Current Opinion in Ophthalmology最新文献

Purpose of review: This review compares two refractive surgery modalities, femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE), focusing on their efficacy, safety, postoperative recovery, and patient-reported outcomes. The aim is to provide an updated review of recent findings and identify areas for additional research to further optimize surgical outcomes and patient selection.

Recent findings: FS-LASIK and SMILE show excellent, comparable visual outcomes for the correction of myopia and astigmatism. SMILE may have a lower risk of dry eye and has no flap-related complications, while FS-LASIK provides quicker visual recovery. SMILE may offer superior long-term visual outcomes, particularly for high myopia. However, customized FS-LASIK (wavefront- and topography-guided) outperform SMILE in some visual metrics, including uncorrected visual acuity and reduction in higher-order aberrations.

Summary: FS-LASIK remains the gold standard refractive procedure due to its rapid recovery and predictable results, but SMILE offers advantages in preserving corneal biomechanical stability and potentially minimizing dry eye symptoms. SMILE may also offer improved long-term stability for patients at risk of myopic regression. However, a growing body of evidence suggests that wavefront- and topography-guided LASIK yield superior visual outcomes compared to SMILE. Additional long-term comparative studies are needed for different refractive treatment requirements.

Purpose of review: To summarize and evaluate the current literature concerning corneal complications associated with common vaccinations, particularly keratitis and corneal graft rejection following vaccination against SARS-CoV-2, Varicella-Zoster, and Influenza.

Recent findings: Small case series and reports have documented keratitis/herpesvirus reactivation and corneal graft rejection following vaccination, prompting concern from ophthalmologists regarding vaccination timing and management of patients. Recent population-based studies have reported higher risks of herpesvirus keratitis and herpes zoster ophthalmicus recurrence associated with the COVID-19 and varicella zoster vaccinations in rare cases, often in patients with identified risk factors. Similarly, corneal graft rejection rates appear to be stable following vaccination when compared with unvaccinated individuals, with the bulk of vaccine-associated rejection noted to occur with penetrating keratoplasties and in patients at a higher risk for rejection.

Summary: While the benefits of vaccination continue to outweigh the risks, clinicians must identify and balance patient-specific risk factors for corneal complications to inform individual management and counseling, potentially with heightened steroid use in the postvaccination period and more stringent follow up for signs of keratitis or graft rejection.

Purpose of review: In this review, we will address advances and limitations in the field of scleral lenses pertaining to the correction of irregular astigmatism.

Recent findings: There are reports on the benefits of scleral lenses for eyes with irregular astigmatism, particularly regarding improvement of visual acuity and the reduction of higher-order aberrations. Innovations such as wavefront-optimized and wavefront-guided optics can improve vision in keratoconus. Customized haptics, topographic and profilometric-based fitting, and impression-based design can achieve fit in problematic eyes with ectasia, after penetrating keratoplasty, and with corneal scarring. Challenges persist, including resource requirements for practitioners, patient difficulty with insertion and removal, and limitations to lens wear, including midday fogging and corneal edema. Risks such as graft failure persist.

Summary: Scleral lenses have emerged as a useful tool in the management of irregular astigmatism, reducing the need for penetrating keratoplasty. By vaulting the cornea and resting on the sclera, scleral lenses neutralize corneal astigmatism, while providing a stable and comfortable surface for advanced optics. Over the past two decades, the use of scleral lenses has increased, reflecting advances in fitting systems, expanded access, greater adoption by clinicians, broader patient eligibility, and improved clinical outcomes.

Purpose of review: The integration of artificial intelligence (AI) in the diagnosis and management of anterior segment diseases has rapidly expanded, demonstrating significant potential to revolutionize clinical practice.

Recent findings: AI technologies, including machine learning and deep learning models, are increasingly applied in the detection and management of a variety of conditions, such as corneal diseases, refractive surgery, cataract, conjunctival disorders (e.g., pterygium), trachoma, and dry eye disease. By analyzing large-scale imaging data and clinical information, AI enhances diagnostic accuracy, predicts treatment outcomes, and supports personalized patient care.

Summary: As AI models continue to evolve, particularly with the use of large models and generative AI techniques, they will further refine diagnosis and treatment planning. While challenges remain, including issues related to data diversity and model interpretability, AI's integration into ophthalmology promises to improve healthcare outcomes, making it a cornerstone of data-driven medical practice. The continued development and application of AI will undoubtedly transform the future of anterior segment ophthalmology, leading to more efficient, accurate, and individualized care.

Purpose of review: Keratoconus is one of the leading indications for corneal transplantation surgery. Although the surgical success rate is high, the long-term outcomes do not match other solid organ transplantation procedures. The availability of minimally invasive techniques has led to a reduction in the number of corneal transplantations in addition to improved visual outcomes in patients with keratoconus.

Recent findings: Collagen crosslinking slows down or stops disease progression in keratoconus. Customized contact lenses provide patient comfort and excellent visual outcomes. Bowman's layer onlay grafts have demonstrated promising outcomes in keratoconus patients. Corneal regeneration approaches provide hope as the next generation treatment option.

Summary: Minimally invasive treatments for keratoconus patients enable alternatives to corneal transplantation. This review summarizes some of the commonly used management approaches with a view into the future.

Purpose of review: This review aims to provide a comprehensive overview of the epidemiology and clinical features of pediatric blepharokeratoconjunctivitis (BKC), with a focus on elucidating the underlying pathophysiology and evaluating new therapeutic strategies.

