Survey of ophthalmology最新文献

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world and anti-vascular endothelial growth factor (VEGF) injections have been the standard of care for the wet/neovascular variant since 2004. Currently, there are conflicting reports regarding its effect on the choroid, which supplies outer retina with oxygen and other nutrients. We synthesize available information of anti-VEGF on choroidal thickness (CT) in treatment-naïve typical neovascular AMD patients during the initial 12-week loading phase. We found 43 studies involving 1901 eyes from 1878 patients were included. Meta-analysis of 35 studies reporting CT at baseline and after 12 weeks suggested a significant decrease in CT with anti-VEGF treatment. A greater mean change with aflibercept compared to ranibizumab was found in subgroup analyses of sub-foveal CT in types 1 and 2 macular neovascularization. The long-term consequences of reduced CT in neovascular AMD remain unclear and require further targeted studies.

Suprachoroidal hemorrhage (SCH) is a potentially visually devastating complication of intraocular surgery, but estimates of perioperative SCH incidence vary. We performed a systematic review and meta-analysis of perioperative SCH incidence among population-based studies published between 1990 and 2023. Thirty-five studies collectively reported 1657 cases of perioperative SCH from a population of 3,028,911 surgeries. The estimated incidence of SCH was 0.12 % (95 % CI, 0.10-0.14 %), or about 1 in every 800 surgeries. The estimated incidence of perioperative massive SCH was 0.06 % (95 % CI, 0.04-0.08 %). In multivariable meta-regression, greater SCH incidence was significantly associated with smaller study population size, comparative study design, multicenter study setting, and intraoperative or delayed SCH timing (vs intraoperative alone), while lower SCH incidence was significantly associated with vitreoretinal or mixed surgery type (vs. cataract) (all P < 0.05). Study year was not a significant predictor of SCH incidence, suggesting that the incidence of SCH has not decreased over the past 3 decades despite improvements in surgical technologies and techniques. Given the rarity of SCH, and the strong effect of study population size on reported SCH incidence rates, future studies of SCH incidence should include a minimum population size of at least 1000 surgeries to obtain an accurate estimate of SCH incidence.

Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter's 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.

Narrative abstract: We focus on the utility of artificial intelligence (AI) in the management of macular hole (MH). We synthesize 25 studies, comprehensively reporting on each AI model's development strategy, validation, tasks, performance, strengths, and limitations. All models analyzed ophthalmic images, and 5 (20 %) also analyzed clinical features. Study objectives were categorized based on 3 stages of MH care: diagnosis, identification of MH characteristics, and postoperative predictions of hole closure and vision recovery. Twenty-two (88 %) AI models underwent supervised learning, and the models were most often deployed to determine a MH diagnosis. None of the articles applied AI to guiding treatment plans. AI model performance was compared to other algorithms and to human graders. Of the 10 studies comparing AI to human graders (i.e., retinal specialists, general ophthalmologists, and ophthalmology trainees), 5 (50 %) reported equivalent or higher performance. Overall, AI analysis of images and clinical characteristics in MH demonstrated high diagnostic and predictive accuracy. Convolutional neural networks comprised the majority of included AI models, including those which were high performing. Future research may consider validating algorithms to propose personalized treatment plans and explore clinical use of the aforementioned algorithms.

The Swedish Interactive Thresholding Algorithm (SITA) is the main measurement acquisition algorithm used on the Humphrey Field Analyser, the most commonly used instrument for visual field (VF) assessment worldwide. We compare the sensitivity outputs and reliability parameters of the three currently available SITA algorithms-SITA Standard (SS), Fast (SF), and Faster (SFR), with a focus on the newly released SFR and the 24-2C test grid. SFR displays similar sensitivity outputs to SS and SF, but may not be interchangeable with SS in eyes with more severe VF loss. The reliability metric with the greatest impact on VF reliability is the level of false positives, although the recommended 15 % false positive cut off may be inappropriate as a threshold for judging whether a test is reliable and should be included for use in SFR. Finally, the 24-2C grid may be useful in flagging the presence of a clustered central VF defect, while the 10-2 grid can be used to more comprehensively characterize central field defects. We also discuss strategies to improve testing frequency in clinical practice.

