Current Opinion in Ophthalmology最新文献

Purpose of review: We describe the history, utilization, and series results of panretinal photocoagulation (PRP) and ranibizumab and provide an analysis of PRP and ranibizumab usage before versus after the publication of the 2-year and 5-year results of the Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol S trial.

Recent findings: Number of ranibizumabs performed began to increase and number of PRPs performed began to decrease in 2016. After publication of the 2-year results, there was significant negative trend in PRP services and significant positive trend in ranibizumab services (both P < 0.001). After publication of the 5-year results, there was significant negative trend in PRP services (P = 0.003). There were significant negative trends (all P < 0.001) in reimbursement factors for PRP from 2013 to 2020: average work RVU (wRVU), nonfacility physical expense RVU, facility PE RVU, malpractice RVU (MP RVU).

Summary: Both PRP and ranibizumab have undergone numerous trials comparing their efficacy to other treatment options or no treatment at all. The publication of the 2-year results of Protocol S was associated with an increase in utilization of ranibizumab and decrease in utilization of PRP, with continued decrease after the publication of the 5-year results.

Purpose of review: With a decline in the use of scleral buckling for rhegmatogenous retinal detachment (RRD) repair in recent years, this review seeks to provide a summary of the most recent research findings regarding the role of scleral buckling in the repair of RRD.

Recent findings: Many recent studies have compared visual and anatomic outcomes between scleral buckling and pars plana vitrectomy (PPV) for RRD repair. Some suggest superior outcomes with primary scleral buckling, particularly in younger, phakic patients, and in association with other risk factors that we review. Children do best with primary scleral buckling surgery. Functionally, scleral buckling may also result in lower rates of retinal displacement compared to PPV. When PPV is necessary, a supplemental buckle may benefit certain patients, while the advantage remains unclear in other clinical scenarios and necessitates further investigation.

Summary: Scleral buckling is an important technique for the repair of RRD and it is crucial to continue training retina surgeons in this technique to maximize patient outcomes.

Purpose of review: The purpose of this review is to evaluate the current state of eco-sustainability in ophthalmology, highlighting key practices, recent advancements, and areas requiring improvement. This review aims to provide ophthalmologists with a comprehensive overview of sustainable practices that can reduce environmental impact.

Recent findings: Recent studies have identified several areas within ophthalmology where sustainable practices can be implemented including multidose eyedrops, adjusting surgical packs, making package inserts available electronically, and reusing surgical instruments. Moreover, there is an increasing emphasis on waste reduction both in the surgical and clinical setting, by decreasing the use of unnecessary materials and implementing more efficient use of recycling programs. Telemedicine has also emerged as a sustainable option, reducing the carbon footprint associated with patient travel. Despite these advancements, significant challenges remain, particularly in balancing the cost and accessibility of sustainable options with traditional practices.

Summary: Eco-sustainability in ophthalmology is gaining momentum as the medical community aims to reduce its environmental impact. While progress has been made, further efforts are required to overcome financial and logistical barriers to widespread implementation. Continued research, education, and policy development are essential to advancing eco-sustainable practices, ensuring that environmental considerations become an integral part of ophthalmic care.

Purpose of review: The advent of minimally invasive glaucoma surgery (MIGS) procedures has ushered in a new era of interventional glaucoma. MIGS has expanded the treatment options for surgeons necessitating a rethinking of the optimal management strategy for patients with glaucoma.

Recent findings: There are several new MIGS devices and procedures available to glaucoma surgeons. With several options available, patient selection is crucial to maximize the utility of MIGS in the context of traditional glaucoma surgery.

Summary: A management algorithm is presented based on our practice pattern to help guide decision-making for glaucoma surgeons. Although we encourage surgeons to continue to broaden their toolkit, we emphasize the continued importance of teaching the next-generation traditional glaucoma surgery in the MIGS era. Future prospective studies are warranted to elucidate the optimal treatment strategy for patients with glaucoma.

Purpose of review: Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 ▪▪ ] . The objective of this review is to review management options for symptomatic vitreous floaters.

