Survey of ophthalmology最新文献

Rhegmatogenous retinal detachment (RRD) is a major cause of vision loss requiring prompt surgical intervention. Recent advances in multimodal retinal imaging, especially macular and peripheral optical coherence tomography (OCT), have significantly improved our understanding of the various factors and biomarkers influencing the clinical outcomes after RRD repair. Several visual disturbances, such as metamorphopsia and aniseikonia, typically persist despite successful reattachment, significantly impacting patients' quality of life. Factors influencing recovery include the timing of surgery, the extent of retinal displacement, and structural integrity of retinal layers. Additionally, recent research is increasingly highlighting the relevant role of numerous OCT biomarkers, including hyperreflective dots, ellipsoid zone, external limiting membrane and outer retinal disruption, and bacillary layer detachment in prognosis. We provide an overview on the above-mentioned factors implied in RRD-related postsurgical prognosis in order to optimize clinical practice.

The corneal triple procedure, combining keratoplasty, cataract extraction, and intraocular lens implantation, remains a valuable option for patients with concurrent corneal opacity and cataract. We synthesize historical and contemporary evidence on penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK) triple procedures, highlighting their indications, surgical techniques, outcomes, and evolving trends. PKP triple is indicated for full-thickness scarring, keratoconus with central scarring, and cases with anterior segment abnormalities, but remains technically demanding due to open-sky cataract surgery and postoperative refractive unpredictability. ALK triple offers tectonic and visual rehabilitation in stromal disorders sparing the endothelium, though technically challenging. EK triple procedures, particularly Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty, are increasingly preferred in endothelial disorders such as Fuchs endothelial corneal dystrophy, offering faster recovery, more predictable refraction, and better graft survival. Advances in capsulotomy, nucleus management, intraocular lens power calculation, and perioperative strategies have improved safety and refractive outcomes across triple procedures. Long-term studies reveal that although visual and anatomical success rates remain high, complications such as graft rejection, glaucoma, and posterior capsular opacification persist. Careful patient selection and tailored surgical planning are essential, as triple procedures continue to evolve toward safer and more predictable outcomes.

Intra-arterial chemotherapy (IAC) has emerged as a targeted alternative to intravenous chemotherapy (IVC) for retinoblastoma; however, the comparative effectiveness and safety of these approaches remain incompletely defined. We performed a systematic review and meta-analysis to evaluate whether IAC-based regimens are associated with improved clinical outcomes compared with IVC in pediatric retinoblastoma. Twelve studies were included. Comparative studies contributed to the quantitative synthesis, whereas selected non comparative IAC series were summarized qualitatively to provide contextual evidence. Overall survival demonstrated a consistent association favoring IAC across both early and advanced disease categories, with a pooled effect estimate of OR 4.72 (95% CI 2.69-8.28). In early-stage disease, the pooled OR was 12.61 (95% CI 3.82-41.58), while advanced-stage disease showed a pooled OR of 3.56 (95% CI 1.88-6.74). Heterogeneity was negligible within subgroups (I² = 0%). Event-free survival favored IAC-based treatment overall with a pooled RR of 1.36 (95% CI 1.13-1.62). When stratified by treatment approach, IAC alone showed a pooled RR of 1.30 (95% CI 1.01-1.66) with moderate heterogeneity (I² = 61%), whereas IAC combined with IVC sequencing demonstrated a pooled RR of 1.43 (95% CI 1.10-1.86) with no heterogeneity (I² = 0%). Globe salvage outcomes were improved with IAC, with a pooled RR of 1.33 (95% CI 1.23-1.42; I² = 9%). Avoidance of enucleation also favored IAC overall, with a pooled RR of 1.69 (95% CI 1.34-2.12). Subgroup analyses indicated a modest and non-significant effect in early-stage disease (RR 1.27, 95% CI 0.89-1.80) and a clearer effect in advanced-stage disease (RR 2.08, 95% CI 1.54-2.80), with minimal heterogeneity (I² = 0%). Metastatic events were rare across studies; nevertheless, pooled analysis suggested lower odds of metastasis in IAC-based regimens compared with IVC (OR 0.42, 95% CI 0.19-0.91; I² = 0%), with no evidence of subgroup differences between IAC alone and IAC plus IVC sequencing. In conclusion, IAC-based strategies were associated with favorable outcomes in survival, disease control, globe salvage, and avoidance of enucleation compared with IVC, with consistently low heterogeneity across major endpoints and metastatic events remaining uncommon in both arms. These findings support the role of IAC as an important component of contemporary retinoblastoma management, particularly in settings with appropriate technical expertise and multidisciplinary resources.

