Therapeutic Advances in Ophthalmology最新文献

Neonatal retinal hemorrhage (RH) and retinopathy of prematurity (ROP) are significant causes of visual impairment in preterm infants, necessitating effective diagnostic and therapeutic strategies. This review synthesizes current approaches to RH and ROP management, highlighting their limitations and the critical need for standardized diagnostic criteria. Indirect ophthalmoscopy, while accessible, suffers from subjective variability, whereas wide-field digital retinal imaging, despite superior visualization, is limited by cost and training requirements. Vaginal delivery and prematurity-related factors, such as fragile retinal vasculature and neonatal complications (e.g., sepsis and hyperbilirubinemia), significantly increase RH and ROP risk, with severe RH correlating with ROP progression. Advances in digital retinal imaging and artificial intelligence (AI) offer promising solutions for early detection, enabling timely interventions such as anti-VEGF therapy to improve visual outcomes. Future directions include developing universal diagnostic standards, exploring novel treatments such as probiotics, and leveraging technologies such as optical coherence tomography. Enhanced screening programs, collaborative research, and public awareness are essential to optimize RH and ROP management, ultimately improving long-term visual prognosis for affected infants.

This study evaluated the effectiveness of topical losartan 1 mg/mL in reducing corneal fibrosis by inhibiting myofibroblast proliferation and improving corneal transparency, offering a potential therapeutic alternative. A prospective, interventional case series enrolled adults with corneal fibrosis. Participants administered topical losartan 1 mg/mL six times daily for 3 months. Visual acuity, slit-lamp examination, corneal tomography, and densitometry were used to assess outcomes. A Random Forest machine learning model identified key predictors of visual improvement. Nineteen eyes from seventeen patients were analyzed. Mean uncorrected distance visual acuity improved from 1.04 ± 0.62 to 0.74 ± 0.46 LogMAR (p = 0.007). Corneal densitometry significantly decreased, particularly in the midperipheral zone (p = 0.0184). Worse baseline visual acuity and longer leukoma duration correlated with greater improvement. The predictive model achieved an AUROC of 0.76, with 86.67% sensitivity, 75.00% specificity, and 84.21% accuracy, confirming its robustness. These findings suggest that topical losartan improves corneal transparency and functional vision in patients with corneal fibrosis. The predictive model provides a clinically useful scoring system to guide treatment selection. Further validation in larger clinical trials is warranted.

Purpose: Corneal high-order aberrations due to pterygium have a significant impact on patients' visual quality. This study aims to assess changes in corneal high-order aberrations following pterygium surgery.

Methods: This hospital-based prospective study included 51 eyes of 51 patients with primary pterygium who underwent pterygium excision with conjunctival autograft. Corneal topography and ocular high-order aberrations (HOA) were measured using corneal topography and aberrometry scans with a Sirius Scheimpflug-Placido topographer, both preoperatively and 6 weeks postoperatively. These values were derived for both 3 and 5 mm pupillary diameters using Zernike polynomial expansion. The relative risk of residual postoperative aberrations was assessed in relation to increasing pterygium size.

Results: The mean age of patients enrolled in the study was 40.3 ± 7.4 years. The root mean square value of total HOA significantly decreased at 6 weeks after uneventful pterygium surgery. Excision of pterygium significantly reduced all parameters (coma: 95% CI, p < 0.05; trefoil: 95% CI, p < 0.05; quadrafoil: 95% CI, p < 0.05), with trefoil being the main contributor. Astigmatism values also showed a significant postoperative reduction. In 15.9% of patients, preoperative "with-the-rule astigmatism" changed to postoperative "against-the-rule astigmatism." A notable increase in the relative risk of residual postoperative HOA was observed when the pterygium length exceeded 4 mm.

Conclusion: Pterygia are associated with corneal higher-order aberrations, particularly trefoil, which were largely eliminated by surgery. Earlier excision of pterygia reduces the likelihood of significant residual aberrations.

Background: Retinal implants have emerged as interventions to partially restore functional vision such as light perception, motion detection or object localisation in patients with severe vision loss from degenerative retinal conditions, including retinitis pigmentosa (RP) and dry age-related macular degeneration (AMD).

