Therapeutic Advances in Ophthalmology最新文献

Introduction: Epiretinal membrane (ERM) formation following a successful rhegmatogenous retinal detachment (RRD) operation has been reported to occur in about 4%-15% of the cases. In this study, we collected vitreous samples from patients with RRD to identify whether the concentration of IL-6 is correlated with the presence of postoperative ERM. We aim is to identify whether the inflammatory cascade could be a potential key factor in the ERM pathogenesis.

Methods: This was a prospective single-centre study where 42 eyes were enrolled. All patients underwent 25G PPV. The vitreous sample was collected before the infusion line was opened so that the sample would not be diluted. Then, the sample was centrifuged at 5000 g for 15 min at 15°C. Afterwards, the supernatant fluid was transferred to an Eppendorf tube and stored at -40°C. Electrochemiluminescence immunoassay (ECLIA) was employed for the measurement of IL-6 concentration (pg/ml). All patients had optical coherence tomography (OCT) scans at the macula at 4 weeks, 3 months and 1 year after primary RRD repair to identify the presence of the ERM.

Results: All patients had a follow-up of at least 12 months. The mean BCVA of all 42 eyes at the end of follow-up period was 0.24 ± 0.31 LogMar. The presence of ERM was identified in 28.6% (n = 12) of the patients, and the mean IL-6 concentration was 573.96 ± 1179.58 pg/ml. It appears that the patients who developed a post op ERM had an IL-6 mean concentration value of 173.96 ± 191.25 pg/ml, and the patients with no post op ERM had 733.97 ± 1364.04 pg/ml with p-value = 0.04 < 0.05. Nevertheless, following a multivariate binary logistic regression model, the above results did not appear to be statistically significant.

Conclusion: High concentration of IL-6 in the vitreous of eyes with RRD does not hold a significant role in the ERM pathogenesis. Our study identified the presence of a draining retinotomy as the most significant risk factor for ERM formation following a successful surgical RRD repair.

Keratoconus is a progressive ectatic corneal disease characterized by corneal thinning, steepening, and irregular astigmatism, presenting unique challenges for intraocular lens (IOL) calculations in cataract surgery. The use of traditional formulas for IOL calculations in eyes with keratoconus frequently leads to significant refractive prediction errors, often resulting in a hyperopic shift, which can lead to suboptimal outcomes and reduced patient satisfaction. This review examines the impact of keratoconus on IOL calculations and highlights recent advancements in formulas specifically designed for eyes with keratoconus, particularly the Barrett True-K and the Kane Keratoconus formulas. We assess the effectiveness of these formulas based on the current literature and provide clinical recommendations aimed at improving surgical outcomes in this complex patient group.

Stargardt disease or Juvenile Macular Degeneration is a rare genetic disorder caused by a mutation in the ABCA4 gene that results in degeneration of the macula and loss of central vision. The mutation in the ABCA4 gene causes a build-up of lipofuscin, which is a substance that is left over from the breakdown and absorption of damaged blood cells. This build-up of lipofuscin causes the death of photoreceptor cells and the subsequent degeneration of the macula. Due to the nature of Stargardt's disease, there are currently no cures or treatment options. However, in recent years, there has been an increase in research and exploration of utilizing stem cell therapy as a potential cure and treatment for Stargardt disease. Growing research in the field of ophthalmology has found that the use of stem cells can potentially replace the loss of photoreceptor cells, slow the progression of the degeneration of vision, and be a potential new treatment option for Stargardt disease.

Background and aim: Multimodal large language models (LLMs) have shown potential in processing both text and image data for clinical applications. This study evaluated their diagnostic performance in identifying retinal diseases from optical coherence tomography (OCT) images.

Methods: We assessed the diagnostic accuracy of GPT-4o and Claude Sonnet 3.5 using two public OCT datasets (OCTID, OCTDL) containing expert-labeled images of four pathological conditions and normal retinas. Both models were tested using single-shot and few-shot prompts, with an overall of 3088 models' API calls. Statistical analyses were performed to evaluate differences in overall and condition-specific performance.

