Therapeutic Advances in Ophthalmology最新文献

Background: The PRESERFLO^® Microshunt procedure offers a safe and effective alternative to trabeculectomy procedure. The adjuvant use of anti-vascular endothelial growth factor (VEGF) with trabeculectomy has been well studied, yet little is known on the effect and safety of anti-VEGF agents used as an adjunctive therapy in PRESERFLO^® procedures.

Objectives: To compare the outcomes of PRESERFLO Microshunt procedure using either mitomycin C (MMC) alone versus MMC augmented with bevacizumab in patients with open angle glaucoma to a follow-up time of 6 months.

Design: Retrospective observational single-center single-surgeon study.

Methods: Patients' records of patients who consecutively underwent PRESERFLO Microshunt at Queen Victoria Hospital, United Kingdom, were examined. From December 2018 to January 2020, eligible patients underwent PRESERFLO Microshunt implantation with MMC alone (0.2-0.4 mg/ml), whereas from February 2020 to January 2022, patients underwent PRESERFLO Microshunt implantation with MMC (0.2-0.4 mg/ml) and adjuvant intracameral 0.1 ml of bevacizumab (1.25 mg/0.05 ml). Efficacy outcomes were analyzed, including changes in intraocular pressure (IOP) and changes in medication use. Postoperative complications and postoperative interventions were also reviewed.

Results: A total of 75 eyes were included in the analysis, 38 eyes received MMC alone, whereas 37 eyes received MMC combined with bevacizumab. There were no statistically significant differences in the demographic or clinical profile of patients between treatment groups.Both strategies were effective in terms of IOP lowering (baseline vs 6 months postoperatively: 20.0 (6.8) mmHg vs 12.8 (3.7) mmHg in the MMC group; 23.6 (6.9) mmHg vs 11.9 (4.2) mmHg in the MMC+ bevacizumab group; p < 0.001 in both comparisons). Mean anti-glaucoma medication use also reduced significantly from baseline with no difference between both groups. A higher proportion of patients required postoperative interventions (5-FU injection, needling, and bleb revision) in the MMC alone group (N = 16; 42.1%) compared to the MMC+ bevacizumab group (N = 4; 9.9%) which was statistically significant (Pearson's χ² test; p = 0.002).

Conclusions: Adjuvant use of bevacizumab in MMC-augmented PRESERFLO Microshunt procedure is at least as effective as MMC alone but helps reduce rates of postoperative interventions.

What is this summary about? This is the summary of an article published in Ophthalmology Retina. This summary presents results from a study that used information from a United States (US) healthcare database to look at how intravitreal injections (injections into the eyeball) of anti-vascular endothelial growth factor (anti-VEGF) may affect vision for patients with either neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME). The study focused on maintaining driving vision over 4 years. What happened in this study? Researchers looked at information in the Vestrum Health database to identify patients diagnosed with nAMD or DME between January 1, 2014 and June 30, 2019 and had medical records that showed how their vision changed while they were receiving anti-VEGF treatment. What were the results? Vision improved for both nAMD and DME patient groups in the first year of anti-VEGF treatment but then got worse over the next 3 years. Patients with nAMD or DME who had more anti-VEGF injections in the first year of treatment had a higher chance of maintaining their driving vision. Both groups of patients were more likely to lose their driving vision if they were older or had worse vision before starting treatment. What do the results mean? These results show that starting anti-VEGF treatment early and having frequent injections is important for keeping driving vision in patients with nAMD or DME. Currently, patients with nAMD or DME may not be getting injections early and often enough to maintain their driving vision over the long term. Where can I find the original article on which this summary is based? You can read the original article published in the journal Ophthalmology Retina at: https://doi.org/10.1016/j.oret.2023.10.010 Who is this article for? The purpose of this plain language summary is to help patients with either nAMD or DME, their caregivers, patient advocates, healthcare professionals, insurance providers, and policy makers better understand the results of this study. When was this plain language summary of publication written? This summary was drafted in December 2023. Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) are among the leading causes of vision loss among individuals aged 50 years and older in the US and worldwide.

Purpose: The aim of this study was to investigate serum Growth Arrest-Specific Protein 6 (Gas6) levels in the active and inactive periods of uveitis.

