Expert Review of Ophthalmology最新文献_第6页

Upper blepharoplasty: advanced techniques and adjunctive procedures 上眼睑整形术：先进的技术和辅助程序

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2023-01-02 DOI: 10.1080/17469899.2023.2175673

Parya Abdolalizadeh, M. Kashkouli, Vahid Khamesi, N. Karimi, Hossein Ghahvehchian, L. Ghiasian

ABSTRACT Introduction Various techniques of upper blepharoplasty are used to correct dermatochalasis as the common sign of aging in periorbital areas. Most patients seeking upper eyelid rejuvenation have other involutional changes in upper face which can be addressed as adjunct to upper blepharoplasty procedure to yield better esthetic and functional outcomes. Areas covered The aim of the present study is to review current concepts in preoperative considerations, surgical techniques, and adjuvant procedures of upper blepharoplasty. The role of social media is also discussed in this arena. A literature search was performed in PubMed database of English-language journals with no restriction on the date of publication using selected keywords. The relevant articles were selected by reviewing the titles and abstracts. Expert opinion Careful preoperative examination of midface and upper face is necessary to assess concomitant ageing deformities besides dermatochalasis. Nowadays, volume preservation approach is the mainstream in upper blepharoplasty. Upper blepharoplasty incisions can be used to address lacrimal gland prolapse, blepharoptosis, Asian medial epicanthoplasty and eyebrow ptosis in selected individuals.

摘要简介各种上睑成形术可用于矫正眶周皮肤松弛症，这是衰老的常见标志。大多数寻求上眼睑再生的患者上脸都有其他退化性变化，这可以作为上眼睑整形术的辅助手段来解决，以获得更好的美学和功能效果。涵盖的领域本研究的目的是回顾上眼睑整形术的术前考虑、手术技术和辅助程序中的当前概念。社交媒体的作用也在这个领域进行了讨论。在PubMed英文期刊数据库中进行文献检索，使用所选关键词对发表日期没有限制。相关文章是通过查阅标题和摘要选出的。专家意见术前仔细检查面部中部和上面部是必要的，以评估除皮肤松弛症外的伴随衰老畸形。目前，保留容量的方法是上眼睑整形术的主流。上睑成形术切口可用于治疗选定个体的泪腺脱垂、上睑下垂、亚洲内上颚成形术和眉毛下垂。

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引用次数: 0

Corneal transplantation in children - when and how? 儿童角膜移植-何时以及如何进行?

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2023-01-02 DOI: 10.1080/17469899.2023.2177153

Abha Gour, A. Garg, Shailja Tibrewal, Julie Pegu, Sonal Gupta, Umang Mathur, V. Sangwan

ABSTRACT Introduction Advanced surgical techniques, better post-operative protocols, imaging, and better understanding of genetic basis have enhanced outcomes of pediatric keratoplasty. However, results in infants and younger children remain a challenge. Transplants in the pediatric age group are challenging because of the complexity of the indications, the procedure itself, and the problems with respect to follow-up and post-operative care in younger recipients. Areas covered This review presents an overview of challenges faced in the management of pediatric corneal grafts, and problems encountered in long-term survival. We discuss the changing trends in these outcomes of PKP with a current review of the recent literature from PubMed. We also share the results of pediatric keratoplasty done at our center in the last three years and have an in-depth discussion about the management of comorbidities like cataracts and glaucoma Expert opinion Despite several advances in microsurgical techniques for corneal transplantation, pediatric keratoplasty remains challenging due to a variety of factors such as young age, repeated need for anesthesia, immature ocular tissues, and accelerated healing. The advent of component surgeries like DALK, DSEK, and DMEK has improved outcomes and simplified management options. Even after specialized surgeries, long-term follow-ups and management of comorbidities become essential.

