Background: This study aimed to present the genetic profile of a rare ocular disease nanophthalmos (NO) in a large Chinese cohort, to explore its genetic characteristics and genotype-phenotype correlations.
Methods: A total of 43 unrelated pedigrees diagnosed with NO were recruited. Whole exome sequencing and copy number variation analysis were performed, followed by validation and pathogenicity classification of the detected variants.
Results: The overall genetic diagnostic rate was 60.5%. Twenty-eight unique genetic variants of MFRP, PRSS56, and MYRF have been identified, of which 19 were reported for the first time. The c.1486G>A variant in MFRP and the c.1066dupC variant in PRSS56 were the two most frequent variants. Patients with variants in MFRP or PRSS56 tended to possess shorter axial lengths than those with MYRF variants. Among patients with MFRP null variants, a higher proportion developed uveal effusion syndrome (UES) than did those without null variants, whereas among patients with PRSS56 null variants, a greater number of patients developed angle-closure glaucoma (ACG). A higher proportion of MFRP-related NO patients developed both UES and ACG.
Conclusions: MFRP, PRSS56, and MYRF account for the majority of genetic causes of NO. MFRP-related NO patients tend to exhibit a strong predisposition to complications. Null variants in MFRP and PRSS56 may increase susceptibility to clinical complications. This study provides insights into the genetic landscape and clinical characteristics of NO. These findings will lead to a better understanding of the mechanisms underlying nanophthalmos and other diseases associated with eye development.
背景:本研究旨在展示一种罕见眼病纳米眼(NO)在中国大样本人群中的遗传特征,探讨其遗传特征和基因表型相关性:本研究的目的是在一个庞大的中国队列中展示一种罕见眼病纳米眼(NO)的遗传特征,探讨其遗传特性以及基因型与表型之间的相关性:方法:共收集了43个确诊为纳米眼病的非亲缘血统。方法:共收集了 43 个确诊为 NO 的非亲缘血统样本,进行了全外显子组测序和拷贝数变异分析,并对检测到的变异进行了验证和致病性分类:结果:总体基因诊断率为 60.5%。结果:总体基因诊断率为 60.5%,发现了 28 个独特的 MFRP、PRSS56 和 MYRF 基因变异,其中 19 个为首次报道。MFRP 中的 c.1486G>A 变异和 PRSS56 中的 c.1066dupC 变异是最常见的两种变异。MFRP或PRSS56变异的患者往往比MYRF变异的患者拥有更短的轴长。在 MFRP 空变异的患者中,发生葡萄膜渗出综合征(UES)的比例高于无空变异的患者,而在 PRSS56 空变异的患者中,发生闭角型青光眼(ACG)的人数较多。MFRP相关NO患者中同时患上UES和ACG的比例较高:结论:MFRP、PRSS56 和 MYRF 占 NO 遗传病因的大多数。结论:MFRP、PRSS56 和 MYRF 占 NO 遗传病因的大多数。MFRP和PRSS56的无效变异可能会增加临床并发症的易感性。这项研究为了解 NO 的遗传情况和临床特征提供了深入的见解。这些发现将有助于更好地了解纳米眼和其他与眼发育相关的疾病的发病机制。
{"title":"MFRP, PRSS56, and MYRF account for 60.5% of a Chinese cohort with nanophthalmos.","authors":"Jing Tao, Zi-Bing Jin, Ren-Juan Shen","doi":"10.1111/ceo.14465","DOIUrl":"https://doi.org/10.1111/ceo.14465","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to present the genetic profile of a rare ocular disease nanophthalmos (NO) in a large Chinese cohort, to explore its genetic characteristics and genotype-phenotype correlations.</p><p><strong>Methods: </strong>A total of 43 unrelated pedigrees diagnosed with NO were recruited. Whole exome sequencing and copy number variation analysis were performed, followed by validation and pathogenicity classification of the detected variants.</p><p><strong>Results: </strong>The overall genetic diagnostic rate was 60.5%. Twenty-eight unique genetic variants of MFRP, PRSS56, and MYRF have been identified, of which 19 were reported for the first time. The c.1486G>A variant in MFRP and the c.1066dupC variant in PRSS56 were the two most frequent variants. Patients with variants in MFRP or PRSS56 tended to possess shorter axial lengths than those with MYRF variants. Among patients with MFRP null variants, a higher proportion developed uveal effusion syndrome (UES) than did those without null variants, whereas among patients with PRSS56 null variants, a greater number of patients developed angle-closure glaucoma (ACG). A higher proportion of MFRP-related NO patients developed both UES and ACG.</p><p><strong>Conclusions: </strong>MFRP, PRSS56, and MYRF account for the majority of genetic causes of NO. MFRP-related NO patients tend to exhibit a strong predisposition to complications. Null variants in MFRP and PRSS56 may increase susceptibility to clinical complications. This study provides insights into the genetic landscape and clinical characteristics of NO. These findings will lead to a better understanding of the mechanisms underlying nanophthalmos and other diseases associated with eye development.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmelo Z Macri, Christopher X Wong, Samuel J Tu, David F Sun, Robert Casson, Kuldev Singh, Sophia Wang, Michelle T Sun
Background: We sought to investigate the association between obesity, metabolic syndrome, and metabolic health with incident primary open-angle glaucoma (POAG).
