Survey of ophthalmology最新文献

Advances in cross-sectional and en face optical coherence tomography have revealed a spectrum of subtle inner retinal changes that occur in both surgical and non-surgical conditions. Among these, inner retinal dimples (IRDs), also referred to as dissociated optic nerve fiber layer (DONFL) appearance, concentric macular dark spots (CMDS), and transient swollen arcuate nerve fiber layer (SANFL) have been described in eyes undergoing internal limiting membrane (ILM) peeling, most commonly for macular hole or epiretinal membrane while paravascular inner retinal defects (PIRD), micro-holes, and clefts have been reported in highly myopic eyes and tractional conditions even without prior surgery. The multiplicity of terms, some modality-dependent, others descriptive of etiology has obscured the relationships among these entities, causing confusion in clinical interpretation and research communication. Herein, we propose a hypothesis-driven conceptual and terminological framework intended to reconcile these disparate observations within a coherent schema grounded in anatomy and imaging phenotype while recognizing that the available evidence remains predominantly retrospective and heterogeneous. By reviewing multimodal imaging studies we clarify that postoperative IRDs, DONFL, CMDS, and SANFL may reflect a remodeling response of the inner retina (largely due to ILM removal/peeling, either surgical or spontaneous) whereas PIRD and its variants stem from chronic biomechanical or tractional stress. The review examines their morphological characteristics, temporal evolution, and available data on structure-function correlations. Standardizing nomenclature and interpretation will enhance clarity in both surgical outcomes assessment and clinical management of myopic or tractional retinal disease.

Optical coherence tomography (OCT) has transformed retinal imaging, primarily focusing on the posterior pole; however, its application in assessing peripheral retinal lesions is an evolving field. Recent advances in widefield (WF) and ultra-widefield (UWF) OCT technology have significantly expanded the ability to image the peripheral retina, allowing for improved detection and characterization of peripheral retinal lesions. We evaluate the effectiveness of OCT in identifying peripheral retinal lesions, assessing vitreoretinal adhesions and tractions, aiding differential diagnosis, and guiding treatment strategies among studies published between 2006 and 2024. WF and UWF OCT have significantly enhanced the visualization and documentation of peripheral retinal abnormalities, facilitating more precise detection of retinal breaks, lattice degeneration, and vitreoretinal traction. These advancements have influenced clinical decisions, ranging from conservative monitoring to laser therapy or surgical intervention. Furthermore, OCT has provided valuable insights into the pathophysiology of these retinal disorders; however, several challenges persist, including the absence of standardized imaging protocols and variability in the interpretation of morphological findings. While peripheral OCT imaging enhances diagnostic accuracy and clinical management, broader adoption requires standardization of acquisition techniques and diagnostic criteria. We explore the role of WF and UWF OCT in visualizing peripheral retinal degenerations, describing their hallmark features on OCT, evaluating their diagnostic value, clinical impact, and current limitations. Future research should focus on refining imaging protocols, developing automated diagnostic tools, and evaluating the prognostic significance of peripheral OCT findings to improve patient outcomes.

Optical coherence tomography angiography (OCT-A) is a non-invasive retinal imaging tool with expanding clinical and research applications, including potential uses as a biomarker for systemic diseases. The influence of age on OCT-A parameters, however, remains incompletely understood. To address this, we conducted a comprehensive review across seven databases, screening 271 full-text articles, of which 156 met inclusion criteria. Extracted data included participant demographics, study design, OCT-A device type, measured parameters, and outcomes across retinal layers in the macula and optic nerve head. Normative OCT-A values for pediatric and older adult populations were also reviewed. Evidence consistently demonstrated an age-related decline in macular vessel density among adults, even after accounting for signal strength. In contrast, pediatric studies showed variable associations between age and vascular parameters. Across all populations, foveal avascular zone size remained largely unaffected by age. These findings highlight the importance of considering age when interpreting OCT-A metrics in both clinical and research settings.

Purpose: We present the life and work of William White Cooper, with a focus on his 1850 study On the conical cornea, the earliest known multicentre epidemiological investigation of keratoconus. We contextualise Cooper's contribution within mid-19th-century ophthalmology, reassessing his findings in light of modern epidemiological knowledge.

Methods: Historical research was conducted using Gallica (the digital platform of the National Library of France (BnF)) and the historical resources of The Lancet website. The keywords used were 'conical cornea' or 'keratoconus,' which were the most common names for keratoconus.

Results: William White Cooper, a leading Victorian ophthalmic surgeon and later Surgeon-Oculist in Ordinary to Queen Victoria, conducted what appears to be the first epidemiological study of keratoconus, nearly a century before the earliest study typically cited in modern literature. Drawing on data from multiple ophthalmic hospitals across England, Scotland, Ireland, and Macao, Cooper compiled prevalence figures from over 200,000 examined patients between 1814 and 1850. Prevalence rates, recalculated for comparison with modern standards, varied markedly between regions: from 0 in Edinburgh to 254.0 cases per 100,000 in Plymouth, with an overall prevalence of 85.92 per 100,000 for the United Kingdom. The highest prevalence was observed in Macao (324.15 per 100,000), leading Cooper to hypothesise that warmer climates might favor the occurrence of keratoconus. Despite the diagnostic limitations of the period, these values are strikingly close to those reported in parts of modern Europe, underscoring the scale and relevance of his pioneering work.