Objectives: To evaluate the long-term efficacy, safety and quality of life (QoL) impact of retinal implants with ⩾1 year of follow-up.

Methods: Following PRISMA guidelines, a systematic search was conducted (31st July to 31st August 2024) in Web of Science, PubMed, Medline, Scopus, Cochrane Library and Embase, using the terms: ('retinal implant' OR 'retinal prosthesis') AND ('long-term' OR 'follow-up') AND ('efficacy' OR 'safety' OR 'quality of life'). No publication date restrictions were applied. Eligible studies were in English, involved human subjects with retinal degenerations, and reported ⩾1 year follow-up. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) cohort study checklist for most studies, as they involved prospective follow-up without randomisation or control groups. The Joanna Briggs Institute (JBI) critical appraisal checklist for case series was applied to studies with a case series design. Narrative synthesis was applied.

Results: Thirteen studies met the inclusion criteria: 53.85% assessed epiretinal implants (Argus II), 30.77% subretinal (Alpha AMS and PRIMA), and 15.38% suprachoroidal (44 and 49-channel STS). Epiretinal implants improved visual function, with up to 89% better in SLT, 50%-56% in DOM, and 30%-40% reaching ⩾2.9 logMAR when activated. Subretinal implants enhanced light perception, localisation, and grating acuity (to 3.33 cycles/degree), with acuity of 20/460 and 20/550 in some cases. Suprachoroidal devices improved SLT, DOM and GVA. Adverse events were more frequent with epiretinal than other implant types. QoL outcomes improved, particularly in mobility, orientation, and daily tasks.

Conclusion: Retinal implants confer functional vision, but acuities remain below 20/200, and recipients continue to meet criteria for legal blindness. Given the high risk of bias, lack of controls and potential placebo effects, further high-quality evidence is needed to confirm their efficacy, safety and QoL impact.

Rituximab, an anti-CD-20 monoclonal antibody, has garnered increasing interest as a therapeutic option in orbital inflammatory disease (OID). We report our institutional experience with intralesional rituximab injections in two cases of orbital granulomatosis with polyangiitis (GPA), and additionally review the literature surrounding intralesional rituximab in OID. Two patients (a 74-year-old male (Case 1) and a 63-year-old female (Case 2)) with orbital GPA received intralesional rituximab injections at our tertiary institution. Case 1 had evidence of left optic neuropathy in extensive bilateral inferomedial orbital inflammation, while Case 2 had severe refractory and relapsing left orbital inflammation. Both patients received intralesional rituximab injections (Riximyo 10 mg/ml), administered weekly over 8-11 weeks. Rituximab injections were adjunctive to systemic induction therapy, including corticosteroids and rituximab infusion in Case 1, and a course of corticosteroids only in Case 2. Both patients demonstrated a clinico-radiological response to treatment. In conclusion, we present our experience with intralesional rituximab injections, used as an adjunctive treatment modality for orbital GPA, in a case of optic neuropathy and another of severe, refractory, and relapsing disease. Further prospective studies are required to define its utility and the long-term outcomes of intralesional rituximab injections in OID.

Background/objectives: To evaluate the effect of macular status and fixation, as determined by chord alpha, on refractive outcomes following combined phacovitrectomy for retinal detachment. Although an optical biometer can be used to calculate the required dioptric power of the intraocular lens, loss of central fixation can introduce errors into the biometric parameters.

Design: Retrospective single-center observational study.

Methods: Patients with retinal detachment and cataract who underwent combined phacoemulsification and vitrectomy following swept-source optical coherence tomography-based biometry (ZEISS IOLMaster 700) were included, and their preoperative macular status, chord-alpha length, and resulting refractive error at the final follow-up appointment were recorded.

Results: A total of 305 eyes were evaluated, of which 150 had macular detachment. There was a statistically significantly higher rate of refractive error in eyes with macular detachment compared to eyes without (p < 0.001). Absolute refractive prediction error of more than 1 diopter was found in 31% of eyes with detached maculae, compared to 12% of eyes without macular involvement. Eyes with a detached macula showed a significantly longer chord alpha (right eye: p = 0.01; left eye: p < 0.0001), and linear regression analysis revealed that a longer chord alpha was associated with a myopic refractive error. The presence of other factors that also correlated with refractive error underscores the multifactorial pathogenesis of refractive prediction error.

