Pub Date : 2025-02-06DOI: 10.1016/j.survophthal.2025.01.013
Charles Zhang, Daniel Lai, Daniel Zhu, Charles Palka, Andrew Reynolds, Nicolas Yannuzzi
Povidone-iodine (PI) is the gold standard for pre-intravitreal injection ocular antisepsis. Chlorhexidine (CHX) is an emerging alternative with less ocular irritation. This meta-analysis aims to evaluate post-injection endophthalmitis rates with the use of CHX compared to PI. A systematic search of PubMed, Embase, and Scopus was performed for studies published between January 1, 2000 and February 21, 2024. Data on the number of injections and endophthalmitis cases were analyzed. A sample-size weighted mean difference (MD) meta-analysis was performed using RevMan 5.4.1, p < 0.05 was considered statistically significant. Five studies including 230,656 injections were pooled to determine an endophthalmitis rate of 0.0003 [95 % CI, 0.0001-0.0005] with preinjection CHX antisepsis. Three studies included an additional PI branch and thus were used for secondary meta-analysis comparing CHX against PI. The analysis consisted of 185,799 injections in the CHX group and 269,441 injections in the PI group. No significant difference in the weighted relative risk of endophthalmitis with CHX was found (RR = 1.27 [95 %CI 0.50-3.22], p = 0.62). A total of 24 and 31 cases of culture-positivity were recorded in the CHX and PI groups respectively but no significant difference in weighted means was found (RR = 1.42[95 %CI 0.96-2.12], p = 0.08). This meta-analysis disclosed that the rate of post-IVI endophthalmitis while using CHX antisepsis is approximately 1 in 3937 injections, compared to 1 in 3906 with PI. CHX was not associated with a significant difference in the rate of endophthalmitis or culture-positivity compared to PI.
{"title":"Chlorhexidine for ocular antisepsis before intravitreal injection: A systematic review and meta-analysis.","authors":"Charles Zhang, Daniel Lai, Daniel Zhu, Charles Palka, Andrew Reynolds, Nicolas Yannuzzi","doi":"10.1016/j.survophthal.2025.01.013","DOIUrl":"10.1016/j.survophthal.2025.01.013","url":null,"abstract":"<p><p>Povidone-iodine (PI) is the gold standard for pre-intravitreal injection ocular antisepsis. Chlorhexidine (CHX) is an emerging alternative with less ocular irritation. This meta-analysis aims to evaluate post-injection endophthalmitis rates with the use of CHX compared to PI. A systematic search of PubMed, Embase, and Scopus was performed for studies published between January 1, 2000 and February 21, 2024. Data on the number of injections and endophthalmitis cases were analyzed. A sample-size weighted mean difference (MD) meta-analysis was performed using RevMan 5.4.1, p < 0.05 was considered statistically significant. Five studies including 230,656 injections were pooled to determine an endophthalmitis rate of 0.0003 [95 % CI, 0.0001-0.0005] with preinjection CHX antisepsis. Three studies included an additional PI branch and thus were used for secondary meta-analysis comparing CHX against PI. The analysis consisted of 185,799 injections in the CHX group and 269,441 injections in the PI group. No significant difference in the weighted relative risk of endophthalmitis with CHX was found (RR = 1.27 [95 %CI 0.50-3.22], p = 0.62). A total of 24 and 31 cases of culture-positivity were recorded in the CHX and PI groups respectively but no significant difference in weighted means was found (RR = 1.42[95 %CI 0.96-2.12], p = 0.08). This meta-analysis disclosed that the rate of post-IVI endophthalmitis while using CHX antisepsis is approximately 1 in 3937 injections, compared to 1 in 3906 with PI. CHX was not associated with a significant difference in the rate of endophthalmitis or culture-positivity compared to PI.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.survophthal.2025.01.018
Mateus Pimenta Arruda, Sara Hira, Rian Vilar Lima, Larissa Irigoyen Teixeira Barbosa, Mariana Tosato Zinher, Lubna Al-Sharif, João Lucas de Magalhães Leal Moreira, Giulia Steuernagel Del Valle
A Bayesian network meta-analysis (NMA) can help compare the various types of analgesics and anesthetics used for lowering pain of panretinal photocoagulation. We carried out a systematic review and network meta-analysis to assess pharmacological interventions for relieving pain in patients undergoing panretinal photocoagulation (PRP). We included 15 randomized controlled trials and 4 crossover trials with a total of 1787 eyes and 45.83 % of the participants were female. The mean age of the participants was 55 years. 2 % peribulbar lidocaine was the only significant treatment compared to placebo (MD -2.4 (95 % CrI -4.7 to -0.20). The rank probability and SUCRA also revealed 2 % peribulbar lidocaine (0.887) as the best treatment in terms of lowering the pain scores followed by etoricoxib (0.809) and potassium diclofenac (0.727). Two per cent peribulbar lidocaine is effective for reducing procedural pain in laser treatment compared to systemic and topical medications. Future studies should evaluate drugs that can reach and act on the posterior segment of the eye.
