Seminars in Ophthalmology最新文献

Purpose: To describe demographic and clinical characteristics of patients with graft failure after keratoplasty, determine the cause of graft failure and outcomes.

Methods: The charts of patients between 2008-2013 in the Cornea Service at Wills Eye Hospital with a history of a corneal transplant before the end of 2012 were retrospectively reviewed. Included were patients who had graft failure after corneal transplantation and had at least one year of follow-up after transplantation. Penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSEK) patients were analyzed separately.

Results: A total of 186 eyes of 170 patients with graft failure after a PK (156) or DSEK (30) procedures were identified. The baseline characteristics included 100 female and 70 male patients with an age between 0 and 90 years (median 63 years). At the time of surgery, 38% had three or more systemic diseases and 68% were using three or more systemic medicines. Mean follow up time for PK was nearly four times of DSEK. Only 2 DSEK eyes (7%) underwent a 3rd DSEK graft, while 47 (30%) PK eyes underwent a 3^rd PK and 15 (10%) PK eyes underwent more than three PK procedures.

Conclusions: Most DSEK failures occurred in 1^st year, while graft failure in PKs is scattered over years. Failure in DSEK is mostly due to graft or surgical risk factors but in PK mostly due to factors in the host. DSEK does not appear to be as affected by the patients' demographic and clinical characteristics as much as PK.

Introduction: Acute dacryocystitis is an acute infection and the lacrimal sac secondary to pathogenic microorganism growth within the stagnant fluid in the lacrimal sac secondary to nasolacrimal duct obstruction.

Methods: A literature review was conducted on the PubMed database using the following search terms "dacryocystic retention" and "dacryocystitis" or "dacryolith" or "lacrimal duct" or "pseudo-dacryocystitis".

Results: The literature review suggests that dacryocystitis in a patent nasolacrimal drainage system can stem from diverse causes including the mechanical impaction by dacryoliths, viral infections and anatomical variations. It is believed that these causes lead to transient obstruction to the nasolacrimal excretory system predisposing to secondary infections. Idiopathic temporary dacryocystic retention is also highlighted in this review.

Conclusions: This review broadens the understanding of dacryocystic retention and highlights the need for careful diagnosis and tailored treatment plans, particularly in cases deviating from the traditional etiological pathways.

Purpose: To study intravitreal brolucizumab in the management of persistent macular fluid in chronic central serous chorioretinopathy (CSCR) without choroidal neovascular membrane (CNVM).

Methods: Retrospective case series which included eyes with chronic CSCR with persistent macular fluid for ≥ 3 months without CNVM. Intravitreal brolucizumab was administered in all eyes. Primary outcome measure was the resolution of intraretinal (IRF) and/or subretinal fluid (SRF) on OCT.

Results: Five eyes (four patients) with chronic CSCR were included. All eyes showed complete resolution of SRF 1 month following injection. Minimal residual IRF was present in two eyes. Best corrected visual acuity (BCVA) was stable in three eyes, and two eyes showed improvement. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) showed reduction.

Conclusion: Intravitreal brolucizumab is effective in the rapid reduction of persistent macular fluid in chronic CSCR without CNVM. Long-term follow-up data are required to study recurrence and adverse effect profile.

Purpose: To evaluate the incidence and cost of intraocular lens(IOL) waste during IOL implantation, as well as the reasons for it.

Methods: A retrospective analysis was conducted on the data of 485 patients from the IOL waste registers of a single tertiary eye hospital in China during 2016-2020. The primary outcomes were the incidence, cost, and reasons for different IOL properties. Cases were examined to ascertain IOL material, design, procedural details, and causes of waste.

Results: IOL waste occurred in 485 (6.62‰) of the 73,246 IOL implantations during the study period. The total cost of IOL waste was 429, 850.26 Chinese Yuan (CNY) related to waste with an average cost of 2, 442.33 CNY per procedure during the study period. Comparisons between IOL properties showed that polymethyl methacrylate (PMMA) material (39, 2.05%), three-piece design (142, 1.49%), and secondary IOL implantation (26, 2.16%) were associated with IOL wastage, and the difference was statistically significant. The causes of IOL waste were damage (107, 60.80%), patient reasons (37, 21.26%), aseptic errors (22, 12.50%), IOL quality problems (8, 4.55%), and loss (2, 1.14%).

