Survey of ophthalmology最新文献

We explore the evolving landscape of macular hole (MH) management, highlighting key advancements in surgical and nonsurgical treatments. While pars plana vitrectomy with internal limiting membrane (ILM) peeling remains the gold standard for MH less than 500 μm in width and in chronic or highly myopic cases, novel techniques have expanded treatment options, including ILM flap approaches, biomaterial grafts, and regenerative therapies. Additionally, emerging nonsurgical modalities, such as pharmacological agents and stem cell-based therapies, present promising alternatives. We synthesize the current evidence in MH management, focusing on clinical implications and limitations of each technique. Furthermore, we discuss future directions to optimize anatomical and functional outcomes of complex and refractory MHs.

Aflibercept biosimilars offer cost-effective alternatives to reference aflibercept for retinal diseases such as neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). By inhibiting vascular endothelial growth factor-mediated vascular damage, they aim to improve visual outcomes with comparable safety and efficacy, increasing treatment access while reducing cost burden. We evaluate their performance against the reference drug. A comprehensive search was done across Cochrane, Embase, PubMed, Scopus and ClinicalTrials.gov. Randomized controlled trials were included, and quality was assessed via RoB 2.0 tool. A random-effects model estimated standardized mean differences (SMD) and risk ratios. 11 studies (4064 participants) were analyzed, 8 focused on nAMD and 2 on DME. No significant differences in best-corrected visual acuity changes were observed between biosimilars and reference aflibercept in studies on nAMD (SMD = -0.04, 95 % confidence inerval [CI]: -0.15-0.06) or DME (SMD = 0.11, 95 % CI: -0.12-0.33). Central subfield thickness change at week 4 and the endpoint also showed no significant differences. Similarly, no significant differences were seen in choroidal neovacularization size, vision maintenance, anti-drug antibody development, treatment-emergent adverse events, or ocular adverse effects. Biosimilar aflibercept show similar efficacy and safety to the original for nAMD and DME, with no significant differences in key outcomes. They offer a cost-effective alternative that offers similar clinical benefits while improving treatment accessibility.

Cataracts and presbyopia represent leading global causes of visual impairment, and demand for spectacle independence after cataract surgery continues to rise. Pseudophakic mini-monovision, a refined adaptation of traditional monovision employing milder anisometropia (-0.75 to -1.50 diopter), has emerged as an effective and versatile strategy to address this need. Compared with conventional monovision, mini-monovision better preserves stereopsis and binocular vision while providing satisfaction and spectacle independence approaching that of multifocal intraocular lenses (IOLs). Success is influenced by factors such as neuroadaptive capacity, ocular dominance, pupil size, and precision of refractive targeting. Advances in IOL technologies, including enhanced monofocal, extended depth of focus, and light-adjustable lenses, have further expanded mini-monovision's applicability, offering customizable visual outcomes. Careful preoperative evaluation and accurate biometry remain critical to screening candidates and optimizing refractive accuracy. Alternative designs, including crossed and hybrid monovision, extend its clinical versatility. By integrating with modern IOL innovations, mini-monovision provides a cost-conscious, patient-centered approach that balances spectacle independence with visual quality, reinforcing its relevance in personalized refractive cataract surgery.

Adverse visual outcomes (AVOs) are common among preterm infants and retinopathy of prematurity (ROP) is a well-known risk factor; however, there is limited information available regarding AVOs in preterm infants without ROP. A librarian (PS) conducted searches for studies in MEDLINE (PubMed), and Scopus (Elsevier), from January 1, 2007, to July 13, 2023. The search was designed to capture articles containing the concepts of ROP and adverse visual outcomes using relevant subject headings and text words adapted for the syntax of each database. Following deduplication, Rayyan was utilized for title abstract and full text screening to identify studies reporting specific AVOs separately for preterm infants with and without ROP. The available literature suggests that ROP is associated with an increased risk for specific AVOs, including low vision and blindness, amblyopia, and strabismus. Astigmatism and color vision abnormalities were not strongly linked to ROP. Preterm infants without ROP still experience AVOs, albeit at lower percentages. While ROP is a risk factor for some AVOs, not all AVOs among preterm infants are associated with ROP. Further research is warranted to better understand the factors contributing to AVOs in preterm infants without ROP.

