Survey of ophthalmology最新文献_第6页

Work-up in patients with retinal vasculitis: A systematic review and meta-analysis: International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) Report 2 视网膜血管炎患者的随访：一项系统回顾和荟萃分析：国际葡萄膜炎研究组（IUSG）视网膜血管炎研究（修订）报告2。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-17 DOI: 10.1016/j.survophthal.2025.09.011

Carlos Cifuentes-González , Ikhwanuliman Putera , Cheong Fu Yuan Walter , Germán Mejía-Salgado , Yong Le Tong , Reo Chan , William Rojas-Carabali , Xin Ying Rachel Song , 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 , Uwe Pleyer

This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conducted in 5 databases and registered in PROSPERO (CRD42023489232). Studies included articles on at least 10 patients with RV without publication date or language restrictions. RV was categorized as secondary RV if they were associated with systemic disease, syndromic if they were associated with a syndromic ocular disease without systemic disease, idiopathic RV without association to systemic or syndromic ocular diseases. This report includes 84 studies analyzing 3480 patients with RV. Among infectious causes, tuberculosis tests were frequently reported, with TST/IGRA positivity observed in 31.4 % (95 % CI: 17.2–50.2 %) of de novo RV cases, increasing to 64.7 % (95 % CI: 47.8–78.9 %) in confirmed tubercular RV and 65.7 % (95 % CI: 39.0–85.1 %) in Eales disease. Chest radiograph abnormalities were present in 21.8 % (95 % CI: 12.9–33.8 %) of tubercular RV cases. Non-infectious causes showed notable regional variability. HLA-B51 positivity was 1 % (95 % CI: 0.03–3.1 %) in de novo RV, but rose to 61.4 % (95 % CI: 23.1–89.4 %) in Behçet's RV. Sarcoidosis RV revealed noncaseating granulomas in 80.5 % (95 % CI: 9.7–99.4 %), with angiotensin-converting enzyme elevation in 4.6 % (95 % CI: 2.3–9.1 %). This study highlights significant geographic variability in RV etiologies. Tuberculosis remains a key infectious cause, while non-infectious causes vary regionally. Region-specific diagnostics and Bayesian testing protocols are critical to improving diagnostic accuracy and patient outcomes.

本系统综述和荟萃分析调查了视网膜血管炎（RV）的全球诊断方法，重点是感染性和非感染性原因。与我们之前的报告一样，系统搜索在五个数据库中进行，并在PROSPERO （CRD42023489232）中注册。研究纳入了至少10例RV患者的文章，没有发表日期或语言限制。如果与全身性疾病相关，则将RV归类为继发性RV，如果与综合征性眼部疾病相关，则将其归类为综合征性RV，无全身性疾病的累及性RV，与全身性或综合征性眼部疾病无关的特发性RV。这包括84项研究，分析了3480例RV患者。在感染原因中，经常报告结核试验，在新发RV病例中31.4% （95% CI: 17.2-50.2%）观察到TST/IGRA阳性，在确诊的结核性RV中增加到64.7% (95% CI: 47.8-78.9%)，在Eales病中增加到65.7% （95% CI: 39.0-85.1%）。21.8% （95% CI: 12.9-33.8%）的结核性RV病例出现胸片异常。非传染性原因表现出显著的区域差异。HLA-B51阳性在新生RV中为1% (95% CI: 0.03-3.1%)，但在behet RV中上升至61.4% （95% CI: 23.1-89.4%）。结节病RV显示非干酪化肉芽肿的发生率为80.5% (95% CI: 9.7-99.4%)， ACE升高的发生率为4.6% （95% CI: 2.3-9.1%）。这项研究强调了RV病因的显著地理差异。结核病仍然是一个主要的传染原因，而非传染原因因区域而异。区域特异性诊断和贝叶斯检测方案对于提高诊断准确性和患者预后至关重要。

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引用次数: 0

Unfolding the diagnostic pipeline of diabetic retinopathy with artificial intelligence: A systematic review 用人工智能展开糖尿病视网膜病变的诊断管道：系统综述。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-17 DOI: 10.1016/j.survophthal.2025.09.008