{"title":"Pharmacological therapy for relieving pain in panretinal photocoagulation: A network meta-analysis of randomized controlled trials.","authors":"Mateus Pimenta Arruda, Sara Hira, Rian Vilar Lima, Larissa Irigoyen Teixeira Barbosa, Mariana Tosato Zinher, Lubna Al-Sharif, João Lucas de Magalhães Leal Moreira, Giulia Steuernagel Del Valle","doi":"10.1016/j.survophthal.2025.01.018","DOIUrl":"10.1016/j.survophthal.2025.01.018","url":null,"abstract":"<p><p>A Bayesian network meta-analysis (NMA) can help compare the various types of analgesics and anesthetics used for lowering pain of panretinal photocoagulation. We carried out a systematic review and network meta-analysis to assess pharmacological interventions for relieving pain in patients undergoing panretinal photocoagulation (PRP). We included 15 randomized controlled trials and 4 crossover trials with a total of 1787 eyes and 45.83 % of the participants were female. The mean age of the participants was 55 years. 2 % peribulbar lidocaine was the only significant treatment compared to placebo (MD -2.4 (95 % CrI -4.7 to -0.20). The rank probability and SUCRA also revealed 2 % peribulbar lidocaine (0.887) as the best treatment in terms of lowering the pain scores followed by etoricoxib (0.809) and potassium diclofenac (0.727). Two per cent peribulbar lidocaine is effective for reducing procedural pain in laser treatment compared to systemic and topical medications. Future studies should evaluate drugs that can reach and act on the posterior segment of the eye.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.survophthal.2025.01.012
Carlos Cifuentes-González, Yong Le Tong, Germán Mejía-Salgado, Reo Chan, Cheong Fu Yuan Walter, William Rojas-Carabali, Ikhwanuliman Putera, Azadeh Mobasserian, Rina La Distia Nora, Jyotirmay Biswas, Sapna Gangaputra, Jose S Pulido, John H Kempen, Quan Dong Nguyen, Alejandra de-la-Torre, Vishali Gupta, James T Rosenbaum, Rupesh Agrawal
This systematic review with meta-analysis explores the global demographic and etiological variations of retinal vasculitis (RV), focusing on differences in frequency, age, sex, and etiology across diverse geographic populations. RV is an inflammatory condition that can lead to visual impairment, making understanding its variations essential for targeted screening and management. Systematic searches were conducted in multiple databases up to February, 2023, following PRISMA guidelines. We included studies with at least 10 RV cases, such that a frequency measurement can be estimated, without restrictions on publication date or language. RV was categorized as Idiopathic RV in the absence of additional ocular or systemic disease, Syndromic RV for ocular involvement without systemic disease, and Secondary RV in those asssociated with systemic disease. The risk of bias was evaluated using standardized tools. A total of 95 studies, including 23,180 patients, were analyzed. The overall RV frequency among uveitis cohorts was 17 %, with European populations showing the highest frequency at 25 %. Idiopathic RV accounted for 1 % of uveitis cohorts and 38 % of RV cohorts, with significant differences across continents. Behçet disease had the highest RV frequency at 56 %. The median age of diagnosis was 33.5 years, and RV was more frequent in males (57 %). Our findings underscore the considerable geographic and demographic variability in RV, particularly in Idiopathic RV, tuberculosis-related RV, and Behçet disease, highlighting the need for tailored, region-specific, and gender-specific approaches to RV diagnosis and treatment.