In this scoping review, we examine the implications of 3 pillars (housing conditions and quality, residential consistency, and housing affordability) of healthy housing on vision health outcomes. We examine barriers based on geographical locations of the studies and World Health Organization income levels. We identified 11,190 abstracts, with 10,996 articles retrieved. Sixty-three met inclusion criteria. Among these, housing conditions emerged as the most frequently observed housing pillar associated with adverse vision health outcomes, cited in 62.1 % of the studies. Environmental pollution, particularly indoor air quality and exposure to harmful substances, was the most common condition associated with poor vision outcomes.

Initially designed for the treatment of type-2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RA) are multifaceted agents with promising neuroprotective and anti-inflammatory properties. The majority of the research exploring the relationship between GLP-1RA use and ophthalmic disease comes from large database studies or secondary-analysis of randomized controlled trials investigating GLP-1RAs in cardiovascular disease and obesity. Current evidence regarding the impact of GLP-1 receptor agonists on ophthalmic diseases remains inconsistent, with studies reporting both protective and detrimental effects. For example, there are conflicting findings of an effect on diabetic retinopathy and non-arteritic anterior ischemic optic neuropathy, as well as age-related macular degeneration, with GLP-1RA use. In contrast, GLP-1RAs have more consistently demonstrated a protective effect against idiopathic intracranial hypertension, glaucoma and dry-eye disease. Importantly, the majority of the clinical ophthalmic studies are from large electronic health record databases. Overall, limitations in the design of these studies, such as the lack of manual chart review and potential miscoding of diagnosis or treatments, prohibit a more granular analysis of comprehensive ocular endpoints. As a heterogenous medication class with differing structures, potencies, and mechanisms of action, we outline the ophthalmic effects of all Food and Drug Administration-approved GLP-1RAs. We discuss the proposed mechanisms of ocular effects and GLP-1RA use, examine the current literature investigating the impact of GLP-1RAs on ophthalmic disease, discuss the effects of specific GLP-1RAs, and outline the perioperative considerations of this medication class.

We conducted a systematic review on the clinical and imaging characteristics of age-related choroidal atrophy (ARCA) that distinguish ARCA from age-related macular degeneration (AMD) and geographic atrophy (GA). Studies were included if they reported on ARCA using clinical or multimodal imaging criteria and differentiated it from AMD and GA. Extracted data included subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), inner retinal layer thicknesses, and fundus findings. Risk of bias was assessed using the Joanna Briggs Institute checklists. Narrative synthesis and descriptive statistics were performed (PROSPERO (ID: CRD420251041101)). Seven studies (n = 329 patients) met inclusion criteria. ARCA was characterized by choroidal thinning (mean SFCT: 69.8-96.45 µm), preserved retinal pigment epithelium (RPE) on fundus autofluorescence, scleral visibility, and fundus features including peripapillary atrophy (83.3 %), tessellated fundus, and pseudodrusen. Compared to control, patients with ARCA had significantly thinner peripapillary nerve fiber layer (mean: 84.2 µm vs. 90.2 µm; p = 0.047) and reduced mean ganglion cell layer, macular internal plexiform layer and CVI. ARCA contrasts with AMD and GA by its distinct imaging features, less severe visual impairment, higher glaucoma prevalence (35.3 %), and more favorable response to anti-vascular endothelial growth factor agents when choroidal neovascularization is present. ARCA is a distinct clinical entity characterized by specific choroidal and retinal findings on multimodal imaging including lower CVI, thin SFCT, preserved RPE with scleral visibility, peripapillary atrophy, and inner retinal thinning. Further studies are warranted to standardize diagnostic criteria and understand long-term outcomes of ARCA.

The anatomy and physiology of aqueous humour (AH) are essential to maintaining ocular health and managing diseases such as glaucoma, diabetic retinopathy, and Fuchs endothelial corneal dystrophy (FECD). This review compiles recent findings on AH dynamics, molecular composition, and clinical applications. AH, produced by the ciliary processes, supports intraocular pressure regulation, nourishes avascular tissues, and preserves immune privilege within the eye. Production occurs through diffusion, ultrafiltration, and active secretion, while drainage relies on trabecular and uveoscleral pathways. Imbalances in these processes can lead to ocular diseases. Elevated levels of cytokines, oxidative stress markers, and growth factors in AH have been associated with conditions such as glaucoma, diabetic retinopathy, and postoperative inflammation. Advanced technologies, including proteomics, metabolomics, and aqueous angiography, have revealed the diagnostic and therapeutic potential of AH analysis. Specific cytokine and metabolic profile changes in diabetic patients correlate with disease severity, while cytokine alterations can influence surgical outcomes in FECD and cataract surgery. Understanding the composition and behaviour of AH is critical for developing precise diagnostic tools and treatments for ocular diseases. Additionally, insights into AH's role in surgical recovery emphasize the importance of customized perioperative care, particularly for patients with conditions such as FECD or diabetes.