K. Suganya Devi , Hemanth Kumar Vasireddi , GNV Raja Reddy , Satish Kumar Satti

Diabetic retinopathy (DR) is a leading cause of vision impairment globally, necessitating early and accurate detection through effective screening methods. We focus on the integration of artificial intelligence (AI) techniques in automating and enhancing DR diagnosis. Timely detection and classification of DR severity are critical for patient management and intervention. AI-driven DR classification frameworks typically consist of sequential stages: image preprocessing, optic disc (OD) localization and removal, blood vessel segmentation, feature extraction, and classification of DR severity. In the proposed and implemented model, each of these phases was systematically addressed to ensure improved performance. The implementation demonstrated superior accuracy, achieving 98.02 % on the widely used MESSIDOR dataset. The pipeline incorporated effective preprocessing to enhance image quality, accurate OD localization and exclusion to avoid false detections, followed by precise vessel segmentation. Extracted features were then used to train deep learning models for DR severity classification. Comparative analysis with existing methods executed on the same dataset revealed that proposed model outperformed other state-of-the-art techniques in terms of classification accuracy and robustness. Ww outline the recent progress in AI-based DR screening, highlighting the significance of each diagnostic phase and their role in improving overall performance. By evaluating multiple approaches and benchmarking them against established dataset, the study emphasizes the transformative role of AI in DR diagnosis. Despite current challenges, AI holds substantial promise in clinical application, offering scalable, accurate, and efficient DR screening solutions that may significantly reduce the risk of blindness in diabetic patients.

糖尿病视网膜病变（DR）是全球视力损害的主要原因，需要通过有效的筛查方法进行早期准确的检测。我们专注于人工智能（AI）技术在自动化和增强DR诊断中的集成。及时发现和分类DR严重程度对患者管理和干预至关重要。人工智能驱动的DR分类框架通常由连续的阶段组成：图像预处理、视盘（OD）定位和去除、血管分割、特征提取和DR严重程度分类。在建议和实现的模型中，系统地处理了这些阶段中的每个阶段，以确保改进性能。在广泛使用的MESSIDOR数据集上，实现的准确率达到98.02 %。该管道采用了有效的预处理来提高图像质量，精确的外径定位和排除以避免误检，然后进行精确的血管分割。然后使用提取的特征来训练深度学习模型，用于DR严重程度分类。与在同一数据集上执行的现有方法进行比较分析表明，所提出的模型在分类精度和鲁棒性方面优于其他最先进的技术。我们概述了基于人工智能的DR筛查的最新进展，强调了每个诊断阶段的重要性及其在提高整体表现方面的作用。通过评估多种方法并根据已建立的数据集对其进行基准测试，该研究强调了人工智能在DR诊断中的变革性作用。尽管目前面临挑战，但人工智能在临床应用中具有巨大的前景，它提供了可扩展、准确和高效的DR筛查解决方案，可以显著降低糖尿病患者失明的风险。

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引用次数: 0

Angioid streaks-related choroidal neovascularization: Clinical features, multimodal imaging-based differential diagnosis, and optimized treatment strategies 血管样条纹相关脉络膜新生血管：临床特征、基于多模态成像的鉴别诊断和优化治疗策略。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-17 DOI: 10.1016/j.survophthal.2025.09.012

Antonio La Rosa MD , Alessandro Feo MD , Elodie Bousquet MD PhD , Diogo Cabral MD , Yousef Fouad MD , Mariacristina Parravano MD , Mario R. Romano MD PhD

Angioid streaks-related choroidal neovascularization (AS-CNV) is a vision-threatening complication arising from breaks in a calcified Bruch membrane, commonly associated with systemic conditions such as pseudoxanthoma elasticum (PXE). This review comprehensively addresses the clinical features of AS-CNV, emphasizing its distinct pathophysiology and systemic implications. We highlight the critical role of multimodal imaging—including color fundus photography, fundus autofluorescence, fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography—in accurately diagnosing and differentiating AS-CNV from other choroidal neovascular pathologies. The integration of imaging biomarkers and vascular pattern analysis facilitates early detection of subclinical and quiescent CNV, allowing for timely, individualized anti- vascular endothelial growth facgtor therapy. Additionally, the systemic management of PXE and its cardiovascular, renal, and gastrointestinal manifestations is underscored to optimize overall patient outcomes. We provide an up-to-date synthesis of diagnostic advances and treatment strategies aimed at improving visual prognosis in patients with AS-CNV.