摘要简介先进的手术技术、更好的术后方案、影像学和对遗传基础的更好理解提高了儿童角膜移植术的疗效。然而，婴儿和幼儿的结果仍然是一个挑战。由于适应症的复杂性、手术本身以及年轻接受者的随访和术后护理问题，儿科年龄组的移植具有挑战性。涵盖的领域本综述概述了儿童角膜移植物管理中面临的挑战，以及在长期生存中遇到的问题。我们通过PubMed最近的文献综述来讨论PKP这些结果的变化趋势。我们还分享了过去三年在我们中心进行的儿童角膜移植术的结果，并就白内障和青光眼等合并症的治疗进行了深入讨论。专家意见尽管角膜移植的显微外科技术取得了一些进展，但由于年龄小、，反复需要麻醉、不成熟的眼组织和加速愈合。DALK、DSEK和DMEK等组件手术的出现改善了结果，简化了管理选项。即使在经过专门的手术后，对合并症的长期随访和管理也变得至关重要。

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引用次数: 1

Factors affecting the prevalence, severity, and characteristics of ocular surface pain. 影响眼表疼痛发生率、严重程度和特征的因素。

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2023-01-01 Epub Date: 2022-12-18 DOI: 10.1080/17469899.2023.2157813

Victor Sanchez, Noah K Cohen, Elizabeth Felix, Anat Galor

Introduction: Ocular surface pain has been traditionally lumped under the umbrella term "dry eye" (DE) but is now understood as its own entity and can occur in the absence or presence of tear dysfunction. Identifying patients at risk for the development of chronic ocular surface pain, and factors contributing to its severity are important in providing precision medicine to patients.

Areas covered: In this review, we discuss factors linked to the presence and severity of ocular surface pain, including eye related features, systemic characteristics, and environmental findings. We discuss corneal nerves, whose anatomic and functional integrity can be characterized through in vivo confocal microscopy images and testing of corneal sensitivity. We review systemic diseases that are co-morbid with ocular surface pain, including physical and mental health diagnoses. Finally, we identify environmental contributors, including air pollution, previous surgeries, and medications, associated with ocular surface pain.

Expert opinion: Intrinsic and extrinsic factors contribute to ocular surface pain and must be considered when evaluating an individual patient. These factors can inform the suspected etiology of the pain, and guide management decisions such as tear replacement or medications targeting nerve pain.

导言：眼表疼痛传统上被归入 "干眼症"（DE）这一总括术语中，但现在已被理解为是一个独立的个体，可在没有或存在泪液功能障碍的情况下发生。识别慢性眼表疼痛的高危患者以及导致其严重程度的因素对于为患者提供精准医疗非常重要：在这篇综述中，我们讨论了与眼表疼痛的存在和严重程度相关的因素，包括与眼睛相关的特征、系统特征和环境因素。我们讨论了角膜神经，其解剖和功能完整性可通过体内共聚焦显微镜图像和角膜敏感性测试来确定。我们回顾了与眼表疼痛并存的全身性疾病，包括生理和心理健康诊断。最后，我们确定了与眼表疼痛相关的环境因素，包括空气污染、既往手术和药物：专家观点：内在和外在因素都会导致眼表疼痛，在评估个体患者时必须加以考虑。这些因素可以为疼痛的疑似病因提供信息，并指导治疗决策，如泪液置换或针对神经痛的药物。

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引用次数: 0

Emerging glaucoma treatments: are we seeing an improvement in adherence? 新兴的青光眼治疗方法：我们是否看到依从性有所改善？

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2023-01-01 Epub Date: 2023-04-12 DOI: 10.1080/17469899.2023.2199981

Andrew P Droste, Paula Anne Newman-Casey

Introduction: Non-adherence to glaucoma medication and poor follow-up is a global health concern.

Areas covered: Glaucoma remains one of the largest causes of irreversible blindness worldwide. Traditional treatment guidelines suggest topical eye drop medication as first line therapy followed by addition of supplementary medications before proceeding to more invasive glaucoma surgeries. Unfortunately, poor glaucoma self-management remains high, leading to disease progression and blindness. Recent advancements in the field of pharmacotherapies, surgeries, and behavioral approaches have taken aim at increasing support for glaucoma self-management. We review the current and emerging approaches towards glaucoma management, with the exception of bleb-based surgical approaches, to investigate if they have had an impact on adherence. Literature searches were conducted via MEDLINE (PubMed), Embase (Elsevier), Cochrane Library (Wiley), and Preprints from January 1^st, 2018, to January 26th, 2023.

Expert opinion: The ability to offer patients a multitude of choices enables patients to tailor their glaucoma treatment to their values and lifestyle. Offering personalized patient education and coaching to support chronic glaucoma self-management would better enable patient engagement in whichever treatment path is chosen. Currently, literature regarding the impact of these new advancements on treatment engagement is lacking; this field is ripe for additional intervention and assessment.

