Therapeutic Advances in Ophthalmology最新文献

Objective: To summarize evidence-based indications of topical 0.1% tacrolimus in treating ophthalmological diseases.

Methods: A comprehensive literature review was conducted using PubMed, Embase, and Wanfang databases. Two independent reviewers screened studies according to predefined criteria: original human research (case reports/series, prospective/retrospective studies, RCTs) on ophthalmic applications of 0.1% tacrolimus were included, while reviews, conference abstracts, non-ophthalmic studies, alternative formulations/routes, and preclinical studies were excluded. Two reviewers independently extracted data using a piloted form, resolving discrepancies through thorough discussion. Extracted variables included study details (author, year, design, location), population characteristics (patients/eyes), and intervention protocols. Data were synthesized thematically by ocular disease category, with comparative analysis of study designs, treatment regimens, and clinical outcomes.

Results: 0.1% topical tacrolimus significantly improves the signs and symptoms of a wide spectrum of inflammatory eye conditions of the anterior segment, namely allergic conjunctivitis, viral conjunctivitis, immune checkpoint inhibitor-related conjunctivitis, ocular cicatricial pemphigoid, nodular episcleritis, graft rejection, graft-versus-host diseases, dry eye disease, autoimmune keratitis, blepharitis, and periorbital dermatitis. In addition to monotherapy, 0.1% tacrolimus can be used as an adjunct alongside other medications such as topical steroids and topical cyclosporine. The medication is generally well-tolerated with minimal side effects, with the most common complaint being local stinging, which dampens over time. Its reassuring safety profile in the ocular application is evidenced by its minimal systemic absorption post-administration.

Conclusion: 0.1% tacrolimus is effective and safe for a wide spectrum of eye diseases involving the anterior segment and adnexa. Not only does 0.1% topical tacrolimus spare patients from the side effects of chronic topical corticosteroid use but it also emerges as an option for patients inadequately managed by other immunosuppressants, highlighting the growing significance of 0.1% tacrolimus in ophthalmic practice.

Background: Intermittent exotropia (IXT) is a prevalent strabismus in Asian children. While surgery is the main treatment, its long-term success can be influenced by postoperative exodrift. Therefore, accurately assessing this exodrift is essential to determine the optimal early postoperative alignment.

Objectives: To investigate postoperative exodrift changes following unilateral lateral rectus recession combined with medial rectus plication (RP) procedure for children with basic type intermittent exotropia (IXT).

Design: Retrospective, Cohort study.

Methods: A retrospective review was conducted on the clinical data of patients with basic type IXT who underwent surgical intervention between 2022 and 2023, with a minimum follow-up of 12 months. Based on the postoperative ocular alignment at near within the first week, patients were divided into three groups: Group exo with exodeviation equal or exceeding 5 prism diopter (PD); Group ortho with exodeviation or esodeviation less than 5 PD; and Group eso with esodeviation equal or exceeding 5 PD. The successful motor outcome was defined as exodeviation or esodeviation equal to or less than 10 PD. The recurrent exotropia was defined as exodeviation exceeding 10 PD, and consecutive esotropia was defined as esodeviation exceeding 10 PD. The clinical features associated with motor outcomes and sensory outcomes were analyzed.

Results: Final exodrift magnitudes were comparable across groups: Group exo (distance: 10.18 ± 10.55 PD, near:7.71 ± 9.82 PD), Group ortho (distance: 8.27 ± 7.23 PD, near: 9.13 ± 8.13 PD), Group eso (distance: 12.50 ± 10.71 PD, near: 12.80 ± 11.69 PD), (p = 0.149 for distance; p = 0.157 for near). Patients exhibiting overcorrection and ortho during the early postoperative period tended to have a better motor outcome compared to those undercorrection. Fusion function improved significantly regardless of the early postoperative ocular alignment (p < 0.001).

Conclusion: Children with basic type IXT who exhibit varying ocular alignment in the early postoperative period demonstrated a comparable magnitude of 10 PD for long-term exodrift. It is recommended to overcorrect within the range of 0 to 10 PD following RP techniques.