{"title":"Global demographic and etiological variations of retinal vasculitis: A systematic review and meta-analysis: International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) Report 1.","authors":"Carlos Cifuentes-González, Yong Le Tong, Germán Mejía-Salgado, Reo Chan, Cheong Fu Yuan Walter, William Rojas-Carabali, Ikhwanuliman Putera, Azadeh Mobasserian, Rina La Distia Nora, Jyotirmay Biswas, Sapna Gangaputra, Jose S Pulido, John H Kempen, Quan Dong Nguyen, Alejandra de-la-Torre, Vishali Gupta, James T Rosenbaum, Rupesh Agrawal","doi":"10.1016/j.survophthal.2025.01.012","DOIUrl":"10.1016/j.survophthal.2025.01.012","url":null,"abstract":"<p><p>This systematic review with meta-analysis explores the global demographic and etiological variations of retinal vasculitis (RV), focusing on differences in frequency, age, sex, and etiology across diverse geographic populations. RV is an inflammatory condition that can lead to visual impairment, making understanding its variations essential for targeted screening and management. Systematic searches were conducted in multiple databases up to February, 2023, following PRISMA guidelines. We included studies with at least 10 RV cases, such that a frequency measurement can be estimated, without restrictions on publication date or language. RV was categorized as Idiopathic RV in the absence of additional ocular or systemic disease, Syndromic RV for ocular involvement without systemic disease, and Secondary RV in those asssociated with systemic disease. The risk of bias was evaluated using standardized tools. A total of 95 studies, including 23,180 patients, were analyzed. The overall RV frequency among uveitis cohorts was 17 %, with European populations showing the highest frequency at 25 %. Idiopathic RV accounted for 1 % of uveitis cohorts and 38 % of RV cohorts, with significant differences across continents. Behçet disease had the highest RV frequency at 56 %. The median age of diagnosis was 33.5 years, and RV was more frequent in males (57 %). Our findings underscore the considerable geographic and demographic variability in RV, particularly in Idiopathic RV, tuberculosis-related RV, and Behçet disease, highlighting the need for tailored, region-specific, and gender-specific approaches to RV diagnosis and treatment.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.survophthal.2025.01.015
Mostafa M. Diab
{"title":"Correspondence regarding the article: A major review of punctal stenosis: Updated anatomy, epidemiology, etiology, and clinical presentation","authors":"Mostafa M. Diab","doi":"10.1016/j.survophthal.2025.01.015","DOIUrl":"10.1016/j.survophthal.2025.01.015","url":null,"abstract":"","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Page 593"},"PeriodicalIF":5.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><div>Because of its benign nature and rarity, circumscribed choroidal hemangioma (CCH) often receives limited attention, leading to a high rate of misdiagnosis and a lack of standardized treatment protocols. We provide a thorough clarification of the demographics, clinical features, diagnosis, management, and prognosis of CCH. We conducted a systematic search of the PubMed, EMBASE, and Ovid databases up to December, 2023, to identify relevant studies. The study included 106 studies encompassing 3854 patients with CCH. The demographic profile revealed a male preponderance (62 %, 95 % CI 61–64 %) and a peak incidence in the working-age population (30–50 years, 48 %, 95 % CI 39–57 %), with the right eye being involved in 50 % of cases (95 % CI 48–53 %). Clinically, the most common symptom was decreased vision (90 %, 95 % CI 78–99 %), followed by blurred vision, visual field defect, and metamorphopsia. Fundus examination frequently revealed an orange-colored tumor (80 %, 95 % CI 58–96 %) located subfoveally (48 %, 95 % CI 42–53 %), often accompanied by subretinal fluid (SRF) (84 %, 95 % CI 78–89 %) and sometimes exudative retinal detachment (69 %, 95 % CI 51–85 %). The proportion of correctly diagnosed CCH upon first presentation was 13 % (95 % CI 3–26 %), with CCH commonly misdiagnosed as unspecified choroidal tumors, choroidal metastasis, and central serous chorioretinopathy. Photodynamic therapy (PDT) was the most widely researched treatment, taking up 18 % (95 % CI 8–31 %), followed by observation, transpupillary thermotherapy (TTT), and laser photocoagulation. When no treatment was applied, 33 % of patients experienced visual acuity improvement, which increased to 76 % (95 % CI 58–90 %) with