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: 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.

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: 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.