0.75-0.87; p < 0.001). Individuals with diabetes who underwent cataract surgery were found to have a greater risk of endophthalmitis (I2 = 95%; OR: 4.90; 95% CI: 2.41, 9.95; p < 0.001), but the result may be influenced by publication bias. Individuals with hypertension (OR: 2.88; 95% CI: 1.53, 5.45; p = 0.001) and intraoperative PCR (OR: 9.18; 95% CI: 3.31, 25.43; p < 0.001) were found to have a greater risk of endophthalmitis. Phacoemulsification significantly reduced the risk of endophthalmitis compared with extracapsular cataract extraction (ECCE) (OR: 0.62; 95% CI: 0.45, 0.85) based on network meta-analysis.

Conclusion: Male sex, hypertension, intraoperative PCR, and the use of the ECCE surgical approach are associated with a greater risk of postoperative endophthalmitis. Although an age-related trend in elevated risk was observed, this finding should be interpreted cautiously.