血管样条纹相关脉络膜新生血管（as - cnv）是一种威胁视力的并发症，由钙化的布鲁氏膜破裂引起，通常与系统性疾病如弹性假性黄瘤（PXE）有关。本文综述了AS-CNV的临床特征，强调了其独特的病理生理学和系统意义。我们强调了多模态成像的关键作用，包括彩色眼底摄影，眼底自身荧光，荧光素和吲吲胺绿血管造影，光谱域光学相干断层扫描（SD-OCT）和光学相干断层扫描血管造影（OCTA）在准确诊断和区分AS-CNV与其他脉络膜新生血管病变中的作用。影像生物标志物和血管模式分析的整合有助于亚临床和静止CNV的早期检测，从而允许及时、个性化的抗vegf治疗。此外，强调PXE及其心血管、肾脏和胃肠道表现的系统管理，以优化患者的整体预后。本文综述了最新的诊断进展和治疗策略，旨在改善as相关CNV患者的视力预后。

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引用次数: 0

Effect of methotrexate in preventing retinal detachment after proliferative vitreoretinopathy surgery: A systematic review and meta-analysis 甲氨蝶呤预防增殖性玻璃体视网膜病变术后视网膜脱离的效果：系统回顾和荟萃分析。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-16 DOI: 10.1016/j.survophthal.2025.09.015

Ibrahim Kocak , Nihat Sayin , Sadik Etka Bayramoglu , Lukman Thalib

Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with the aim of preventing recurrent PVR and subsequent retinal detachment; however, its efficacy remains uncertain. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to December, 2024, for studies evaluating intravitreal MTX as an adjuvant therapy in PVR surgery. The primary analysis included randomized controlled trials (RCTs), while supplementary analyses incorporated non-randomized studies. All meta- analyses were conducted using random-effect models. Study quality was assessed using the Cochrane Risk of Bias (ROB2) tool, and the certainty of evidence was evaluated using the GRADE approach. Three RCTs with 145 eyes met the eligibility criteria. The meta-analysis showed a pooled RR estimate of 0.64 (95 % CI 0.30–1.38), indicating a 36 % reduction in the risk of recurrent RD in MTX-treated eyes, although this was not statistically significant. No significant differences were observed in visual acuity improvement (SMD = 0.04; 95 % CI −0.53–0.60). Additionally, our meta-analysis of 5 non-randomized studies involving 277 eyes found no evidence to suggest that MTX reduces the incidence of recurrent retinal detachment in eyes undergoing surgery for PVR (RR = 0.90; 95 % CI 0.49–1.64). The RCTs were rated as having moderate risk of bias, while most non-randomized studies were assessed as having high risk of bias. Funnel plots indicated potential publication bias, and the certainty of evidence was rated as moderate according to GRADE. Although MTX was associated with a clinically relevant 36 % reduction in recurrent RD risk, the effect was not statistically significant. Larger, high-quality RCTs with adequate power are needed to confirm these findings.

玻璃体甲氨蝶呤（MTX）越来越多地作为手术干预的辅助治疗，用于增殖性玻璃体视网膜病变（PVR）或其发展的高风险患者，目的是预防复发性PVR和随后的视网膜脱离；然而，其功效仍不确定。我们检索了PubMed， EMBASE， CINAHL和Cochrane图书馆，从成立到2024年12月，以评估玻璃体内MTX作为PVR手术辅助治疗的研究。主要分析包括随机对照试验（rct），补充分析包括非随机研究。所有meta分析均采用随机效应模型进行。使用Cochrane风险偏倚（ROB2）工具评估研究质量，使用GRADE方法评估证据的确定性。3项随机对照试验145只眼符合入选标准。荟萃分析显示，合并RR估计为0.64 (95% CI 0.30-1.38)，表明mtx治疗的眼睛复发RD的风险降低了36%，尽管这没有统计学意义。两组在视力改善方面无显著差异（SMD = 0.04; 95% CI -0.53 ~ 0.60）。此外，我们对涉及277只眼睛的5项非随机研究的荟萃分析发现，没有证据表明MTX可以降低PVR手术中复发性视网膜脱离的发生率（RR = 0.90; 95% CI 0.49-1.64）。随机对照试验被评为具有中等偏倚风险，而大多数非随机研究被评估为具有高偏倚风险。漏斗图显示潜在的发表偏倚，证据的确定性根据GRADE被评为中等。尽管MTX与临床相关的复发性RD风险降低36%相关，但效果没有统计学意义。需要更大规模、高质量的随机对照试验来证实这些发现。