We evaluated retinal microvascular changes in patients with diabetic retinopathy (DR) treated with panretinal photocoagulation (PRP), using optical coherence tomography angiography (OCTA). Nineteen studies were included that assess changes in vessel density (VD) within the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the foveal avascular zone (FAZ) area. PRP was associated with a significant increase in VD in the SCP, particularly in the foveal region, with greater improvements observed during long-term follow-up. In contrast, changes in the DCP were less consistent; however, a mild increase in foveal VD was noted over time. Additionally, a borderline reduction in FAZ area was observed after PRP, suggesting enhanced macular perfusion. These findings highlight the localized and time-dependent vascular effects of PRP and support the use of OCTA as a non-invasive, layer-specific tool for monitoring treatment outcomes in DR.

Transorbital endoscopic approaches (TEAs) for orbital surgery have gained considerable traction since the concept was first formalized approximately 2 decades ago. While the distinction in the nomenclature between TEAs and transorbital neuroendoscopic surgery can be at times ambiguous, this review focuses exclusively on TEAs for primary orbital pathology. The current literature on TEAs encompasses preclinical cadaveric dissection studies, clinical case reports and case series. Orbital roof lesions accessed via a superior lid crease incision to enter the subperiosteal space predominated in the early literature. Since then, TEAs have expanded to orbital lesions within both the extraconal and intraconal spaces, and the orbital apex. Clinical series thus far have reported favorable outcomes, with a low risk of permanent functional sequelae. We discuss the advantages and limitations of TEAs.

A 76-year-old man with advanced non-small cell lung carcinoma undergoing treatment with carboplatin and paclitaxel plus pembrolizumab presented to the emergency department with a one-week history of rapidly progressive, severe bilateral visual loss and pain on eye movement. Ocular movements were full, with no other neurological deficits noted. Visual acuity was reduced bilaterally: 20/63 right eye, 20/200 left eye. Color vision testing was borderline normal, bilateral visual fields were constricted, while both funduscopy and optical coherence tomography were unremarkable. Urgent magnetic resonance imaging of the brain revealed patchy FLAIR hyperintensities in both optic nerves and faint post-contrast enhancement. By the time of neurological assessment one week later, the patient had experienced partial spontaneous improvement in vision. A comprehensive neuro-oncological differential diagnosis was performed, prompting the request for further diagnostic tests. This case illustrates the evolving landscape of neuro-oncology, where advances in diagnostic approaches and the use of immunotherapies such as pembrolizumab may alter immune tolerance, leading to immune-related adverse events such as myelin oligodendrocyte glycoporotein antibody-associated disease.

Anterior segment optical coherence tomography (AS-OCT) is emerging as an essential tool in the diagnosis and monitoring of uveitis. Offering noninvasive, high-resolution imaging, AS-OCT allows clinicians to visualize and quantify subtle changes in the anterior chamber (AC), iris, cornea, sclera, and lens that may be difficult to capture with slit-lamp examination alone. We highlight how AS-OCT improves the detection of AC cells and flare, supports disease monitoring through automated, reproducible metrics, and facilitates care in challenging settings, such as pediatric uveitis or clinical trials. In the cornea, AS-OCT allows detailed evaluation of keratic precipitates and subclinical endothelial dysfunction. It also provides disease-specific metrics of iris thickness and surface smoothness in conditions such as Fuchs uveitis syndrome. In the sclera, AS-OCT can distinguish episcleritis from scleritis, differentiate their subtypes, and monitor inflammation resolution. Emerging applications, including anterior vitreous imaging and artificial intelligence-driven analysis, suggest a growing role for AS-OCT in personalized care. As evidence expands, AS-OCT is poised to become a cornerstone of multimodal imaging in uveitis, enhancing precision, reducing subjectivity, and improving outcomes for patients across a wide spectrum of inflammatory eye disease.

Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery that may rarely result in vision loss. In most cases PCME resolves spontaneously, which makes it challenging to establish the efficacy of therapeutic and prophylactic interventions. Although no consensus exists regarding management or prevention, most surgeons advocate prophylaxis primarily for high-risk eyes. Nevertheless, the costs associated with preventive measures have risen substantially in recent years. In this review, we summarize the current evidence on the epidemiology, pathogenesis, diagnosis, risk factors, treatment, and prophylaxis of PCME, to provide a comprehensive understanding of its clinical indications and the cost-effectiveness of available strategies.