导言：不坚持青光眼药物治疗和随访不力是一个全球性的健康问题：青光眼仍然是导致全球不可逆转性失明的最大原因之一。传统的治疗指南建议将局部滴眼液作为一线疗法，然后在进行更具侵入性的青光眼手术之前添加辅助药物。遗憾的是，青光眼患者的自我管理能力仍然很差，导致病情恶化和失明。药物治疗、手术和行为疗法领域的最新进展旨在加强对青光眼自我管理的支持。我们回顾了当前和新出现的青光眼管理方法（除基于眼泡的手术方法外），以研究这些方法是否对坚持治疗青光眼有影响。从2018年1月1日至2023年1月26日，我们通过MEDLINE（PubMed）、Embase（Elsevier）、Cochrane Library（Wiley）和Preprints进行了文献检索：为患者提供多种选择的能力使患者能够根据自己的价值观和生活方式定制青光眼治疗方案。提供个性化的患者教育和指导以支持慢性青光眼的自我管理，将更好地帮助患者参与所选择的治疗途径。目前，有关这些新进展对治疗参与度影响的文献还很缺乏；这一领域的干预和评估时机已经成熟。

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引用次数: 0

How can the safety of antibody therapy for retinopathy of prematurity be improved? 如何提高早产儿视网膜病变抗体疗法的安全性？

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2023-01-01 Epub Date: 2023-04-09 DOI: 10.1080/17469899.2023.2200934

M Elizabeth Hartnett

引用次数: 0

Evaluating gap junction variants for a role in pediatric cataract: an overview of the genetic landscape and clinical classification of variants in the GJA3 and GJA8 genes 评估间隙连接变异在儿童白内障中的作用:GJA3和GJA8基因变异的遗传景观和临床分类概述

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2022-12-20 DOI: 10.1080/17469899.2023.2160320

Johanna L Jones, K. Burdon

ABSTRACT Introduction Variants in the two lens-expressed gap junction genes GJA3 and GJA8 are among the most common causes of inherited pediatric cataract. These two genes alone account for up to 18% of the cases, second only to the crystallin gene family. Areas covered All published cataract-associated variants in the GJA3 and GJA8 genes were reviewed for a role in pediatric cataract. Autosomal dominant inheritance was most frequently reported, alongside instances of reduced penetrance and autosomal recessive disease. Variant curation using the ACMG-AMP guidelines identified that many variants do not meet the modern standards for clinical interpretation of pathogenicity. There is broad phenotypic heterogeneity of cataract associated with gap junction gene variants. Pathogenic variants are located throughout both proteins with an enrichment in the N-terminal, first two transmembrane domains, and two extracellular loops. Expert opinion Nearly half the gap junction gene variants observed in cataract patients lack sufficient evidence of pathogenicity to form a useful clinical opinion. For many variants, this may be rectified over time as the variant is observed in additional patients but would be vastly accelerated by the generation of well-characterized and standardized functional data evaluating the specific effect of each variant on protein function.

两个晶状体表达的间隙连接基因GJA3和GJA8的变异是遗传性儿童白内障的最常见原因之一。仅这两个基因就占了18%的病例，仅次于晶体蛋白基因家族。本文回顾了所有已发表的GJA3和GJA8基因的白内障相关变异在儿童白内障中的作用。常染色体显性遗传是最常见的报道，同时减少外显率和常染色体隐性遗传病的实例。使用ACMG-AMP指南的变异管理发现，许多变异不符合现代临床解释致病性的标准。与间隙连接基因变异相关的白内障存在广泛的表型异质性。致病性变异位于两种蛋白质中，富集在n端，前两个跨膜结构域和两个细胞外环。专家意见在白内障患者中观察到的间隙连接基因变异中，近一半缺乏足够的致病性证据，无法形成有用的临床意见。对于许多变体，这可能会随着时间的推移而纠正，因为变体在其他患者中观察到，但通过生成充分表征和标准化的功能数据来评估每种变体对蛋白质功能的特定影响，这将大大加速。

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引用次数: 1

Why are soft contact lens wear discontinuation rates still too high? 为什么软性隐形眼镜的停用率仍然过高？

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2022-12-20 DOI: 10.1080/17469899.2022.2160321