Age-related macular degeneration (AMD) is a progressive and irreversible degenerative disease of the retina. Slowing progression to late AMD is the only way to prevent vision loss. Given that AMD treatments are noncurative, understanding the personal characteristics associated with progression is of critical importance for people with increased AMD risk. We conducted an overview of systematic reviews and meta-analyses (SRMAs) to assess the scope of the existing literature on prognostic factors (PFs) for AMD progression. We included all systematic reviews of PFs for the progression of AMD from early or intermediate to late. We used the Cochrane Eyes and Vision Database of Systematic Reviews (current to September, 2024). We identified 64 potentially relevant studies in the database and included 17 SRMAs, which most commonly studied functional or structural ocular (10/17), lifestyle (7/17), and intervention-related factors (7/17). Across all reviews, 218 PFs were reported. We extracted 79 and grouped these into 20 distinct types of PFs across 8 categories. The modifiable PFs with most evidence for slowing progression were increased dietary supplementation with antioxidants and multivitamins and reduced smoking. Most PFs were non modifiable. Although most PFs may not be targetable, by integrating high-risk optical coherence tomography findings, monitoring relevant comorbidities, and considering individual lesion characteristics, clinicians may better predict disease trajectories and support patients in slowing progression and preserving vision. Notably, no reviews studied social determinants as potential PFs for AMD progression, representing a critical gap in the evidence base. Future reviews should investigate social, systemic, and AI-identified biomarkers to provide a more comprehensive understanding of AMD progression.

Silicone oil (SO) remains an essential intraocular tamponade in vitreoretinal surgery, particularly for complex retinal detachments; however, its long-term use is associated with significant complications, of which emulsification is the most clinically impactful. We offer a comprehensive synthesis of the pathophysiology, clinical presentation, imaging features, and management of SO emulsification. We begin by outlining the chemical structure and biophysical properties of SO, emphasizing the role of viscosity, interfacial tension, and molecular purity in emulsification resistance. The manufacturing process and its relevance to residual impurities, including surfactant-like components, are highlighted as critical contributors to emulsification risk. Clinical risk factors spanning preoperative inflammation, intraoperative techniques, and postoperative dynamics are detailed. Multimodal imaging including optical coherence tomography, ultrasound biomicroscopy, and fundus autofluorescence provides diagnostic insight into emulsified SO, while standardized grading systems offer a framework for clinical assessment. We also address pharmacokinetic alterations in SO-filled and emulsified eyes, impacting drug distribution and efficacy of anti-vascular endothelial growth factor agents, steroids, and antimicrobials. Management strategies include individualized algorithmic decision-making approach regarding the timing and technique of SO removal, acknowledging the challenges in achieving complete elimination of microdroplets. Emerging innovations in SO formulations, surface modifications, fluorinated oils, and AI-driven imaging tools are discussed as future solutions. Ultimately, our review underscores the need for an integrative approach combining material science, surgical expertise, and personalized care to mitigate the complications of SO emulsification and optimize long-term outcomes in retinal surgery.

Deep-learning (DL) algorithms are widely promoted for diabetic-retinopathy (DR) screening, yet their prospective diagnostic accuracy is not well defined. PubMed, EMBASE and ClinicalTrials.gov were searched to April, 2025, for prospective evaluations of DL systems using color-fundus images. Two reviewers screened records, extracted data, and applied QUADAS-2. Hierarchical bivariate random-effects models produced pooled sensitivity and specificity for referable and vision-threatening DR), analyzed separately at patient and eye level. Twenty-one prespecified moderators were explored with uni- and multi-variate meta-regression; publication bias was assessed with Deeks' test Seventy-three studies from 23 countries (255,330 examinations) met the criteria. Pooled patient-level sensitivity was 0.94 (95 % CI 0.92-0.95) and specificity 0.90 (95 % CI 0.87-0.93); eye-level values were 0.93 (95 % CI 0.91-0.95) and 0.94 (95 % CI 0.92-0.96). DR subtype, retinal-field strategy, camera form factor, and prevalence independently explained heterogeneity (p < 0.05). Performance matched or exceeded pivotal FDA trials (IDx-DR, EyeArt). AI gradability was ≥ 95 % in 60 % of cohorts, including handheld and smartphone systems. DL-based DR screening achieves consistent, high accuracy across devices and care settings, enabling scalable deployment in primary care, pharmacies, and mobile clinics. Quality assurance and ongoing monitoring are essential to maximize population-level benefits.