Recent findings: Ongoing research continues to refine the management of pediatric BKC. Recent evidence suggests that disease remission can be achieved in approximately 95% of cases through an integrated approach involving topical or systemic antibiotics, corticosteroids, topical immunosuppressants, and lid hygiene. Notably, a significant advancement in the treatment of Demodex blepharitis is the FDA approval of 0.25% lotilaner ophthalmic solution, which has demonstrated safety and efficacy with twice-daily application over six weeks.

Summary: Pediatric blepharokeratoconjunctivitis is a chronic inflammatory condition affecting the eyelids, conjunctiva, and cornea. It is underdiagnosed and associated with significant vision-threatening complications. While there is no established consensus on the most effective therapeutic strategy, management currently includes lid hygiene, topical/systemic antibiotics, corticosteroids, immunosuppressants, lubricants, and dietary supplements. Challenges arise from its chronicity, recurrence, and lack of standardized treatment protocols. This underscores the importance of early diagnosis, education, and continued research on treatment methods to prevent severe outcomes.

Purpose of review: The purpose of this article is to provide a summary of in-office procedures available for dry eye treatment. Dry eye is a multifactorial condition of the ocular surface with increasing prevalence among patients. There have been advances in nonpharmacological treatment options for patients in recent years. Most of these new treatments are geared towards evaporative dry eye due to meibomian gland deficiency.

Recent findings: Standard treatment of dry eye usually starts with topical treatments, such as artificial tears and inflammation modulators. However, options have now broadened to in-office procedural treatments. Most devices and procedures available for dry eye syndrome focus on the health of the lid structures involved in tear secretion, specifically the meibomian glands. There are fewer procedural options that address aqueous deficiency dry eye cases. The recent recall in over-the-counter eye drops may have caused patients to research nonpharmacological alternatives.

Summary: There are now numerous nonpharmacological options for dry eye therapy. A range of thermal devices are used for the purpose of assisting in meibomian gland expression. Intense pulsed light (IPL) is also a popular therapy option. In addition to thermal properties to melt the meibum, it also has the benefit of an anti-inflammatory effect. Radiofrequency can be used in combination with IPL. Meibomian gland probing is an option as a rejuvenator for improving meibomian gland function. Treating aqueous deficiency dry eye still favors topical treatments, but the surgical procedure of salivary gland transplantation is occasionally used.

Purpose of review: To provide an overview of research from recent randomized clinical trials (RCTs) on novel binocular treatments for amblyopia, inherently designed to force binocular integration by simultaneous dichoptic stimulation. Second, to present an update on the most recent research.

Recent findings: In recent years, binocular treatments as either standalone or adjunct first-line therapies for amblyopia have been gaining acceptance, particularly for older patients and those who are either resistant to or noncompliant with traditional penalization therapy. The findings from a growing body of high-level clinical evidence are highlighted.

Summary: Clinically significant improvements in visual acuity and stereopsis can be achieved with binocular therapy. Several of these therapies are commercially available and have consistently shown noninferiority over standard patching treatment or full-time refractive correction. The data suggest binocular treatments should be considered as standalone or adjunct first-line therapy. However, more research is necessary to support some reports of superiority and long-term stability of gains, and to establish specific clinical recommendations with consideration of patient's age and amblyopia etiology.

Purpose of review: Proliferative vitreoretinopathy (PVR) is a severe complication of retinal detachment and trauma, posing significant challenges to surgical success and visual prognosis. Despite advancements in vitreoretinal surgery, PVR incidence remains unchanged, this review presents a synthesis of the principal clinical and preclinical research findings from recent years.

Recent findings: Recent research has focused on anti-inflammatory, antiproliferative, and antifibrotic agents. Corticosteroids, such as triamcinolone and dexamethasone, show promise in reducing inflammation but have inconsistent results. Methotrexate and mitomycin C demonstrate efficacy in preclinical and select clinical scenarios. Anti-vascular endothelial growth factor agents and immunotherapies, like infliximab, have shown limited clinical benefits despite promising preclinical data. Novel approaches, including CB2 receptor agonists, exosome-based drug delivery, and nuclear factor kappa B pathway inhibitors, are gaining traction. Additionally, RNA-based and multitargeted therapies highlight the importance of addressing inflammation, fibrosis, and proliferation simultaneously.

Summary: Effective management of PVR requires multifaceted therapies targeting its complex pathogenesis. While current treatments are limited, ongoing research in precision drug delivery and combination therapies offers hope for improved outcomes. Future strategies should focus on translating promising preclinical findings into robust clinical applications.

Purpose of review: The goal of this review is to summarize emerging clinical trial and real world evidence for faricimab and high dose aflibercept (8 mg), two recently approved treatments for wet age-related macular degeneration and diabetic macular edema.

Recent findings: Faricimab, a bispecific monoclonal antibody targeting vascular endothelial growth factor (VEGF) and angiopoietin-2, and high-dose aflibercept have demonstrated significant potential for extending treatment intervals while maintaining efficacy. Pivotal clinical trials such as YOSEMITE, and RHINE established faricimab to be noninferior to standard anti-VEGF therapy with superior durability. Real-world data corroborated these results, demonstrating improved anatomic outcomes with extended treatment intervals, though improvements in best corrected visual acuity (BCVA) remains varied. High-dose aflibercept has similarly demonstrated noninferiority in landmark clinical trials such as PHOTON and PULSAR, with extended dosing intervals. However, comprehensive real-world data for high dose aflibercept remains limited and warrants further investigation.

Summary: Both faricimab and high-dose aflibercept show promise in reducing treatment burden for wet age-related macular degeneration and diabetic macular edema through extended dosing intervals while maintaining or improving clinical outcomes compared to standard anti-VEGF therapy. Faricimab has demonstrated this both in clinical trials as well as real-world studies, while high-dose aflibercept has demonstrated similar durability in trials but requires additional real-world evidence.