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引用次数: 0

A scoping review on clinical and genetic diagnostic approaches for cerebral visual impairment 脑性视觉障碍的临床和遗传诊断方法综述。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-16 DOI: 10.1016/j.survophthal.2025.09.010

Henar Albertos-Arranz , Tamara Juvier-Riesgo , François Sainfort , Anuj Jayakar , Eduardo C. Alfonso , Virginia A. Jacko , Carlos E. Mendoza-Santiesteban

In recent years, the prevalence of cerebral/cortical visual impairment (CVI) in pediatric population has risen in developed countries; however, the condition’s heterogeneity complicates its assessment and the creation of standardized diagnostic and treatment protocols. We review current clinical and genetic approaches to the diagnosis of CVI. A PubMed search conducted in October, 2024, identified original articles on the genetic and clinical diagnosis of children or young adults with CVI or at risk. Articles differentiating CVI from other diagnoses or typically developing children, as well as those examining screening tools, were also included. Of 565 references, 10 focused on the genetic features of CVI and 56 on clinical characteristics using different protocols or tests. Up to 40 % of CVI patients showed chromosomal abnormalities, and 26.9 % had genetic pathogenic variants linked to seizures, global developmental delay, intellectual disabilities, or birth complications. Ten of 17 questionnaires or screening tools are validated. Diagnostic protocols for identifying or diagnosing CVI (n = 12) included medical history, parent reports, visual field testing, optic nerve and oculomotor examinations, and visual perceptual assessments. Individuals with CVI showed poor visual performance on eye tracking (n = 9). Different visual evoked potential tests can help detect CVI (n = 9), and some studies highlight magnetic resonance imaging abnormalities in the dorsal and ventral stream and the thalamus. Several tests and screening tools are used to diagnose CVI, but their limited validation and variability make it challenging to establish precise protocols. Genetic testing can provide essential diagnostic information given the numerous genes involved, particularly after the main possible causes have been excluded.

近年来，发达国家儿童脑/皮质性视力障碍（CVI）患病率有所上升；然而，这种情况的异质性使其评估和标准化诊断和治疗方案的创建复杂化。我们回顾目前临床和遗传学方法诊断CVI。2024年10月进行的PubMed检索确定了患有CVI或有风险的儿童或年轻人的遗传和临床诊断的原始文章。区分CVI与其他诊断或典型发育儿童的文章，以及检查筛查工具的文章也包括在内。在565篇参考文献中，10篇关注CVI的遗传特征，56篇关注使用不同方案或测试的临床特征。高达40%的CVI患者表现出染色体异常，26.9%的患者具有与癫痫发作、整体发育迟缓、智力残疾或出生并发症相关的遗传致病性变异。17份问卷或筛选工具中的10份得到了验证。识别或诊断CVI （n=12）的诊断方案包括病史、家长报告、视野测试、视神经和动眼肌检查以及视觉知觉评估。患有CVI的个体在眼动追踪中表现出较差的视觉表现（n=9）。不同的视觉诱发电位测试可以帮助检测CVI (n=9)，一些研究强调了背、腹侧流和丘脑的磁共振成像异常。有几种测试和筛选工具用于诊断CVI，但它们的有效性和可变性有限，因此很难建立精确的方案。考虑到涉及的基因众多，特别是在排除了主要可能原因之后，基因检测可以提供基本的诊断信息。

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引用次数: 0

Impact of artificial intelligence in vision science: A systematic review of progress, emerging trends, data domain quantification, and critical gaps 人工智能在视觉科学中的影响：对进展、新趋势、数据域量化和关键差距的系统回顾。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-16 DOI: 10.1016/j.survophthal.2025.09.014