C. McMonnies

ABSTRACT Introduction Notwithstanding continuing improvements in contact lens technology and increasing use of daily disposables, discontinuations from soft contact lens wear remain a significant problem with ‘drop-out’ too often occurring after patients have initially achieved successful routine use. Areas covered This review examines the possibility that the signs and symptoms of discontinuations might, for example be associated with corneal and/or lid wiper neuropathy and/or aqueous, mucin and lipid deficiencies and/or mental health disorders. In addition, this review examines how soft contact lens wear places high demands on tear functions. Expert opinion Limitations in clinically detecting evidence of some adverse responses to soft contact lens wear may explain how discontinuations can sometimes be described as unexplained. Similarly, limitations in clinically determining the significance of different forms of tear dysfunction and their exacerbation by soft contact lens wear may be a barrier to explaining why symptoms of dryness are most commonly associated with discontinuations. The wider experience obtained with cosmetic contact lens fittings that is discussed in this review may be relevant to problems encountered in therapeutic contact lens applications.

摘要简介尽管隐形眼镜技术不断进步，日常一次性用品的使用也越来越多，但停止佩戴软性隐形眼镜仍然是一个重大问题，在患者最初成功完成常规使用后，经常会出现“脱落”。涵盖的领域本综述探讨了停药的体征和症状可能与角膜和/或刮盖神经病变和/或水性、粘蛋白和脂质缺乏和/或心理健康障碍有关的可能性。此外，这篇综述考察了软性隐形眼镜佩戴对撕裂功能的高要求。专家意见在临床上检测到佩戴软性隐形眼镜的某些不良反应的证据方面存在局限性，这可以解释为什么有时会将停用描述为无法解释。同样，在临床上确定不同形式的泪液功能障碍的意义及其因佩戴软性隐形眼镜而恶化的局限性可能是解释为什么干燥症状最常见与停药相关的障碍。本综述中讨论的美容隐形眼镜配件的更广泛经验可能与治疗性隐形眼镜应用中遇到的问题有关。

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引用次数: 3

Emerging biosimilars for retinal diseases 新兴的视网膜疾病生物仿制药

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2022-11-02 DOI: 10.1080/17469899.2022.2152005

Ashish Sharma, N. Parachuri, Nilesh Kumar, F. Bandello, B. Kuppermann

ABSTRACT Introduction Biosimilars for retinal diseases have been a topic of discussion recently due to the approval of two biosimilar ranibizumab by the US FDA and EMA. It is important to understand this emerging field in retina with many other biosimilar anti-VEGF molecules in the final stage of their trials. Hopefully, they will be available for clinical use very soon. Areas covered Articles update about the approved biosimilar ranibizumab for retinal diseases and list out ranibizumab and aflibercept biosimilars in the pipeline. Expert opinion Approval of biosimilar anti-VEGFs might be able to drive a geographically variable change in the usage of retinal pharmacotherapy based on the local policies of the health system.

最近，由于美国FDA和EMA批准了两种雷尼单抗生物类似药，视网膜疾病的生物类似药一直是人们讨论的话题。重要的是要了解这一新兴领域的视网膜与许多其他生物类似药抗vegf分子在他们的试验的最后阶段。希望它们很快就能用于临床。文章更新了已批准的用于视网膜疾病的雷尼单抗生物类似药，并列出了正在研发中的雷尼单抗和阿非利塞普生物类似药。抗vegf生物仿制药的批准可能会推动基于当地卫生系统政策的视网膜药物治疗使用的地理变量变化。

引用次数: 1

Endoplasmic reticulum stress as an underlying factor in leading causes of blindness and potential therapeutic effects of 4-phenylbutyric acid: from bench to bedside 内质网应激是导致失明的潜在因素，4-苯基丁酸的潜在治疗效果：从试验台到床边

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2022-11-02 DOI: 10.1080/17469899.2022.2145945

S. Askari, F. Azizi, Pegah Javadpour, N. Karimi, Rasoul Ghasemi

ABSTRACT Introduction Mounting evidence has emerged showing that endoplasmic reticulum (ER) stress participates in triggering cell injuries in ocular tissues, manifested as disorders such as cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. Areas covered ER stress is a condition in which the ER is perturbed by the accumulation of unfolded and misfolded proteins. In a dynamic signaling cascade, the unfolded protein response (UPR) is triggered by three ER-transmembrane stress sensors to restore homeostasis and cell survival, however, if it fails, the cell will undergo a sustained ER stress condition which deteriorates cell function and promote cell death. Sustained ER stress is shown to contribute in a wide range of diseases including ophthalmologic disorders. Targeting ER stress by inhibitor agents might have promising therapeutic implications in treating eye disorders. The current review summarizes the results of the latest studies in support of the potential therapeutic utility of 4-phenylbutyric acid (4-PBA), an FDA approved ER stress inhibitor, in disorders leading to permanent vision loss. Expert opinion The therapeutic potential of 4-PBA in ophthalmic diseases is strongly supported by many experimental studies. Safety and efficacy studies of intravitreal injection of 4-PBA and other ER stress by inhibitors, are lacking.