Background: Moderate-to-severe lens subluxation poses surgical challenges due to extensive zonular weakness and the need to maintain stable intraocular lens (IOL) positioning while preserving the capsular bag.

Objectives: To evaluate the outcomes and safety of a modified technique using intrascleral suture fixation of a standard capsular tension ring (CTR) to preserve the capsular bag in moderate-to-severe lens subluxation.

Design: Retrospective, single-center case series.

Methods: Consecutive eyes with 120°-300° zonular dialysis underwent phacoemulsification via a 2.4 mm clear corneal incision and a 0.8 mm lateral incision. Capsular bag stabilization was achieved by intrascleral fixation of a standard CTR using a knotless Z-suture with double-strand 8-0/9-0 polypropylene, followed by in-the-bag IOL implantation. Primary outcomes were postoperative IOL centration and corrected-distance visual acuity (CDVA); secondary outcomes included refractive error and complications. Follow-up was scheduled at 1, 3, 6 months (some at 12 months) and annually thereafter.

Results: Sixteen eyes of nine patients were included. Median follow-up was 328.0 days (interquartile range (IQR) 256.5, 443.0). Median logMAR CDVA improved from 0.35 (IQR 0.30, 0.57) preoperatively to 0.19 postoperatively. Mean absolute spherical equivalent decreased from 9.82 ± 1.02 D to 1.16 ± 0.25 D. IOLs were well‑centered in 13 eyes (81.3%); a slight, clinically insignificant tilt was observed in 3 eyes (18.7%). One intraoperative posterior capsule rupture did not preclude in-the-bag IOL implantation. Two eyes had transient postoperative intraocular pressure elevation managed medically. No other significant complications occurred.

Conclusion: Intrascleral fixation of a standard CTR is a simple, accessible, and effective bag-preserving technique for moderate-to-severe lens subluxation, enabling stable in-the-bag IOL implantation with favorable visual and refractive outcomes.

Registration: ClinicalTrials.gov: NCT06627062.

Blue light, emitted by natural and artificial sources such as digital screens, has raised concerns regarding its impact on ocular health, visual comfort, and circadian rhythms. Prolonged exposure has been linked to digital eye strain (DES), visual fatigue, potential retinal damage, and sleep disturbances. Blue-light-filtering spectacle lenses have been developed to mitigate these effects by reducing short-wavelength blue light transmission, but their efficacy remains debated. Studies indicate that these lenses have minimal or no significant impact on contrast sensitivity, color discrimination, and task performance, with visual outcomes comparable to standard lenses. While some research suggests minor benefits in reducing DES and visual fatigue in specific populations, most studies report no significant differences. This highlights the multifactorial nature of DES. Experimental evidence supports the potential for blue-light-filtering spectacle lenses to reduce oxidative stress and phototoxicity in retinal cells, which may offer protection against retinal damage and age-related macular degeneration (ARMD). Additionally, these lenses show promise in neurological and psychological domains, including reduced migraine frequency, alleviation of mania symptoms, and improved sleep quality through circadian rhythm regulation. However, subjective sleep improvements are often not supported by objective measures. In summary, blue-light-filtering spectacle lenses may provide benefits in retinal protection, sleep regulation, and neurological health. However, their effectiveness in reducing visual fatigue, enhancing task performance, and preventing ARMD remains inconclusive. Further research with standardized methodologies and larger sample sizes is needed to clarify their clinical and everyday utility.