radiotherapy and 58 % (95 % CI 50–67 %) with PDT. In terms of tumor shrinkage, radiotherapy was most effective (100 %), with PDT close behind (95 % CI 96–100 %), and TTT at 63 % (95 % CI 45–80 %). PDT led to SRF resolution in 89 % (95 % CI 77–97 %) of patients and cystoid macular edema (CME) resolution in 73 % (95 % CI 38–97 %), while radiotherapy achieved the highest efficacy with 100 % SRF resolution (95 % CI: 99–100 %) and 100 % CME resolution (95 % CI: 83–100 %). Complication rates were highest with radiotherapy (14 %, 95 % CI 5–25 %) and PDT (9 %, 95 % CI 4–16 %). First-line treatment failure rates were highest for TTT (71 %, 95 % CI 44–92 %) and laser (70 %, 95 % CI 28–99 %), with radiotherapy showing the lowest rate (0 %, 95 % CI 0–2 %). Recurrence rates were highest for laser (68 %, 95 % CI 17–100 %) and TTT (62 %, 95 % CI 26–93 %), whereas radiotherapy had the lowest recurrence rate (0 %, 95 % CI 0–1 %). CCH predominantly affects the working-age male population, often leading to vision impairment and SRF. The diagnosis of CCH remains challenging, with low accuracy and frequent misdiagnoses. While PDT is the most widely researched treatment, radiotherapy offers superior outcomes in visual acuity, tumor shrinkage, and resolution of SRF and CME, t
{"title":"Clinical features, diagnosis, management, and prognosis of circumscribed choroidal hemangioma","authors":"Zuyi Yang , Dianzhe Tian , Zhixuan Xie , Tiantian Cheng , Youxin Chen , Xinyu Zhao","doi":"10.1016/j.survophthal.2025.01.001","DOIUrl":"10.1016/j.survophthal.2025.01.001","url":null,"abstract":"<div><div>Because of its benign nature and rarity, circumscribed choroidal hemangioma (CCH) often receives limited attention, leading to a high rate of misdiagnosis and a lack of standardized treatment protocols. We provide a thorough clarification of the demographics, clinical features, diagnosis, management, and prognosis of CCH. We conducted a systematic search of the PubMed, EMBASE, and Ovid databases up to December, 2023, to identify relevant studies. The study included 106 studies encompassing 3854 patients with CCH. The demographic profile revealed a male preponderance (62 %, 95 % CI 61–64 %) and a peak incidence in the working-age population (30–50 years, 48 %, 95 % CI 39–57 %), with the right eye being involved in 50 % of cases (95 % CI 48–53 %). Clinically, the most common symptom was decreased vision (90 %, 95 % CI 78–99 %), followed by blurred vision, visual field defect, and metamorphopsia. Fundus examination frequently revealed an orange-colored tumor (80 %, 95 % CI 58–96 %) located subfoveally (48 %, 95 % CI 42–53 %), often accompanied by subretinal fluid (SRF) (84 %, 95 % CI 78–89 %) and sometimes exudative retinal detachment (69 %, 95 % CI 51–85 %). The proportion of correctly diagnosed CCH upon first presentation was 13 % (95 % CI 3–26 %), with CCH commonly misdiagnosed as unspecified choroidal tumors, choroidal metastasis, and central serous chorioretinopathy. Photodynamic therapy (PDT) was the most widely researched treatment, taking up 18 % (95 % CI 8–31 %), followed by observation, transpupillary thermotherapy (TTT), and laser photocoagulation. When no treatment was applied, 33 % of patients experienced visual acuity improvement, which increased to 76 % (95 % CI 58–90 %) with radiotherapy and 58 % (95 % CI 50–67 %) with PDT. In terms of tumor shrinkage, radiotherapy was most effective (100 %), with PDT close behind (95 % CI 96–100 %), and TTT at 63 % (95 % CI 45–80 %). PDT led to SRF resolution in 89 % (95 % CI 77–97 %) of patients and cystoid macular edema (CME) resolution in 73 % (95 % CI 38–97 %), while radiotherapy achieved the highest efficacy with 100 % SRF resolution (95 % CI: 99–100 %) and 100 % CME resolution (95 % CI: 83–100 %). Complication rates were highest with radiotherapy (14 %, 95 % CI 5–25 %) and PDT (9 %, 95 % CI 4–16 %). First-line treatment failure rates were highest for TTT (71 %, 95 % CI 44–92 %) and laser (70 %, 95 % CI 28–99 %), with radiotherapy showing the lowest rate (0 %, 95 % CI 0–2 %). Recurrence rates were highest for laser (68 %, 95 % CI 17–100 %) and TTT (62 %, 95 % CI 26–93 %), whereas radiotherapy had the lowest recurrence rate (0 %, 95 % CI 0–1 %). CCH predominantly affects the working-age male population, often leading to vision impairment and SRF. The diagnosis of CCH remains challenging, with low accuracy and frequent misdiagnoses. While PDT is the most widely researched treatment, radiotherapy offers superior outcomes in visual acuity, tumor shrinkage, and resolution of SRF and CME, t","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Pages 389-400"},"PeriodicalIF":5.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.survophthal.2025.01.010