The prognostic implications of delaying treatment for primary uveal melanoma remain debated. We evaluate the impact of choroidal nevi and melanoma doubling times on metastatic death incidence and compare this impact across different tumor sizes. A literature search in PubMed and Web of Science targeted studies published after 1980 that quantified growth rates for choroidal or ciliochoroidal melanomas or nevi based on serial imaging found 199 melanomas and 87 growing nevi from 5 studies. In a random effects model, the estimated average volume doubling time was 360 days across all patients, with doubling times of 717, 421, and 307 days for small, medium, and large melanomas, respectively, and 6392 days for growing nevi. A mixed-effects model estimated that the 10-year incidence of metastatic death increases by 0.3, 1.8, and 4.0 percentage points every month a small, medium, and large melanoma remains untreated. Similar results were produced using two independent sources for survival data. These findings suggest that choroidal melanoma growth follows a super-exponential curve, with larger tumors exhibiting shorter doubling times. Based on these growth rates, delaying definitive treatment increases the risk of metastatic death by nearly zero to several percentage points per month, depending on tumor size.

We evaluate the pharmacokinetics, safety, and optimal dosages of intravitreal agents in silicone oil (SO)-filled eyes, addressing challenges in administering such therapies. We assessed the pharmacological properties and safety profiles of intravitreal drugs in SO-filled eyes, deriving conclusions and guidance from available literature and expert consensus. Preclinical data suggest comparable half-lives of anti-vascular endothelial growth factoragents in SO-filled eyes, but clinical evidence is mainly from case reports and small series. Available research prioritizes standard dosages, particularly for bevacizumab (1.25 mg), supported by stronger evidence than aflibercept (2 mg) or ranibizumab (0.5 mg). Intravitreal steroids, especially dexamethasone at 0.7 mg, show efficacy and safety, while evidence for fluocinolone acetonide at 0.19 mg is limited. Intravitreal methotrexate has been reported at the dosage of 250-400 μg, with keratitis as the primary expected side effect. Case reports indicate tolerability of standard dosages of antivirals (foscarnet 1.2-2.4 mg/0.1 mL, ganciclovir 4 mg/0.1 mL) and the antibiotic combination piperacillin/tazobactam (250 μg/0.1 mL). We offer guidance based on current, but limited, literature. Standard dosage of intravitreal agents should be carefully considered, along with close monitoring for potential side effects, which should be discussed with patients.

MicroRNAs (miRNAs) function as posttranscriptional regulators of gene expression by targeting specific messenger RNA (mRNA). This interaction modulates mRNA stability or translational efficiency, ultimately impacting the level of protein production. Emerging evidence suggests that miRNAs act as critical regulators in corneal diseases. These molecules finetune key processes like cell proliferation, differentiation, inflammation, and wound healing. We reviewed the literature to understand the role that miRNAs may play in the development of challenging and poorly understood corneal diseases. We focused on vernal keratoconjunctivitis, neurotrophic keratitis, keratoconus, Fuchs endothelial corneal dystrophy, and limbal stem cell deficiency. Furthermore, we explored currently studied agonists or antagonists of miRNAs that share similar pathways with ocular diseases and could be employed in ophthalmology in the future. The distinct miRNA expression profiles observed in different ocular surface pathologies, combined with the remarkable stability and relatively easy access of miRNA sampling in biofluids, present possibilities for the development of noninvasive and highly accurate diagnostic tools. Furthermore, comprehending miRNA's pathophysiological role could open new frontiers to a more comprehensive understanding of the pathophysiology underlying ocular surface diseases, thereby paving the way for the creation of novel therapeutic strategies.

The terminology "vitreous cortex remnants" (VCR) indicates the outermost lamellae of vitreous cortex that remains attached to the retinal surface as a consequence of vitreoschisis. The relevance of VCR removal in eyes with rhegmatogenous retinal detachment (RRD) is unknown. We conducted a review from January 1, 2000, to July 30, 2023, examining 1493 eyes. Outcome measures included: prevalence of VCR, relationship between VCR and detachment recurrence due to proliferative vitreoretinopathy (PVR), and relationship between VCR and epiretinal membrane (ERM) formation. A meta-analysis was performed with data reported as odds ratios (OR) or mean difference and 95 % confidence intervals. Prevalence of macular and peripheral VCR was 53.4 and 46.8, respectively, with an overall VCR prevalence of 50.8 (95 % CI 42.6, 59.1) Given the scarcity of available data, meta-analysis regarding the relationship between peripheral VCR and redetachment due to PVR was not feasible. The odds of developing ERM were not statistically different between eyes that had had macular VCR removal vs. eyes that had not (log OR -0.08 [95 % CI -1.06, 0.89 p= 0.89]. Additional prospective studies are required to verify whether removal of VCR may reduce the odds of recurrence of RRD due to PVR and the development of ERM.

Focal choroidal excavation is a morphological abnormality that has been recognized with the widespread application of optical coherent tomography. It can exist alone or in combination with or secondary to other chorioretinopathies, so investigators have applied many classification methods, but its pathogenesis is currently not completely understood. We summarize the latest progress in focal choroidal excavation and offer a rethinking of its pathogenesis.