Central retinal artery occlusion (CRAO) is a rare emergency, often affecting individuals over 60, with risk factors such as hypertension, diabetes, and smoking. Hyperbaric oxygen therapy (HBOT), classified as level IIb by the American Heart Association for CRAO, helps maintain retinal oxygenation during ischemic events by diffusing oxygen through choroidal capillaries. While HBOT appears promising for addressing various vision-threatening conditions, including retinal occlusions and diabetic macular edema, it has not been officially approved for these indications. A 70-year-old male presented with painless vision loss in his right eye, noticed upon waking, accompanied by high blood pressure. On examination, light perception was detected in the right eye, and visual acuity in the left was 0.6. Biomicroscopy revealed CRAO in the right eye, with a cherry-red spot, retinal edema, and absent circulation. Optical coherence tomography (OCT) confirmed retinal edema and subretinal fluid. Given that the thrombolysis window had passed, HBOT was initiated within 48 h of presentation. Following the first treatment, the patient experienced improvement in vision, with light perception expanding beyond the peripheral area. CRAO is an ocular emergency, and early treatment is crucial for improving visual outcomes. HBOT, recommended within 6-12 h of diagnosis, has shown promise in restoring vision. In our case, HBOT administered within 48 h led to improved peripheral vision, with the presence of a cherry-red spot on the macula associated with better recovery. While HBOT can have side effects, none were observed here. Despite challenges in conducting large-scale trials, HBOT remains a potentially effective treatment for CRAO, especially if started early.

Background: Minimally invasive glaucoma surgeries (MIGS) have gained attention for their safety and efficacy, especially in clinical trials involving primary open-angle glaucoma. However, real-world data on pseudoexfoliation glaucoma (PEX glaucoma) remain limited. To our knowledge, this is the first real-world study comparing postoperative outcomes of Kahook Dual Blade Excisional Goniotomy (KDB) or trabecular aspiration (TA) in PEX glaucoma.

Objective: To compare the efficacy and safety of combined clear cornea cataract extraction with either KDB or TA in patients with PEX glaucoma.

Design: A retrospective analysis.

Methods: We reviewed 113 eyes from 99 patients who underwent cataract surgery combined with either KDB (n = 71) or TA (n = 42) between May 2017 and May 2023 at the University Eye Hospital. Propensity score matching was used to create comparable groups of 30 KDB and 30 TA cases based on age, sex, baseline intraocular pressure (IOP), and number of glaucoma medications. Key outcomes included IOP, number of glaucoma medications, complications, and reoperations.

Results: The mean patient age was 80.5 ± 7.3 years for KDB and 80.4 ± 7.7 years for TA, p = 0.94. 73.3% were women, p = 1.0. The mean baseline IOP was 20.4 ± 7.1 for KDB and 20.0 ± 8.4 for TA, p = 0.35, and the baseline number of glaucoma medications (Meds) was 2.0 ± 1.2 for KDB and 2.0 ± 1.2 for TA, p = 0.78. The mean postoperative IOP at 12 months was 13.5 ± 3.6 mmHg for KDB and 14.2 ± 2.6 mmHg for TA, p = 0.12, and Meds at 12 months were 1.0 ± 1.2 for KDB and 1.4 ± 1.1 for TA p = 0.12. The median follow-up was 13.1 (IQR: 11.6-17.1) months for the whole group. A total of four eyes following KDB and two after TA required additional surgery to lower the IOP.

Conclusion: Both KDB and TA with cataract extraction lowered IOP in PEX glaucoma. However, KDB was associated with a higher rate of additional surgical interventions to achieve adequate IOP control.

Purpose: To compare the preoperative clinical features in patients with basic unilateral exotropia who underwent single versus two and three or more strabismus surgeries.

Design: retrospective.

Method: Two thousand four hundred fifty-seven patients with unilateral basic exotropia were recruited over 10 years. Of these, 1886 (76.8%) had one surgery, 411 (16.7%) had two, and 160 (6.5%) had three or more surgical interventions. Preoperative data included the best corrected distance visual acuity (BCVA), refractive error, magnitude of exotropia, and amblyopia type and severity.