Material and methods: In this study, serum Gas6 levels were evaluated in 21 patients during active and inactive periods. After measuring serum Gas6 levels in the active phase, the serum Gas6 test was repeated in the inactive period. Commercial Enzyme-Linked Immunosorbent Assay (ELISA) kits (Gas6, WKEA Med Supplies Corporation, NY, USA) were used to measure Gas6 levels. Plasma concentrations were analyzed with an ELISA reader at 450 nm following the manufacturer's instructions.

Results: In the study, the mean age of 21 patients was 33 (7-62) years. The mean follow-up period was 30.05 ± 18.76 months. While the average Gas6 value measured during active uveitis attacks was 1.02 ± 0.39 ng/mL (range: 0.54-2.12), the Gas6 value during the passive period was 0.71 ± 0.23 ng/mL (range: 0.39-1.17). The Gas6 level during active uveitis attacks was significantly higher than during the passive period (p = 0.04).

Conclusion: The findings of this study suggest a notable elevation in serum Gas6 levels across all cases of active uveitis, irrespective of the underlying etiology, whether infectious or noninfectious. To successfully integrate serum Gas6 levels into the diagnostic and follow-up protocols for active uveitis, additional comprehensive investigations are imperative.

Background: The travoprost intracameral implant and cataract surgery both lower intraocular pressure (IOP).

Objectives: We evaluated the safety and IOP-lowering effect at 3 months following administration of travoprost intracameral implant in combination with cataract surgery.

Design: Prospective, 12-month, open-label, single-arm trial.

Methods: We enrolled patients with age-related cataracts and open-angle glaucoma or ocular hypertension in the same eye. At baseline, patients were required to have an unmedicated mean diurnal IOP (average of 8:00 am, 10:00 am, and 4:00 pm IOPs) of 24 mmHg or greater, and an IOP of 36 mmHg or less at each of these three timepoints. On the day of the combined procedure (day 1), patients who had uncomplicated phacoemulsification cataract surgery received a travoprost intracameral implant. Follow-up evaluations occurred on day 2-3, week 2, week 6, and month 3 visits.

Results: Sixty patients had uncomplicated cataract surgery and received a travoprost intracameral implant. There were no serious adverse events. Study eye adverse events were reported in 8.3% of patients. The most frequently reported adverse event was dry eye (6.7%). At month 3, the mean diurnal IOP change from baseline was -10.6 mmHg (95% confidence interval: -11.2, -9.9; p < 0.0001) from an unmedicated baseline mean diurnal IOP of 25.2 mmHg. In addition, at month 3, 97% of eyes had a 20% or greater mean diurnal IOP reduction from baseline, and 91.0% of eyes had a mean diurnal IOP of 18 mmHg or less.

Conclusion: Administration of a travoprost intracameral implant combined with routine cataract surgery was safe. The sizable -10.6 mmHg IOP change from baseline at month 3 was both statistically significant and clinically relevant.

Trial registration: NCT06061718, Travoprost Intraocular Implant in Conjunction with Cataract Surgery, https://clinicaltrials.gov/study/NCT06061718.

Background: Selective suture removal has been demonstrated to be effective in reducing post-keratoplasty astigmatism, while the remaining sutures are left in place. Existing studies typically focus on outcomes immediately after selective suture removal, without delving into the final suture-out keratometric astigmatism.

Objectives: To examine the impact of selective suture removal on corneal graft astigmatism following keratoplasty in keratoconus and identify potential factors associated with the changes in graft astigmatism after suture removal.

Design: Retrospective, comparative interventional case series.

Methods: The study included 118 consecutive eyes of 118 cases that underwent corneal transplantation for keratoconus and had a keratometric astigmatism of ⩾4 D. One or two interrupted sutures corresponding to the steep meridian were removed per session. Patients were re-evaluated at 1 to 2-month intervals, repeating the procedure until achieving a keratometric astigmatism of <4.0 D or no interrupted sutures remained in the steep meridian.

Results: The mean recipient age was 28.4 ± 8.4 years. A total of 234 selective suture removals were performed, with a mean of 2.0 ± 1.1 removals per eye. Pre-suture removal keratometric astigmatism significantly decreased from 6.3 ± 2.0 D to 3.91 ± 2.23 D after the completion of selective suture removal (p < 0.001). This value was significantly increased to 5.45 ± 2.93 D after all suture removal (p < 0.001). Higher pre-suture removal astigmatism and deep anterior lamellar keratoplasty were associated with a more favorable response to selective suture removal.