Conclusions: The incidence of IOL waste is low, but still leads to a significant cost burden due to a large number of cataract surgeries. PMMA material, three-piece design, and secondary implantation were identified as factors increasing IOL waste. Damage emerged as the primary reason for waste, largely attributed to human error. Therefore, the development of strategies to mitigate IOL waste is imperative.

Purpose: The burst of modern information has significantly promoted the development of global medicine into a new era of big data healthcare. Ophthalmology is one of the most prominent medical specialties driven by big data analytics. This study aimed to describe the development status and research hotspots of big data in ophthalmology.

Methods: English articles and reviews related to big data in ophthalmology published from January 1, 1999, to April 30, 2024, were retrieved from the Web of Science Core Collection. The relevant information was analyzed and visualized using VOSviewer and CiteSpace software.

Results: A total of 406 qualified documents were included in the analysis. The annual number of publications on big data in ophthalmology reached a rapidly increasing stage since 2019. The United States (n = 147) led in the number of publications, followed by India (n = 77) and China (n = 69). The L.V. Prasad Eye Institute in India was the most productive institution (n = 50), and Anthony Vipin Das was the most influential author with the most relevant literature (n = 45). The electronic medical records were the primary source of ophthalmic big data, and artificial intelligence served as the principal analytics tool. Diabetic retinopathy, glaucoma, and myopia are currently the main topics of interest in this field.

Conclusions: The application of big data in ophthalmology has experienced rapid growth in recent years. Big data is expected to play an increasingly significant role in shaping the future of research and clinical practice in ophthalmology.

Purpose: To describe the presence of pupillary peaking and dysphotopsias in a sample of eyes following glaucoma drainage device (GDD) surgery.

Methods: Cross-sectional analysis of 68 glaucoma patients with GDD, 45 patients with glaucoma and no GDD, and 50 control patients was conducted in a single academic center. Patients with an appropriate diagnosis that met the inclusion criteria were asked to enroll in the study. All patients received an 8-item dysphotopsia questionnaire and were age-matched. Photographs of pupils were taken to assess pupillary peaking. One-way analysis of variance (ANOVA) testing was performed for statistical analysis.

Results: Of the 68 patients with GDD, 25 (36.76%) had pupillary abnormalities with peaking most commonly occurring in the direction of the tube entry superotemporally, and 50 (73.53%) had reported one or more dysphotopsias. In patients reporting one or more dysphotopsias, the rate of lines, crescents, ghost images, and shadows was significantly higher when compared to glaucoma patients without GDD and control patients (p < .01). This corresponded to a lower best-corrected visual acuity in the GDD group compared to the glaucoma and control groups (p < .001).

Conclusions: Over a third of glaucoma patients receiving GDD had pupillary abnormalities, and nearly 3 out of 4 patients with GDD reported one or more dysphotopsias when compared to glaucoma patients without GDD and an age-matched control group. Glaucoma specialists and patients should be aware of these complications when proceeding with GDD surgery.

Purpose: To describe the application of artificial intelligence (AI) in ophthalmic diseases and its possible future directions.

Methods: A retrospective review of the literature from PubMed, Web of Science, and Embase databases (2019-2024).

Results: AI assists in cataract diagnosis, classification, preoperative lens calculation, surgical risk, postoperative vision prediction, and follow-up. For glaucoma, AI enhances early diagnosis, progression prediction, and surgical risk assessment. It detects diabetic retinopathy early and predicts treatment effects for diabetic macular edema. AI analyzes fundus images for age-related macular degeneration (AMD) diagnosis and risk prediction. Additionally, AI quantifies and grades vitreous opacities in uveitis. For retinopathy of prematurity, AI facilitates disease classification, predicting disease occurrence and severity. Recently, AI also predicts systemic diseases by analyzing fundus vascular changes.

Conclusions: AI has been extensively used in diagnosing, following up, and predicting treatment outcomes for common blinding eye diseases. In addition, it also has a unique role in the prediction of systemic diseases.