Elham Sadeghi, Elham Rahmanipour, Nicola Valsecchi, Saloni Kapoor, Maria Vittoria Cicinelli, Jay Chhablani
The global increase in the prevalence of type 2 diabetes has led to the development and implementation of new classes of antidiabetic medications, introducing advanced therapeutic options for the management of the disease. These new medications, though primarily designed to regulate blood glucose levels, also have applications in weight management, potentially transforming the current approaches to diabetes treatment. Newer medications, however, have ophthalmic side effects with controversies in trials and real-life data. We comprehensively assessed the ocular benefits and adverse effects of traditional and newer-generation anti-diabetic drugs. Our primary focus is on how these newer medications affect the stage of diabetic retinopathy. Additionally, we explore the associations between these medications and other ocular conditions, including age-related macular degeneration, glaucoma, orbital conditions, and diseases impacting the ocular surface. Furthermore, we provide contextual background by discussing the ocular effects of traditional anti-diabetic drugs.
{"title":"An update on ocular effects of antidiabetic medications.","authors":"Elham Sadeghi, Elham Rahmanipour, Nicola Valsecchi, Saloni Kapoor, Maria Vittoria Cicinelli, Jay Chhablani","doi":"10.1016/j.survophthal.2025.01.010","DOIUrl":"10.1016/j.survophthal.2025.01.010","url":null,"abstract":"<p><p>The global increase in the prevalence of type 2 diabetes has led to the development and implementation of new classes of antidiabetic medications, introducing advanced therapeutic options for the management of the disease. These new medications, though primarily designed to regulate blood glucose levels, also have applications in weight management, potentially transforming the current approaches to diabetes treatment. Newer medications, however, have ophthalmic side effects with controversies in trials and real-life data. We comprehensively assessed the ocular benefits and adverse effects of traditional and newer-generation anti-diabetic drugs. Our primary focus is on how these newer medications affect the stage of diabetic retinopathy. Additionally, we explore the associations between these medications and other ocular conditions, including age-related macular degeneration, glaucoma, orbital conditions, and diseases impacting the ocular surface. Furthermore, we provide contextual background by discussing the ocular effects of traditional anti-diabetic drugs.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1016/j.survophthal.2025.01.008
Elham Sadeghi , Maria F. Colorado-Zavala , Hussein Almuhtaseb , Ramesh Venkatesh , Barbara Parolini , Jay Chhablani
Internal limiting membrane (ILM) peeling has been an acceptable step in vitrectomy surgeries for various retinal diseases such as macular hole, chronic macular edema following epiretinal membrane (ERM), and vitreoretinal traction. Despite all the benefits, this procedure has some side effects, which may lead to structural damage and functional vision loss. Light and dye toxicity may induce reversible and irreversible retina damage, which will be observed in postoperative optical coherence tomography scans. Retinal nerve fiber layer damage is attributed to ganglion cell degeneration and axonal transport alteration and dissociated optic nerve fiber layer is due to Müller cell damage. Eccentric MHs and recurrence of previous MHs may also lead to vision loss. Iatrogenic retinal damage may cause structural retinal changes without significant vision loss or progression to choroidal neovascularization. The mechanism of persistent macular edema after membrane peeling is still unclear, but it has been related to tractional trauma and blood-retina barrier damage. The reappearance of ERM is another cause of decreased vision after ILM peeling, which might be secondary to incomplete membrane removal. In glaucoma patients, ILM peeling is associated with significantly worsening the mean deviation on the visual field test after the surgery. We discussed various causes of vision loss and structural changes following ILM peeling. These causes may be attributed to the surgical procedure itself or the associated steps, instruments, and dyes used during the ILM peeling procedure.