Conclusions: Compared to non-macular involvement, macular detachment led to worse refractive outcomes in combined phacovitrectomy, and chord alpha, as a marker for central fixation, might serve as an explanation. Further research is needed to determine whether combined phacoemulsification and vitrectomy should be performed in patients with macular detachment.

Background: Facial masks are essential for preventing respiratory infections, particularly among healthcare workers. However, prolonged mask use may lead to ocular surface disruption, known as mask-associated dry eye (MADE).

Objectives: To evaluate the impact of different types of disposable surgical masks on tear film parameters and corneal wavefront aberrations during an 8-h work shift.

Design: Randomized clinical trial.

Methods: Sixty healthcare personnel at Rajavithi Hospital were randomly assigned to three mask groups: Group 1 (earloop surgical mask; Medimask^®), Group 2 (earloop surgical mask with adhesive nose strip), and Group 3 (anti-fog earloop surgical mask; Welcare 3D Blue Line Anti-Fog Mask^®). Non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and conjunctival redness were assessed using the Oculus Keratograph^®5M. Corneal higher-order aberrations (HOAs) were measured using the GALILEI Dual Scheimpflug Analyzer before and after 8 h of mask wear.

Results: TMH decreased significantly in all groups: Group 1 from 201.13 ± 85.10 µm to 174.53 ± 42.01 µm (p = 0.003), Group 2 from 188.81 ± 59.55 µm to 164.61 ± 50.58 µm (p = 0.036), and Group 3 from 194.50 ± 58.29 µm to 166.25 ± 45.90 µm (p = 0.034). NIBUT showed slight, non-significant decreases: Group 1 (9.26 ± 4.47-8.35 ± 3.26 s), Group 2 (8.88 ± 3.79-8.20 ± 3.12 s), and Group 3 (9.14 ± 4.20-8.55 ± 3.74 s). Conjunctival redness increased significantly only in Group 1 (1.75 ± 0.47-1.98 ± 0.52, p = 0.048). HOAs were mostly unchanged, except for total HOAs at the 6 mm zone, which were higher in Group 3 (1.85 ± 1.20) than in Group 1 (1.14 ± 0.48) and Group 2 (1.28 ± 0.58; p = 0.012).

Conclusion: An 8-h shift of mask use reduced TMH across all groups and increased conjunctival redness in earloop surgical masks without adhesive. Although most optical aberrations remained unchanged, elevated HOAs in the anti-fog earloop surgical mask group may affect vision quality under mesopic conditions.

Thai clinical trials registry: TCTR 20230725002 (https://www.thaiclinicaltrials.org/show/TCTR20230725002).

This comprehensive review analyzes different types of intrastromal corneal ring segments (ICRS) used in the treatment of keratoconus, focusing on visual outcomes, complication rates, and patient selection criteria for INTACS, KeraRing, Ferrara Ring, MyoRing, and corneal allogenic intrastromal ring segments (CAIRS). We reviewed clinical studies, case reports, and long-term follow-ups to compare visual outcomes, corneal stability, and safety profiles of these ICRS types, with specific emphasis on parameters such as uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), keratometry (Kmax reduction), and complication rates, including migration, extrusion, and postoperative visual disturbances. Each type of ICRS exhibits distinct advantages, with efficacy varying according to disease severity and corneal irregularity. INTACS demonstrated reliable visual improvements for moderate keratoconus with minimal complication rates. KeraRing provided customizable options that significantly improved UDVA and CDVA in cases with irregular astigmatism, although segment migration was more common. The Ferrara Ring was highly effective in central keratoconus, offering substantial corneal flattening with a moderate risk of visual disturbances. MyoRing effectively reduced higher-order aberrations in advanced keratoconus but was associated with a higher reoperation rate. CAIRS, combined with corneal crosslinking, showed promising outcomes with enhanced biocompatibility and minimal complications, particularly for patients sensitive to synthetic materials. ICRS types offer tailored options for keratoconus management. INTACS remains effective for moderate cases, while KeraRing and Ferrara Ring are suitable for advanced stages, especially where customization and flattening are needed. MyoRing offers significant benefits for severe ectasia, and CAIRS presents a novel, biocompatible alternative. Optimizing outcomes and minimizing complications requires tailored selection based on patient-specific corneal characteristics and disease stage. Further comparative studies are needed to refine patient selection criteria and assess the long-term efficacy of each ICRS type.