Results: GPT-4o's accuracy improved from 56.29% with single-shot prompts to 73.08% with few-shot prompts (p < 0.001). Similarly, Claude Sonnet 3.5 increased from 40.03% to 70.98% using the same approach (p < 0.001). Condition-specific analyses revealed similar trends, with absolute improvements ranging from 2% to 64%. These findings were consistent across the validation dataset.

Conclusion: Few-shot prompted multimodal LLMs show promise for clinical integration, particularly in identifying normal retinas, which could help streamline referral processes in primary care. While these models fall short of the diagnostic accuracy reported in established deep learning literature, they offer simple, effective tools for assisting in routine retinal disease diagnosis. Future research should focus on further validation and integrating clinical text data with imaging.

Background: Cardiovascular disease increases the risk for cerebrovascular disease (CBVD) and cognitive decline. The retina has become an ideal target for imaging cerebrovascular changes via optical coherence tomography angiography (OCTA). Whether OCTA metrics map onto clinical outcomes in adults at high risk for CBVD and cognitive decline remains unknown.

Objectives: This study examined the relationship between OCTA metrics and domain-specific cognition in older adults recently discharged from a 12-week cardiac rehabilitation program, who are at high risk of both CBVD and cognitive decline.

Design: This was a prospective, feasibility/pilot study to determine whether OCTA metrics are related to cognition in this unique population of high-risk adults.

Methods: Twenty-two older adults recruited within 3 months of completing a 12-week cardiac rehabilitation program participated in a single visit consisting of cognitive assessment and OCTA imaging. Cardiac/exercise metrics were compared pre- and post-rehabilitation. Primary outcomes were analyzed using partial correlation, and multiple regression assessed whether exercise moderates the relationship between retinal vasculature and cognition.

Results: Higher performance in episodic memory predicted retinal vascular perfusion. Change in time spent performing exercise and change in systolic blood pressure from pre- to post-cardiac rehabilitation were associated with higher logical memory performance post-rehab. Exercise did not moderate the relationship between retinal vascular perfusion and cognition.

Conclusion: The results of this study support a direct relationship between retinal vascular integrity and cognition in those at high risk for cognitive impairment and cardiovascular disease (CVD). Future research in larger samples with data collection both pre- and post-cardiac rehabilitation will inform whether this relationship is mediated by exercise.

Purpose: To evaluate the safety, visual performance, and patient satisfaction of a new presbyopic pseudophakic intraocular lens (IOL).

Methods: An ambispective non-randomized study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed femtosecond laser-assisted cataract surgery (FLACS), performed between October 2020 and September 2021, with a 24-month follow-up period. The Intensity SL (Hanita Lenses) IOL was bilaterally implanted. Uncorrected distance, intermediate, and near visual acuity (UDVA/UIVA/UNVA, respectively), and defocus curve as well as safety parameters were measured, and patient satisfaction was evaluated with the VF-14 QOL questionnaire.

Results: A total of 120 eyes of 60 patients (34 women and 26 men) aged 68.32 ± 8.9 years (54-85) were included. At the last follow-up, the mean monocular UDVA in eyes (n = 120) with an Intensity SL IOL implanted was 0.01 ± 0.07 logMAR, and the corrected distance visual acuity (CDVA) was -0.05 ± 0.06 logMAR. For 120 cm, mean UIVA was 0.06 ± 0.11 logMAR; for 80 cm, mean UIVA was 0.07 ± 0.07 logMAR; for 66 cm, mean UIVA was 0.05 ± 0.07 logMAR and for 40 cm, mean UNVA was 0.09 ± 0.08 logMAR (-0.1 to 0.2). The mean binocular UDVA in our patient group was -0.05 ± 0.05 logMAR. Glare and halo were rare phenomena. Patient satisfaction was high. The mean score value of the VF-14 QOL questionnaire 24 months postoperatively was 98.6.

Conclusion: Patients underwent safe bilateral implantation with Intensity SL IOL, achieving spectacle independence in most cases, and reported a high degree of satisfaction, refraction, and vision stability 24 months after surgery.