越来越多的证据表明内质网应激参与触发眼部组织细胞损伤，表现为白内障、年龄相关性黄斑变性、青光眼和糖尿病视网膜病变等疾病。区域覆盖内质网应激是内质网受到未折叠和错误折叠蛋白质积累的干扰的一种情况。在一个动态信号级联中，未折叠蛋白反应(UPR)由三个内质网跨膜应激传感器触发，以恢复体内平衡和细胞存活，然而，如果它失败，细胞将经历持续的内质网应激状态，从而恶化细胞功能并促进细胞死亡。持续内质网应激被证明在包括眼科疾病在内的广泛疾病中起作用。利用内质网应激抑制剂治疗眼病可能具有很好的治疗意义。本综述总结了支持4-苯基丁酸(4-PBA)潜在治疗效用的最新研究结果，4-苯基丁酸是FDA批准的内质网应激抑制剂，用于治疗导致永久性视力丧失的疾病。许多实验研究有力地支持了4-PBA在眼科疾病中的治疗潜力。目前缺乏玻璃体内注射4-PBA和其他内质网应激抑制剂的安全性和有效性研究。

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引用次数: 0

Surgical management of recurrent rhegmatogenous retinal detachment 复发性孔源性视网膜脱离的手术治疗

IF 0.7 Q4 OPHTHALMOLOGY

Expert Review of Ophthalmology

Pub Date : 2022-11-02 DOI: 10.1080/17469899.2022.2152004

Lucy V. Cobbs, Taku Wakabayashi, Y. Yonekawa

ABSTRACT Introduction Primary rhegmatogenous retinal detachment (RRD) repair with modern surgical techniques provides high rates of anatomic success; however, anatomic failure may still occur with any primary surgery, including after pneumatic retinopexy (PR), scleral buckle (SB), and pars plana vitrectomy (PPV), resulting in recurrent RRD. Areas covered This review includes a summary of surgical options and management strategies for eyes with primary failure of PR, SB, and PPV. Expert opinion No standardized protocol is available for determining the optimal secondary surgical options to treat recurrent RRD. However, understanding of the causes and characteristics of the re-detachment, expected anatomic success rates with each surgical option, and potential complications, may improve the outcomes after re-operations. Causes of primary failure include formation of new breaks, re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy (PVR). Rescue PR, revision of SB, and reoperation with PPV with membrane peeling, relaxing retinectomy, and/or long-acting tamponade combined with or without encircling SB, are effective options depending on the cause of primary failure and characteristics and severity of the re-detachment. Further advances in the management of PVR, which is a major cause of primary failure, will help improve treatment outcomes for eyes with complicated recurrent detachments.

摘要介绍原发性孔源性视网膜脱离(RRD)修复与现代外科技术提供了高的解剖成功率;然而，任何原发性手术仍可能发生解剖失败，包括充气视网膜固定术(PR)、巩膜扣合(SB)和玻璃体切割(PPV)后，导致复发性RRD。本综述综述了原发性PR、SB和PPV失败的手术选择和治疗策略。专家意见没有标准化的方案可用于确定治疗复发性RRD的最佳二次手术选择。然而，了解再脱离的原因和特征，每种手术选择的预期解剖成功率，以及潜在的并发症，可能会改善再手术后的结果。主要失败的原因包括新裂口的形成，原有裂口的重新打开，裂口错过，最常见的是增殖性玻璃体视网膜病变(PVR)。根据最初失败的原因、再脱离的特征和严重程度，救援PR、SB修复、再手术PPV并剥离膜、松弛性视网膜切除术和/或长效填塞联合或不包围SB是有效的选择。PVR是原发性眼病的主要原因，其治疗的进一步进展将有助于改善复杂复发性眼角膜脱离的治疗效果。

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引用次数: 0