{"title":"Anatomical and functional changes after internal limiting membrane peeling","authors":"Elham Sadeghi , Maria F. Colorado-Zavala , Hussein Almuhtaseb , Ramesh Venkatesh , Barbara Parolini , Jay Chhablani","doi":"10.1016/j.survophthal.2025.01.008","DOIUrl":"10.1016/j.survophthal.2025.01.008","url":null,"abstract":"<div><div>Internal limiting membrane (ILM) peeling has been an acceptable step in vitrectomy surgeries for various retinal diseases such as macular hole, chronic macular edema following epiretinal membrane (ERM), and vitreoretinal traction. Despite all the benefits, this procedure has some side effects, which may lead to structural damage and functional vision loss. Light and dye toxicity may induce reversible and irreversible retina damage, which will be observed in postoperative optical coherence tomography scans. Retinal nerve fiber layer damage is attributed to ganglion cell degeneration and axonal transport alteration and dissociated optic nerve fiber layer is due to Müller cell damage. Eccentric MHs and recurrence of previous MHs may also lead to vision loss. Iatrogenic retinal damage may cause structural retinal changes without significant vision loss or progression to choroidal neovascularization. The mechanism of persistent macular edema after membrane peeling is still unclear, but it has been related to tractional trauma and blood-retina barrier damage. The reappearance of ERM is another cause of decreased vision after ILM peeling, which might be secondary to incomplete membrane removal. In glaucoma patients, ILM peeling is associated with significantly worsening the mean deviation on the visual field test after the surgery. We discussed various causes of vision loss and structural changes following ILM peeling. These causes may be attributed to the surgical procedure itself or the associated steps, instruments, and dyes used during the ILM peeling procedure.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Pages 357-368"},"PeriodicalIF":5.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.survophthal.2025.01.009
Cristina Ţurcaş , Simona Delia Nicoară
Age-related macular degeneration (AMD) is a leading cause of visual impairment and irreversible blindness worldwide. High-resolution imaging techniques have been pivotal in characterizing the morphological alterations in the retina and in identifying structural biomarkers with prognostic significance. In clinical practice, visual function is primarily assessed through visual acuity testing, which, however, does not completely reflect the functional deficits experienced by patients. Microperimetry provides a more comprehensive evaluation of macular function, enabling a direct correlation with retinal structure. We examine the current literature on the correlation between morphological biomarkers – identified via optical coherence tomography, optical coherence tomography angiography, and fundus autofluorescence – and retinal sensitivity, as assessed by microperimetry. By encompassing all stages of AMD, we explore the association between retinal sensitivity and a broad spectrum of structural parameters, including distinct drusen phenotypes, hyperreflective foci, the integrity and thickness of various retinal layers, the junctional zone of geographic atrophy, exudative features of neovascular AMD, choriocapillaris flow deficits, and diverse patterns of autofluorescence, among numerous other relevant structural markers. By offering a deeper understanding of the structure-function correlations in disease progression, we provide critical up-to-date insights into the underlying mechanisms of AMD. Moreover, as novel therapeutic strategies continue to emerge, these correlations may serve as more robust endpoints for future clinical trials.