Colby F. Lewallen PhD, Davide Ortolan PhD, Dominik Reichert MS, Ruchi Sharma PhD, Kapil Bharti PhD

The prominence of artificial intelligence (AI) is growing exponentially, yet its implementation across research domains is uneven. To quantify AI trends in vision science, we evaluated over 100,000 PubMed article metadata spanning 35 years. Using Medical Subject Headings (MeSH) terms, we analyzed trends across four prominent ocular diseases: age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract. Most articles utilized research techniques from at least one of the following domains: biological models, molecular profiling, image-based analysis, and clinical outcomes. Our quantification reveals that AI prominence is disproportionally concentrated in the image-based analysis domain, and, additionally, among 4 diseases evaluated, AI prevalence in cataract research is lagging. Contributing factors towards these disparities include insufficient data standardization, complex data structures, limited data availability, unresolved ethical concerns, and not gaining meaningful improvements over human-based interpretations. By mapping where AI thrives and where it lags, we offer a quantitative reference for funding agencies, clinicians, and vision scientists. Connecting various research domains with multimodal and generative AI could improve diagnostic utility; enabling earlier diagnosis, personalized therapy, reduced healthcare costs, and accelerate innovation. Future work should move AI in vision science beyond image-centric pattern recognition toward integrative, mechanistic analyses that explain – rather than merely detect – disease.

人工智能（AI）的重要性呈指数级增长，但其在各个研究领域的实施却参差不齐。为了量化视觉科学中的人工智能趋势，我们评估了35年来超过10万篇PubMed文章元数据。使用医学主题标题（MeSH）术语，我们分析了四种主要眼部疾病的趋势：年龄相关性黄斑变性、糖尿病性视网膜病变、青光眼和白内障。大多数文章利用了以下领域中至少一个领域的研究技术：生物模型、分子谱、基于图像的分析和临床结果。我们的量化结果显示，人工智能突出程度不成比例地集中在基于图像的分析领域，此外，在评估的4种疾病中，人工智能在白内障研究中的流行程度滞后。造成这些差异的因素包括数据标准化不足、复杂的数据结构、有限的数据可用性、未解决的伦理问题，以及没有获得比基于人类的解释有意义的改进。通过绘制人工智能在哪里繁荣和落后的地图，我们为资助机构、临床医生和视觉科学家提供了定量参考。将多个研究领域与多模态和生成式人工智能联系起来可以提高诊断效用；实现早期诊断、个性化治疗、降低医疗成本并加速创新。未来的工作应该使人工智能在视觉科学中超越以图像为中心的模式识别，转向综合的、机制的分析，以解释——而不仅仅是检测——疾病。

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引用次数: 0

Interventions to improve patients’ knowledge in ophthalmology: A systematic review and narrative synthesis 提高患者眼科知识的干预措施：系统回顾和叙述综合。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-13 DOI: 10.1016/j.survophthal.2025.09.006

Dayyanah Sumodhee , Estelle Ioannidou , Rishi Ramessur , Jai Prashar , Mohammed Abbas , Konstantinos Balaskas , Nikolas Pontikos , Peter Thomas

Low eye health knowledge is associated with suboptimal treatment adherence, self-care practice and follow-up rate leading to poorer outcomes. The aim of this review was to survey what interventions are effective at improving patients’ knowledge of eye disease and treatments. Randomised controlled trials and cross-sectional studies delivering interventions to improve patients’ knowledge about eye diseases were reviewed. Databases, grey literature, reference lists and journals were searched for relevant studies. Three authors reviewed and extracted the data and assessed quality. Seventeen publications were included examining different types of interventions. Thirteen studies showed significant improvements on patients’ eye disease knowledge following intervention. These included all 5 verbal interventions, 5 out of 6 video interventions, 5 out of 8 written or image material interventions, and 1 out of 2 using other formats. Study quality varied, with 7 studies rated as having low risks of bias, 8 moderate, and 2 high. Intervention design varied considerably across studies, making comparisons challenging. Interventions to improve patients’ knowledge of eye conditions show promising results in particular verbal and video interventions; however, higher quality studies, as well as standardisation of reporting and intervention formats, are required to strengthen the evidence base.