Background: The success of trabeculectomy is highly dependent on postoperative control of inflammation and fibrosis. Prednisolone acetate is the most commonly used topical steroid after ophthalmic surgery. However, non-compliance and adherence problems are constantly thwarting this goal. A topical eye drop regimen that requires fewer drops per day and still achieves the same success rates regarding controlling fibrosis and inflammation is desirable.

Objective: This study aimed to evaluate whether similar success rates can be achieved with topical difluprednate, comparable to prednisolone acetate, following trabeculectomy.

Design: A single-center, single-surgeon retrospective chart review.

Methods: Retrospectively, medical records were evaluated. Inclusion criteria were age ⩾18 years with no upper limit and a diagnosis of open-angle glaucoma. Exclusion criteria were follow-up of <3 months and a history of a concurrent surgery that lowers IOP other than laser trabeculoplasty, cataract surgery, or trabecular meshwork bypass procedures. Success was defined as IOP ⩽ 21 mmHg and ⩾20% reduction below baseline after 1 month, no hypotony (IOP > 5 mmHg), no subsequent glaucoma surgery, and no loss of light perception vision. Primary outcome measures were time to failure and Kaplan-Meier survival, and secondary outcome measures were change in IOP, number of anti-glaucoma medications (AGM), and postoperative interventions and complications.

Results: In all, 115 eyes were analyzed: 75 eyes in the prednisolone acetate group, and 40 eyes in the difluprednate group. Baseline characteristics and demographics were similar between the groups. IOP and AGM were significantly lowered, with no difference between the two groups. Failure rates varied between 12% and 31% at 1 year in the prednisolone arm, and between 12% and 35% in the difluprednate arm. No differences between the two treatment arms were found regarding survival statistics.

Conclusion: There was no difference in the success rate between the drug used to treat postoperative inflammation and prevent scarring after trabeculectomy. However, fewer drops per day were necessary in the difluprednate group. Both groups showed no difference in the amount by which IOP and AGM were reduced.

Background: Dry eye disease is a common condition that causes symptoms such as dryness, irritation, and blurry vision. The pathophysiology of dry eye disease features both aqueous deficiency (loss of aqueous tear production) and increased evaporation (loss of the lipid layer), with the latter mechanism responsible for most of the disease presentation. Ocular surface disease (OSD) is a prevalent condition, often linked to meibomian gland dysfunction (MGD), characterized by tear film instability and symptoms like dryness and irritation. Thermal pulsation therapy, an FDA-approved treatment for MGD, uses heat and pressure to restore gland function, improving tear film stability and ocular health. Studies show its benefits last up to a year, enhancing Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), and Meibomian Glands Yielding Secretion Score (MGYSS) scores. This systematic review evaluates LipiFlow compared to placebo, warm compresses, and other devices, focusing on safety, efficacy, and its impact on recovery and long-term outcomes.

Methods: A comprehensive search was performed across PubMed, MEDLINE, Embase, and Scopus until December 2024. Only randomized controlled trials (RCTs) evaluating LipiFlow were included. The primary outcomes assessed were OSDI and TBUT, with secondary outcomes including meibomian gland expression scores, corneal fluorescein staining (CFS), MGYSS, and lipid layer thickness (LLT). Meta-analyses were conducted using a random-effects model, and heterogeneity was assessed using I² statistics.

Results: Thirteen studies reported OSDI (Std diff -0.076, 95% CI -0.277 to 0.125, p = 0.255, I² = 71.21%). Twelve studies evaluated MGYSS, showing significant improvement (Std diff 0.449, 95% CI 0.173-0.725, p = 0.001, I² = 78.49%). TBUT results from twelve studies were not statistically significant (Std diff 0.211, 95% CI -0.017 to 0.440, p = 0.8350, I² = 0%). CFS showed significant improvement in six studies (Std diff -0.130, 95% CI -0.248 to -0.012, p = 0.031, I² = 0%). LLT changes were insignificant (Std diff -0.071, 95% CI -0.381 to 0.239, p = 0.653, I² = 0%).

Conclusion: LipiFlow effectively improves meibomian gland function, as indicated by TBUT, MGYSS, and CFS, but its impact on LLT and OSDI is not significant. The therapy is most beneficial for patients with severe baseline MGD. Further research is needed to establish long-term benefits and patient-specific outcomes.