Recent findings: Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 ▪▪ ,3,4] .

Summary: This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.

Purpose of review: This review highlights treatment options, both under investigation and currently available, for the treatment of dry age-related macular degeneration (AMD). An update on current clinical studies for dry AMD has been summarized.

Recent findings: Advanced dry AMD, characterized by geographic atrophy (GA), is a leading cause of blindness in the developed world, though prior to 2023 there was no approved treatment. There are now two approved treatments in the United States for GA. Additionally, there are several studies and trials to investigate therapeutic potential and effects of therapies for earlier intervention in dry AMD. Approaches to therapy include inhibiting the complement system, utilizing gene therapy, stem cell therapy, laser therapy, and surgical implants.

Summary: While there has been notable prior advancement in the treatment for neovascular or wet AMD, for the first time there are Food and Drug Administration (FDA) approved treatments for GA. Clinical studies have shown promise for additional methods for managing dry AMD both medically and surgically.

Purpose of review: In recent years, the field of aesthetic medicine has witnessed a paradigm shift with an increasing demand for minimally invasive cosmetic procedures, including cosmetic injectables. This review aims to delineate the distinctive role played by oculoplastic surgeons in the administration of cosmetic injectables, comparing their expertise to that of nonphysician practitioners.

Recent findings: Complications arising from cosmetic injections are discussed, including skin discoloration, inflammation, necrosis, vision loss, retinal pathology, and central nervous system adverse effects. Injector expertise, patient factors, type of filler, location of injection, and management strategies are reviewed. Findings highlight diverse practitioner involvement, common adverse effects like skin necrosis and vision loss, with hyaluronic acid fillers being prominent. Areas at the highest risk for ocular complication include the glabella and nose with potential management involving dissolving fillers and reducing pressure. Emphasis is placed on expert injector selection and patient awareness.

Summary: The administration of cosmetic injectables requires a profound understanding of facial anatomy, vasculature, and potential complications. In contrast to nonphysician practitioners, oculoplastic and aesthetic surgeons bring a level of anatomical precision and clinical acumen that is essential for navigating the complexities of cosmetic injectables. Emphasis on training and collaboration among practitioners will be essential in advancing the field while prioritizing patient safety and satisfaction.

Purpose of review: To discuss available premium intraocular lenses (IOLs), patient selection, and important considerations for each premium IOL.

Recent findings: We review important topics and considerations for premium IOL selection: specifically, toric, extended depth of focus (EDOF), multifocal/trifocal, light adjustable lenses (LALs), and small aperture IOLs. Toric lenses are an excellent option for patients with astigmatism. However, to achieve optimal patient satisfaction, it is critical to account for the ATR astigmatism contribution from the posterior cornea and high angle alphas. Additionally, examining the ocular surface prior to placement of EDOF/multifocal IOLs is important, yet the significance of HOAs on outcomes after implantation still must be elucidated more. Finally, recent studies reveal that the small aperture lens is a good alternative for those with corneal irregularities, and second generation LALs are a great option to achieve target refractions in those with less predictable refractive outcomes, such as in Fuchs' dystrophy or in eyes with previous refractive surgery.

Purpose of review: Large language models (LLMs) are rapidly entering the landscape of medicine in areas from patient interaction to clinical decision-making. This review discusses the evolving role of LLMs in ophthalmology, focusing on their current applications and future potential in enhancing ophthalmic care.

Recent findings: LLMs in ophthalmology have demonstrated potential in improving patient communication and aiding preliminary diagnostics because of their ability to process complex language and generate human-like domain-specific interactions. However, some studies have shown potential for harm and there have been no prospective real-world studies evaluating the safety and efficacy of LLMs in practice.

Summary: While current applications are largely theoretical and require rigorous safety testing before implementation, LLMs exhibit promise in augmenting patient care quality and efficiency. Challenges such as data privacy and user acceptance must be overcome before LLMs can be fully integrated into clinical practice.

Purpose of review: To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease.

Recent findings: Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes.

Summary: Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.