低眼保健知识与次优治疗依从性、自我保健实践和随访率相关，导致较差的结果。本综述的目的是调查哪些干预措施可以有效地提高患者对眼病和治疗的认识。综述了提供干预措施以提高患者眼病知识的随机对照试验和横断面研究。检索数据库、灰色文献、参考文献表和期刊，查找相关研究。三位作者对数据进行了审查和提取，并对质量进行了评估。17份出版物审查了不同类型的干预措施。13项研究表明，干预后患者对眼病的认识有了显著提高。这些包括所有5个口头干预，6个视频干预中的5个，8个书面或图像材料干预中的5个，以及2个使用其他格式的1个。研究质量各不相同，7项研究被评为低偏倚风险，8项为中等偏倚风险，2项为高偏倚风险。不同研究的干预设计差异很大，使得比较具有挑战性。提高患者眼病知识的干预措施，特别是口头和视频干预显示出有希望的结果；然而，需要更高质量的研究以及报告和干预格式的标准化来加强证据基础。

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引用次数: 0

Radiological features of lacrimal gland masses 泪腺肿块的影像学特征。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-13 DOI: 10.1016/j.survophthal.2025.09.005

Sonia Huang , Jessica Y. Tong , Valerie Juniat , Abdullah Almater , Ilse Mombaerts , Dinesh Selva

Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definitive diagnosis cannot always be reached with imaging alone, it can be particularly useful in assisting with identifying benign and malignant features and therefore guiding appropriate further investigation and management. We perform a detailed literature review and describe the radiological features of various lacrimal gland pathologies.

计算机断层扫描和磁共振成像在泪腺肿块的检查中起着关键作用。不同的泪腺肿块表现出不同的影像特征。虽然仅凭影像学不能做出明确的诊断，但它在帮助确定良性和恶性特征方面特别有用，从而指导适当的进一步调查和治疗。我们进行了详细的文献回顾和描述各种泪腺病理的放射学特征。

引用次数: 0

Current advances in dome-shaped macula and associated conditions 穹顶状黄斑及其相关疾病的最新进展。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-06 DOI: 10.1016/j.survophthal.2025.09.004

Matteo Mario Carlà , Elise Philippakis , David Gaucher , Aude Couturier , Alain Gaudric

Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring across a broader spectrum of refractive conditions, including mild myopia and even emmetropia. Since its initial description in 2008, advances in imaging technologies and longitudinal studies have significantly improved our understanding of DSM. We analyzed the recent literature, focusing on publications from the last 10 years. DSM affects about 0.2 % of the general population, with a prevalence reaching 10–20 % in highly myopic eyes. Its pathophysiology involves complex mechanisms ranging from emmetropization processes in non-myopic eyes to differential scleral biomechanics and asymmetric posterior segment growth in high myopia. Polarization-sensitive optical coherence tomography provided new insights into scleral fiber architecture, showing horizontal interpapillomacular fibers corresponding to the typical horizontal DSM configuration. DSM plays a dual role in myopic complications, potentially protecting against foveal retinoschisis while predisposing to serous retinal detachment (SRD) and retinal pigment epithelium (RPE) atrophy when the dome height exceeds specific thresholds. SRD, the most common (8–50 % of cases), and RPE atrophy are the main complications directly related to DSM. There are numerous treatment approaches for SRD with variable success rates. Longitudinal studies have described DSM evolution over time and shown that an increased dome height correlated with the axial elongation. We provide updated information on the epidemiology, pathophysiology, clinical presentation and management of DSM to improve the diagnosis and treatment of this increasingly recognized condition.