{"title":"A comprehensive review of structure-function correlations in age-related macular degeneration: Contributions of microperimetry","authors":"Cristina Ţurcaş , Simona Delia Nicoară","doi":"10.1016/j.survophthal.2025.01.009","DOIUrl":"10.1016/j.survophthal.2025.01.009","url":null,"abstract":"<div><div>Age-related macular degeneration (AMD) is a leading cause of visual impairment and irreversible blindness worldwide. High-resolution imaging techniques have been pivotal in characterizing the morphological alterations in the retina and in identifying structural biomarkers with prognostic significance. In clinical practice, visual function is primarily assessed through visual acuity testing, which, however, does not completely reflect the functional deficits experienced by patients. Microperimetry provides a more comprehensive evaluation of macular function, enabling a direct correlation with retinal structure. We examine the current literature on the correlation between morphological biomarkers – identified via optical coherence tomography, optical coherence tomography angiography, and fundus autofluorescence – and retinal sensitivity, as assessed by microperimetry. By encompassing all stages of AMD, we explore the association between retinal sensitivity and a broad spectrum of structural parameters, including distinct drusen phenotypes, hyperreflective foci, the integrity and thickness of various retinal layers, the junctional zone of geographic atrophy, exudative features of neovascular AMD, choriocapillaris flow deficits, and diverse patterns of autofluorescence, among numerous other relevant structural markers. By offering a deeper understanding of the structure-function correlations in disease progression, we provide critical up-to-date insights into the underlying mechanisms of AMD. Moreover, as novel therapeutic strategies continue to emerge, these correlations may serve as more robust endpoints for future clinical trials.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Pages 426-450"},"PeriodicalIF":5.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.survophthal.2025.01.006
Gustavo Ortiz-Morales , Raul E. Ruiz-Lozano , Nallely R. Morales-Mancillas , J. Homar Paez-Garza , Alejandro Rodriguez-Garcia
Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic and recurrent ocular surface inflammatory disorder affecting children in early life. It is frequently under- or late- diagnosed, representing a potential cause of severe visual morbidity worldwide. An expert panel consensus recently agreed on its definition and proposed diagnostic criteria for suspected and definitive PBKC to reduce confusion and avoid varied terminology previously used in the literature, improving early and precise diagnosis. Previous evidence has pointed to the role of the adaptive immune system in recognizing and handling antigenic eyelid bacterial products, particularly from the cell wall, and the direct toxic and inflammatory effects of their cytolytic exotoxins on the ocular surface. PBKC is a frequent referral in pediatric and cornea clinics characterized by a history of recurrent chalazia, blepharitis, meibomian gland dysfunction, conjunctival hyperemia, phlyctenules formation, and corneal infiltrates with vascularization and scarring. The latter is a major cause of significant visual loss and amblyopia. Current treatment strategies aim to control inflammation on the ocular surface, halt disease progression, and avoid corneal involvement. Further research on pathogenic mechanisms will shed light on novel potential therapeutic strategies. Awareness of PBKC should enhance early diagnosis, prompt adequate treatment, and improve outcomes. We compile current evidence on epidemiology, pathophysiology, clinical spectrum of disease, diagnostic criteria, and management strategies for PBKC.
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Pub Date : 2025-01-15DOI: 10.1016/j.survophthal.2025.01.002
Kia Bayat , Parisa Pooyan , Mehdi Azizmohammad Looha , Kosar Namakin , Andrew R. Carey , J. Fernando Arevalo , Hamid Ahmadieh
The impact of various neurodegenerative diseases on the retina has been investigated in recent years using optical coherence tomography (OCT). Epilepsy, classified as a neurodegenerative disorder, has been indicated to affect the structural integrity of the retina. Moreover, there is ongoing debate regarding the relative contribution of the disease pathogenesis and the consumption of anti-epileptic drugs (AEDs) to these retinal changes. The lack of systematic reviews has hindered our understanding of the true effects of epilepsy and AEDs on retinal health, as well as the efficacy of OCT in detecting these alterations. To comprehensively review the impact of epilepsy and AEDs on the structure of retina, we thoroughly searched the PubMed, EMBASE, and Web of Science databases to identify relevant articles published until July 7, 2024, and performed a meta-analysis. We updated our search in November, 2024. Random effect models have been used to calculate pooled effect estimates. Nineteen studies with a total number of 1851 eyes were identified. Adult patients showed significant reduction with respect of retinal nerve fiber layer (RNFL) thickness; average, as well as all quadrants. Significant reductions were also detected in all quadrants of ganglion cell complex (GCC). Conversely, average GCC and central macular thickness did not differ significantly between cases and controls. Additionally, in terms of various volume measurements in the retina, significant losses were observed in macular RNFL, ganglion cell-inner plexiform layer and total macula volumes in adult patients. In contrast, the inner nuclear layer volume remained comparable between the 2 groups. In pediatric patients with epilepsy receiving valproic acid, significant reductions was observed in the average RNFL thickness, as well as in the nasal and inferior quadrants; however, there were no significant changes in the thickness of the superior and temporal quadrants of RNFL, nor in foveal thickness. The analysis of pediatric patients receiving levetiracetam indicated no significant changes in retinal structural measurements across various RNFL categories, or in foveal thickness. This meta-analysis revealed the structural retinal alterations following AEDs administration in patients with epilepsy (PwE). OCT appears to be a reliable device that reflects retinal toxicity with AED consumption in PwE.