Conclusion: Selective suture removal effectively modifies graft curvature to reduce post-keratoplasty astigmatism in keratoconus patients. However, its efficacy markedly diminishes after all sutures are removed. This procedure is particularly effective in patients with higher pre-suture removal astigmatism and those undergoing deep anterior lamellar keratoplasty.

Background: Small conjunctival incision size is desirable in strabismus surgery under topical anesthesia.

Objective: To study the feasibility and tolerability of a small bulbar conjunctival incision (SB).

Design: Non-randomized feasibility pilot study.

Methods: After applying a 5-0 PGA (polyglycolic acid) traction suture, we did a 3-4 mm single conjunctival incision posterior and parallel to the rectus muscle insertion. A hang-back recession was done (6-0 PGA suture), and the conjunctiva closed (8-0 PGA suture). The outcome measures were feasibility, tolerability, and motor result.

Results: Twenty-five patients were included. The median pain scale score was 3/10, and the satisfaction Net Promoter Score was 72. Mean duration of a recession was 12 min (range: 9-14 min). Mean duration of inflammatory signs and hemorrhage were 2.2 days (95% CI, 1.4-2.9), and 8.5 days (95% CI, 7.1-9.9), respectively. Distance deviation at 2 months was 3.1 Prism Diopters (95% CI, 1.5-4.5).

Conclusion: SB is feasible and well tolerated for extraocular rectus muscle surgery.

Background: Age-related macular degeneration (AMD) is a prevalent cause of irreversible vision loss among the elderly. The prevalence and detailed characteristics of Charles Bonnet syndrome (CBS) remain largely unexplored in patients with geographic atrophy (GA) secondary to AMD.

Objectives: To investigate the prevalence and characteristics of CBS in patients with GA secondary to AMD.

Design: Prospective cross-sectional study.

Methods: A total of 149 patients with GA secondary to AMD were previously screened and examined for clinical studies. These patients were then prospective contacted by telephone for this study, and 120 patients responded and agreed to do an interview on symptoms of CBS. All with CBS were inquired about detailed characteristics of their hallucinations.

Results: Patients with GA secondary to AMD were aged 82.1 ± 6.2 years and 62% were of female biological sex. The prevalence of CBS was 25 in 120 (20.8%). Thirteen (52%) of those with CBS were not previously informed of the disease. We found no difference between those with and without CBS in terms of age, biological sex, hearing difficulties, whether living alone or with others, co-morbidity of psychiatric or neurological diseases, or psychotropic use. Characteristics of the visual hallucinations were reported to occur at various frequencies from daily to less than monthly, occur during various times of the day, and almost always last minutes at most. Ten in 25 (40%) had not told anyone of having CBS.

Conclusion: One in five with GA has CBS, which ranks GA as an eye disease with one of the highest reported prevalences of CBS. The condition presents with a significant variation across the patient group. A very large proportion of those with CBS were not informed of the disease and had never told anyone of their condition by their own initiative.

Objective: To perform a systematic literature review analyzing visual outcomes of immediate, early, and delayed vitrectomy in the treatment of acute endophthalmitis after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Methods: We conducted a literature search using the Ovid Medline, Embase.com, and Web of Science databases, and relevant articles were selected from original English papers published from 2005 to 2021. Inclusion criteria were studies reporting cases of acute post-anti-VEGF endophthalmitis, defined as occurring within 6 weeks of injection treatment. Exclusion criteria were pediatric cases and cases explicitly reported to be caused by injections of contaminated drugs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool for case reports and case series. The study dataset for descriptive and statistical analysis comprised patient-level data extracted from included studies. The timing of vitrectomy compared were defined as (1) immediate vitrectomy as occurring within 24 h of endophthalmitis diagnosis; (2) early vitrectomy as occurring between 24 and 48 h of endophthalmitis diagnosis; (3) late vitrectomy as occurring after 48 h of endophthalmitis diagnosis. Primary outcome was final visual acuity following treatment with vitrectomy.