圆顶状黄斑（DSM）是一种独特的解剖实体，其特征是黄斑向内凸出，最初在高度近视的后葡萄肿中被描述，但现在认为它发生在更广泛的屈光条件下，包括轻度近视甚至斜视。自2008年首次描述以来，成像技术和纵向研究的进步显著提高了我们对DSM的理解。这篇综述分析了最近的文献，重点是最近10年的出版物。DSM影响大约0.2%的普通人群，在高度近视的人群中患病率达到10-20%。其病理生理机制复杂，从非近视眼的正视化过程到高度近视眼的差异巩膜生物力学和不对称后段生长。偏振敏感OCT提供了对巩膜纤维结构的新见解，显示水平乳头间纤维对应于典型的水平DSM配置。DSM在近视并发症中起双重作用，当穹顶高度超过特定阈值时，可能会防止中央凹视网膜裂，同时易导致浆液性视网膜脱离（SRD）和视网膜色素上皮（RPE）萎缩。最常见的SRD（8-50%的病例）和RPE萎缩是与DSM直接相关的主要并发症。SRD有许多治疗方法，成功率各不相同。纵向研究描述了DSM随时间的演变，并表明穹顶高度的增加与轴向伸长相关。我们提供DSM的流行病学、病理生理学、临床表现和管理方面的最新信息，以提高对这一日益被认可的疾病的诊断和治疗。

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引用次数: 0

Choroidal vascularity index as a marker of health and disease: systematic review and meta-analyses 脉络膜血管指数作为健康和疾病的标志：系统回顾和荟萃分析。

IF 5.9 2区医学 Q1 OPHTHALMOLOGY

Survey of ophthalmology

Pub Date : 2025-09-05 DOI: 10.1016/j.survophthal.2025.09.003

Nicholas Chieh Loh , William Rojas-Carabali , Yuan Heng Lim , Jo Earn Bong , Valeria Villabona-Martinez , Carlos Cifuentes-González , Meenakshi Kumar , Srinivas Sadda , Leopold Schmetterer , Chui Ming Gemmy Cheung , Vishali Gupta , Dilraj S. Grewal , Sharon Fekrat , Alejandra de-la-Torre , Bernett Lee , Xin Wei , Lisa Nivison-Smith , Rupesh Agrawal

The Choroidal Vascularity Index (CVI), derived from optical coherence tomography (OCT), has emerged as a potential biomarker for detecting vascular changes. Understanding its variability across physiological states, ocular conditions, and systemic diseases is crucial for its integration into clinical practice.

We evaluated variations in CVI across different physiological states (e.g., first-trimester pregnancy), ocular conditions (e.g., age-related macular degeneration[AMD]), and systemic diseases (e.g., diabetes mellitus) compared to healthy controls.

From 1210 identified articles, 63 studies (7316 participants: 4000 controls and 3316 cases) met inclusion criteria. Data covered 12 distinct conditions and physiological states. Most studies were conducted in Europe and Asia, predominantly using spectral-domain OCT machines with a low risk of bias. Increased CVI was seen in some physiological states (e.g., Valsalva maneuver, first-trimester pregnancy) and some disorders (e.g. active panuveitis, inactive thyroid eye disease). Reduced CVI was found in diabetes mellitus (both with or without diabetic retinopathy), hyperopic amblyopia, and AMD.

CVI demonstrates potential as a biomarker to differentiate between physiological states and pathological conditions compared to healthy controls. These findings underscore the choroid’s adaptive response to systemic and ocular challenges, highlighting CVI’s relevance in understanding disease mechanisms and monitoring health.

脉络膜血管指数（CVI）源于光学相干断层扫描（OCT），已成为检测血管变化的潜在生物标志物。了解其在生理状态、眼部状况和全身性疾病中的可变性对于其融入临床实践至关重要。与健康对照组相比，我们评估了不同生理状态（如妊娠早期）、眼部状况（如年龄相关性黄斑变性）和全身性疾病（如糖尿病）的CVI变化。从1210篇确定的文章中，63项研究（7316名受试者：4000名对照和3316例病例）符合纳入标准。数据涵盖了12种不同的条件和生理状态。大多数研究在欧洲和亚洲进行，主要使用低偏倚风险的光谱域OCT （SD-OCT）机器。在某些生理状态（如Valsalva动作、妊娠早期）和某些疾病（如活动性全葡萄膜炎、非活动性甲状腺眼病）中可见CVI升高。CVI降低见于糖尿病（伴或不伴糖尿病视网膜病变）、远视弱视和AMD。与健康对照相比，CVI显示了作为区分生理状态和病理状态的生物标志物的潜力。这些发现强调了脉络膜对系统和眼部挑战的适应性反应，强调了CVI在理解疾病机制和监测健康方面的相关性。

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