近年来，人们利用光学相干断层扫描（OCT）研究了各种神经退行性疾病对视网膜的影响。癫痫，归类为神经退行性疾病，已表明影响视网膜的结构完整性。此外，关于疾病发病机制和抗癫痫药物（aed）的使用对这些视网膜变化的相对贡献，目前还存在争议。缺乏系统综述阻碍了我们理解癫痫和抗癫痫药对视网膜健康的真正影响，以及OCT检测这些改变的有效性。为了全面回顾癫痫和抗癫痫药对视网膜结构的影响，我们对PubMed、EMBASE和Web of Science数据库中截至2024年7月7日发表的相关文章进行了全面检索，并根据我们的发现进行了荟萃分析。我们在2024年11月更新了搜索结果。随机效应模型已被用于计算合并效应估计。19项研究共涉及1851只眼睛。成人患者视网膜神经纤维层（RNFL）厚度明显降低；平均，以及所有象限，以及所有象限的神经节细胞复合体（GCC）厚度。相反，平均GCC和中央黄斑厚度在病例和对照组之间没有显着差异。此外，在视网膜的各种体积测量中，观察到成人患者黄斑RNFL、神经节细胞-内丛状层和黄斑总体积的显著损失。相比之下，两组之间的内核层体积保持相当。在接受丙戊酸治疗的小儿癫痫患者中，观察到RNFL的平均厚度以及鼻和下象限显著降低；然而，RNFL的上象限和颞象限的厚度以及中央凹的厚度没有显著变化。对接受左乙拉西坦治疗的儿童患者的分析表明，在各种RNFL类别中，视网膜结构测量以及中央凹厚度没有显著变化。这项荟萃分析揭示了癫痫（PwE）患者服用aed后视网膜结构的改变。OCT可以作为可靠的替代装置，反映PwE患者使用AED后的视网膜毒性。
{"title":"Retinal structural alterations in patients with epilepsy taking antiepileptic drugs: A systematic review and meta-analysis of OCT findings","authors":"Kia Bayat , Parisa Pooyan , Mehdi Azizmohammad Looha , Kosar Namakin , Andrew R. Carey , J. Fernando Arevalo , Hamid Ahmadieh","doi":"10.1016/j.survophthal.2025.01.002","DOIUrl":"10.1016/j.survophthal.2025.01.002","url":null,"abstract":"<div><div>The impact of various neurodegenerative diseases on the retina has been investigated in recent years using optical coherence tomography (OCT). Epilepsy, classified as a neurodegenerative disorder, has been indicated to affect the structural integrity of the retina. Moreover, there is ongoing debate regarding the relative contribution of the disease pathogenesis and the consumption of anti-epileptic drugs (AEDs) to these retinal changes. The lack of systematic reviews has hindered our understanding of the true effects of epilepsy and AEDs on retinal health, as well as the efficacy of OCT in detecting these alterations. To comprehensively review the impact of epilepsy and AEDs on the structure of retina, we thoroughly searched the PubMed, EMBASE, and Web of Science databases to identify relevant articles published until July 7, 2024, and performed a meta-analysis. We updated our search in November, 2024. Random effect models have been used to calculate pooled effect estimates. Nineteen studies with a total number of 1851 eyes were identified. Adult patients showed significant reduction with respect of retinal nerve fiber layer (RNFL) thickness; average, as well as all quadrants. Significant reductions were also detected in all quadrants of ganglion cell complex (GCC). Conversely, average GCC and central macular thickness did not differ significantly between cases and controls. Additionally, in terms of various volume measurements in the retina, significant losses were observed in macular RNFL, ganglion cell-inner plexiform layer and total macula volumes in adult patients. In contrast, the inner nuclear layer volume remained comparable between the 2 groups. In pediatric patients with epilepsy receiving valproic acid, significant reductions was observed in the average RNFL thickness, as well as in the nasal and inferior quadrants; however, there were no significant changes in the thickness of the superior and temporal quadrants of RNFL, nor in foveal thickness. The analysis of pediatric patients receiving levetiracetam indicated no significant changes in retinal structural measurements across various RNFL categories, or in foveal thickness. This meta-analysis revealed the structural retinal alterations following AEDs administration in patients with epilepsy (PwE). OCT appears to be a reliable device that reflects retinal toxicity with AED consumption in PwE.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Pages 412-425"},"PeriodicalIF":5.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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