Results: Twenty-five articles were published that met our inclusion and exclusion criteria for a total of 86 cases. Thirty-seven were immediate vitrectomy, 25 were early, and 24 were late vitrectomy treatment groups, respectively. We observed differences in final visual outcomes and in improvement from diagnosis to final visual acuity, with patients receiving immediate and late vitrectomy to have better final visual outcomes than those patients receiving early vitrectomy (p < 0.005).

Conclusion: Our results show that there may be an association between time to vitrectomy and visual outcomes. Immediate and late vitrectomy treatment groups had better visual outcomes than the early group. Our results were limited by the reliance on case reports and series and the paucity of data available specifying the timing of vitrectomy. Additional research is necessary to elucidate the effects of treatment timing in patients with endophthalmitis following anti-VEGF injection.

Diabetic retinopathy and retinal vein occlusion represent two prevalent vision-threatening retinal diseases. Retinal laser therapy still plays an important role in treating these conditions, but its successful administration often requires referral to specialized centers and retina experts. It is, therefore, essential to develop a new treatment methodology that enables patients to benefit from the expertise of specialists from reference centers. For this purpose, we investigated the feasibility of teleguided photocoagulation conducted across continents to determine if different ophthalmologists can consensually devise and safely execute treatment plans remotely. Two patients from Italy (Europe) with diabetic retinopathy and one from Arizona (USA) with central retinal vein occlusion underwent retinal photocoagulation using Navilas^® 577s with remote teleguidance from the corresponding continental counterpart. The process included remote planning and execution, supported by an audio connection for real-time communication. Teletreatment success criteria included treatment plan completion, patient tolerance, remote connection stability, and technical quality. All treatments have been successfully performed with accurate spot application and no technical issues. Follow-ups at three weeks confirmed positive outcomes for each patient. Remote teleguided retinal photocoagulation appears feasible, offering a promising tool for global collaborations in retina care and potential benefits to regions with limited access to expert supervision.

Background: Selective laser trabeculoplasty (SLT) is an effective long-term option for the treatment of open-angle glaucoma.

Objectives: To investigate the real-world efficacy and safety of SLT with the Zeiss VISULAS green laser in medically treated primary open-angle glaucoma (POAG).

Design: Retrospective, single-center study.

Methods: POAG patients ⩾18 years of age on at least one antiglaucoma medication prior to the procedure, who underwent SLT with the Zeiss VISULAS green laser (Carl Zeiss Meditec, Jena, Germany). Medications were terminated or reinstated at subsequent follow-ups depending on the intraocular pressure (IOP) control. The primary efficacy outcome measures were mean reduction in glaucoma medications and mean reduction in IOP at 3, 6, and 12 months compared to baseline. Safety outcomes were intra- or post-procedural complications.

Results: One hundred fifty-six eyes of 156 patients, aged 66.5 ± 13.2 years, were recruited. The mean number of medications was reduced from 2.3 ± 1.0 at baseline to 0.8 ± 1.1 and 0.8 ± 1.2 at 3- and 6 months, respectively (p < 0.001). Despite the reduction of medications, the mean IOP (mmHg) was reduced from 16.6 ± 3.10 at baseline to 15.4 ± 3.82 at 3 months (n = 156) and 15.1 ± 3.30 at 6 months (n = 140) (p < 0.001). IOP reduction ⩾20% was observed in 28.8% of patients at 3 months and 27.9% of patients at 6 months. In the 12-month follow-up group (n = 22), mean medications and IOP (mmHg) at baseline were 2.3 ± 0.9 and 16.0 ± 2.80, respectively, which decreased to 0.9 ± 1.1 (p < 0.001) and 14.5 ± 1.92 (p = 0.103), respectively. At 3- and 6-month post-procedure, 59.6% of patients and 60% of patients, respectively, were medication-free compared to none at baseline. At 6 months, 69.3% of patients maintained IOP lower than or equal to pre-procedure IOP on fewer medications compared to baseline. No vision-threatening intra- or post-procedure complications were noted.

Conclusion: SLT with the Zeiss VISULAS green laser resulted in a clinically and statistically significant reduction in number of medications needed for IOP control. The procedure had a good safety profile similar to that described in the literature for SLT, with no vision-threatening complications.