Conclusion: Cooper's 1850 investigation represents the earliest known multicentre epidemiological study of keratoconus, predating modern reports by nearly a century. Despite methodological limitations inherent to the mid-19th century, his findings anticipated contemporary prevalence patterns and introduced the hypothesis of environmental influences on disease occurrence. This work not only enriches the historical record of keratoconus, but also highlights the enduring value of early clinical observation in shaping epidemiological understanding.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of indolent extranodal B-cell non-Hodgkin lymphoma. Orbital and conjunctival MALT lymphomas (OAML) are the most common primary ocular adnexal lymphomas, while gastric MALT lymphoma remains a prototypical site linked to Helicobacter pylori infection. Despite the disparate anatomical locations, mounting evidence suggests a shared pathogenesis, including chronic antigenic stimulation, lymphoid accumulation, and genetic events. We explore the epidemiologic, pathophysiologic, and molecular connections between OAML and gastric MALT lymphoma, with particular emphasis on the therapeutic implications. The role of H. pylori as a driver of gastric lymphomagenesis is well-established, and antibiotic eradication therapy has revolutionized treatment. By contrast, the evidence for microbial triggers and antibiotic responsiveness in OAML remains equivocal, although Chlamydia psittaci has been proposed in some populations. We comprehensively evaluate treatment modalities for OAML, including watchful waiting, antibiotic therapy, low-dose radiotherapy, immunochemotherapy (e.g., rituximab, bendamustine), and targeted agents. The differences in natural history, treatment response, and relapse patterns between gastric and ocular MALTomas are reviewed, and a proposed treatment algorithm is presented. Finally, we highlight knowledge gaps and future directions, including molecular profiling, predictive biomarkers, and microbiome-targeted interventions.

We synthesized current evidence on the spectrum of ophthalmic alterations in prematurely born children without retinopathy of prematurity (ROP). A literature review was conducted in accordance with PRISMA guidelines. Scopus, PubMed, Web of Science, and Cochrane Library were searched for English-language studies published between 2000 and 2025. Eligible studies included observational designs reporting ophthalmic outcomes in infants born before 37 weeks of gestation without ROP. A total of 32 studies consisting of 4,548 individuals were investigated. Data were qualitatively synthesized across visual, refractive, anterior segment, and posterior segment domains. Mean visual acuity in preterm children without ROP ranged from -0.06 to 0.16 LogMAR and was generally comparable to term peers. Stereoacuity was reduced but showed improvement with age. Strabismus was reported in 5-20% of cases, increasing with age, and most commonly presented as esotropia. Nystagmus incidence ranged from 0-14%. Anisometropia was reported in 1.4-16.7% of preterm children without ROP, with one study demonstrating a higher prevalence compared to term peers. Hyperopia was highly prevalent, ranging from 20.9% to 86.2%, while astigmatism was reported in 14.1-65.1% of cases. Astigmatism predominated at one year of age, whereas hyperopia became the most common refractive error by six years. Hyperopia tends to increase with age, astigmatism gradually declines, and myopia rates remain relatively stable. Anterior segment findings in infancy included greater central corneal thickness, smaller corneal diameter, reduced axial length, shallower anterior chamber depth, and increased lens thickness. Posterior segment alterations included thicker central macula and focal thinning of the retinal nerve fiber layer in some reports. Premature birth, even in the absence of ROP, is independently associated with persistent structural and functional ophthalmic alterations. These findings highlight the need for long-term surveillance and early ophthalmologic intervention in this population.

This systematic review evaluates conbercept, ranibizumab, and laser therapy for retinopathy of prematurity (ROP) through 53 studies (14 RCTs, 29 retrospective, 10 single-arm) involving 8,787 eyes. Primary endpoints included inactive ROP rates (resolution of plus disease/vascular tortuosity), disease regression, recurrence rates, and retreatment needs, with safety assessments covering ocular complications (retinal detachment, vitreous hemorrhage) and systemic events (apnea, arrhythmias). Exploratory analyses examined conbercept dosing regimens (0.15mg, 0.25mg, 0.3mg). Conbercept showed superior cumulative efficacy (SUCRA=0.815) versus laser (0.533) and ranibizumab (0.152), though initial treatment responses were comparable. Ranibizumab had higher recurrence (RR=3.62, 95%CI:1.31-11.64) and retreatment rates (RR=2.31, 95%CI:1.18-5.55) than laser, which ranked best for preventing recurrence (SUCRA=0.792). Conbercept's ocular AE rate (3.85%) was lower than laser (9.82%) and ranibizumab (5.03%), with fewer systemic complications (3.49% NICU admissions vs 42.17% for laser). Dose-response analysis revealed 0.25mg conbercept balanced efficacy (82.70% inactivity) and safety (3.84% AEs), while 0.3mg showed peak efficacy (90.7%) but limited safety data. Higher doses reduced recurrence (22.97% at 0.15mg vs 17.00% at 0.25mg).