Scleral necrosis is a rare but severe complication caused by various etiologies. The main therapeutic approach is topical and systemic medical treatment. Surgical interventions may be indicated in unresponsive cases. These approaches, however, may fail to control the scleral necrosis. In addition, both medical and surgical treatment may lead to a number of ocular and systemic side effects, calling for noninvasive but effective treatment for the management of scleral necrosis. This review aims to summarize current studies investigating the role of topical erythropoietin in the treatment of scleral necrosis caused by various etiologies. Different electronic databases were extensively searched for relevant studies published until May 30, 2025, using the following keywords: "erythropoietin" AND "scleral necrosis" OR "necrotizing scleritis" OR "scleral ischemia." The primary outcomes assessed were the indication for topical erythropoietin administration, with secondary outcomes including the efficacy and ocular and systemic safety of treatment with this medication. Seven studies reported the outcomes of the administration of topical erythropoietin for the treatment of scleral necrosis. Of which, two were experimental studies, two were single case reports, including three eyes of two patients, two were case series, including 11 eyes of 11 patients, and one was a nonrandomized case-control study, including 11 eyes of nine patients. Etiologies for scleral necrosis were chemical burns in 15 eyes, thermal burn in one eye, surgically-induced scleral necrosis in six eyes, and systemic autoimmune diseases in three eyes. The necrotic lesions were improved in all eyes 9-90 days after the initiation of treatment with topical erythropoietin. Regarding ocular safety, two eyes developed granulation tissue, which resolved after the cessation of the treatment. Corneal vascularization was observed in 16 eyes with limbal stem cell deficiency due to chemical/thermal burns. No intraocular vascularization or systemic adverse reactions were observed during treatment with topical erythropoietin. Topical administration of erythropoietin can be safe and effective for the management of scleral necrosis caused by various etiologies. However, more studies, including randomized clinical trials, are needed to establish the role of topical erythropoietin in the treatment of this rare but sight-threatening complication.

In recent years, descemet stripping only (DSO) has emerged as an alternative to descemet membrane endothelial keratoplasty (DMEK) in certain patients with Fuchs endothelial dystrophy (FED). We herein report the 10-year follow-up of a 77-year-old male patient after bilateral DSO. The patient initially underwent DSO on the right eye for circumscribed cornea guttata. Three weeks after DSO, the best-corrected visual acuity (BCVA) already increased from 0.5 logarithm of the Minimum Angle of Resolution (logMAR) [Endothelial Cell Density (ECD) 1667/mm², Central Corneal Thickness (CCT) 583 µm] to 0.2 logMAR, and further improved to 0 logMAR 1 year after surgery (ECD 2213/mm², CCT 567 µm). This excellent visual acuity remained stable over the following 5 years (ECD 1696/mm², CCT 568 µm). Five years after the successful surgery on the right eye, DSO was also performed on the left eye by the same surgeon as FED progressed, with BCVA dropping to 0.5 logMAR (ECD unmeasurable, CCT 703 µm). However, this time, the treatment did not improve vision. Consequently, a DMEK was performed 7 months after DSO, which increased the BCVA to 0.1 logMAR. Ten years after successful DSO of the right eye, corneal guttata were observed, indicating de novo formation of a descemet membrane, and vision deteriorated again to 0.2 logMAR (ECD not measurable, CCT 641 µm). DMEK was also performed on the right eye ten years after successful DSO, which improved vision to 0.2 logMAR at one-year follow-up. This case suggests that DSO may be a temporary alternative to DMEK in FED, potentially providing excellent visual gain and good central endothelial cell density for nearly ten years. However, it may still fail due to long-term progression of the disease. It also highlights that the outcome may be limited by individual factors. Therefore, it is crucial to educate the patient about the limitations of DSO, both in short and long term. Nevertheless, if DSO fails, endothelial keratoplasty can still be successfully performed.