Results: The mean age at first surgery was 26.3 ± 13.35 years (age range: 2-77) with no significant difference between groups with one, two, and three or more surgeries (p = 0.770). Mean BCVA in the strabismic eye was significantly worse in patients who underwent three or more surgeries (0.82 ± 0.076 logMAR) than those who had one (0.55 ± 0.018 logMAR; p < 0.001) or two surgeries (0.52 ± 0.038 logMAR; p < 0.001). Spherical equivalent refraction in the strabismic eye was significantly more hyperopic in patients who underwent three or more surgeries (0.79 ± 0.37 D), compared with those with one (-0.95 ± 0.094 D; p < 0.001) or two surgeries (-0.36 ± 0.16 D; p < 0.001). Relative to one surgery, undergoing two surgeries was independently associated with larger distance horizontal deviation (adjusted odds ratio (aOR) per prism diopter = 1.012; 95% CI, 1.003-1.022; p = 0.009). Undergoing three or more surgeries was independently associated with amblyopia severity (aOR = 2.368; 95% CI, 1.279-4.384; p = 0.006); in the strabismic eye, and higher spherical power markedly increased the odds (aOR = 13.553; 95% CI, 12.801-14.348; p < .001).

Conclusion: Worse preoperative BCVA, greater hyperopia, and higher angle of deviation were associated with a greater likelihood of requiring more than one surgery. Surgeons should optimize preoperative refractive and amblyopia management and counsel high-risk patients about the increased likelihood of additional procedures.

Demodex blepharitis is a chronic, progressive condition characterized by inflammation, ocular irritation, and erythema due to an overgrowth of mites in hair follicles and oil glands of the eyelids. AZR-MD-001(AZR) is a selenium sulfide-containing ophthalmic ointment that is a potential treatment option for Demodex blepharitis. We wished to complete a case study to identify the potential of this agent to treat Demodex blepharitis. A patient with chronic Demodex blepharitis applied AZR 0.5% to the right lower eyelid every other day at bedtime for 6 weeks, discontinued treatment for 6 weeks, then treated the left lower eyelid with vehicle only for 6 weeks, followed by use of AZR 0.5% for both lower eyelids twice a week for 6 weeks. Eyelashes were removed and pooled for evidence of mites and collarettes before and after the first treatment, and eyes were inspected for signs of blepharitis before and after each treatment period. After treatment with AZR 0.5%, resolution of blepharitis occurred in the treated eye, with no evidence of Demodex mites. The untreated eye showed no difference from baseline. After discontinuing for 6 weeks, the signs of blepharitis returned, similar to baseline. After 6 weeks of vehicle application to the left eye, no changes in signs were observed. After treatment with AZR 0.5% for 6 weeks to both eyes, complete resolution of blepharitis occurred in both eyes. No adverse events were reported. Treatment with AZR 0.5% was efficacious in eradicating Demodex blepharitis, which was not evidenced when using vehicle or a lack of treatment. This demonstrated a potential new use for AZR to treat Demodex blepharitis. Further studies are required to establish the safety and efficacy of this product.

The purpose of this summary is to explain the findings of a literature review, which is a summary and analysis of scientific discoveries that other researchers have published about a topic. This review looked at treatment approaches in an eye disease that is a common complication of diabetes called diabetic retinopathy (DR). The literature review described how DR can damage the light-sensing area at the back of the eye called the retina. In DR, a damage to blood vessels can impair the normal blood flow to parts of the retina. This condition is what doctors call retinal non-perfusion (RNP). RNP can result in vision loss, seriously affecting people's daily life and activities. Current treatments may help to lessen the severity of DR, but more research is needed to understand how to treat the underlying problem of the reduced blood flow to the retina (RNP) and stop the progression of disease earlier. Current treatments often impose burdens on patients due to side effects, the need for frequent treatment appointments, and pain associated with the administration procedure. New drugs are now being studied to help improve blood flow to the retina and slow or stop sight loss in people with diabetes. Proteins called semaphorin 3A (Sema3A) and neuropilin 1 (Nrp1) regulate blood flow to the retina. New drugs that work against these proteins to help to increase blood flow to the retina are currently being investigated by doctors. Several other drugs that may increase blood flow to the retina are also being studied in animals and humans. Such treatments could protect people's vision and enhance their quality of life over the long term.