Methods: We included 103 249 UK Biobank participants without previously diagnosed glaucoma or glaucoma-related procedures at enrolment. The primary outcome was POAG identified from diagnostic coding via linked hospital inpatient and primary care data. We used multivariable Cox regression to evaluate the association of body mass index (BMI), and the interaction with metabolic syndrome (MetS) and a novel definition of metabolic health status with incident POAG. BMI was modelled as a time-varying coefficient. Multivariable analysis was adjusted for age, sex, ethnicity, intraocular pressure, spherical equivalent, polygenic risk score and stratified by the presence of primary care data.
Results: There were 647 events of incident POAG over 464 117 580 person-years and a mean follow-up of 12.6 years. At baseline (time = 0), each one unit increase in BMI was associated with a 9% lower hazard of incident glaucoma (HR 0.91, CI 0.86-0.97, p = 0.0066). Further, compared to a normal BMI range of 18.5-24 kg/m2, a BMI ≥30 kg/m2 was associated with a 65% relative hazard reduction (HR 0.35, CI 0.16-0.80, p = 0.012). There was no significant interaction between BMI and metabolic syndrome or metabolic health (all p > 0.05).
Conclusion: The effect of BMI on the risk of incident POAG varied with time. Higher BMI was associated with a decreased risk of incident POAG in this large prospective cohort. There was no significant association with systemic metabolic health.
{"title":"Association of obesity and metabolic syndrome with incident primary open angle glaucoma in the UK Biobank.","authors":"Carmelo Z Macri, Christopher X Wong, Samuel J Tu, David F Sun, Robert Casson, Kuldev Singh, Sophia Wang, Michelle T Sun","doi":"10.1111/ceo.14467","DOIUrl":"10.1111/ceo.14467","url":null,"abstract":"<p><strong>Background: </strong>We sought to investigate the association between obesity, metabolic syndrome, and metabolic health with incident primary open-angle glaucoma (POAG).</p><p><strong>Methods: </strong>We included 103 249 UK Biobank participants without previously diagnosed glaucoma or glaucoma-related procedures at enrolment. The primary outcome was POAG identified from diagnostic coding via linked hospital inpatient and primary care data. We used multivariable Cox regression to evaluate the association of body mass index (BMI), and the interaction with metabolic syndrome (MetS) and a novel definition of metabolic health status with incident POAG. BMI was modelled as a time-varying coefficient. Multivariable analysis was adjusted for age, sex, ethnicity, intraocular pressure, spherical equivalent, polygenic risk score and stratified by the presence of primary care data.</p><p><strong>Results: </strong>There were 647 events of incident POAG over 464 117 580 person-years and a mean follow-up of 12.6 years. At baseline (time = 0), each one unit increase in BMI was associated with a 9% lower hazard of incident glaucoma (HR 0.91, CI 0.86-0.97, p = 0.0066). Further, compared to a normal BMI range of 18.5-24 kg/m<sup>2</sup>, a BMI ≥30 kg/m<sup>2</sup> was associated with a 65% relative hazard reduction (HR 0.35, CI 0.16-0.80, p = 0.012). There was no significant interaction between BMI and metabolic syndrome or metabolic health (all p > 0.05).</p><p><strong>Conclusion: </strong>The effect of BMI on the risk of incident POAG varied with time. Higher BMI was associated with a decreased risk of incident POAG in this large prospective cohort. There was no significant association with systemic metabolic health.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pablo Ballester Dolz, Karin Ålander, Petra Smedberg, Per Vihlborg, Ing-Liss Bryngelsson, Jessica Westerlund, Karim Makdoumi
Background: Chronic kidney disease (CKD) is a growing health issue that is becoming more prevalent globally, increasing financial cost on healthcare systems. The purpose of this study is to investigate the incidence of eye diseases in patients diagnosed with CKD in Sweden and to evaluate which eye diseases are most likely to develop.
Methods: A longitudinal population-based retrospective case-control study was conducted including all individuals diagnosed with chronic kidney disease during the time period 2001-2019. A total of 19 455 cases and 38 890 controls were included. For each case, two controls were matched with the same sex, age, and county of residence.
Results: CKD patients had a significantly higher risk of contracting any eye disease compared to individuals without kidney disease HR 1.73 (CI 1.67-1.79), with an elevated risk for all blocks of diagnoses except for glaucoma HR 0.95 (CI 0.85-1.06). However, this condition developed earlier in cases than in controls. Subanalyses showed an increased risk for chronic eye disease patients to develop cataract HR 1.70 (CI 1.63-1.78), other retinal disorders HR 1.86 (CI 1.72-2.02), and retinal vascular occlusions HR 2.08 (CI 1.73-2.51). In general, diagnosis of an eye disease occurred earlier in cases than controls.
Conclusions: The results from this study suggest that CKD patients have an increased risk to develop eye disease. Ocular disease seems to develop considerably earlier in CKD, even without staging the severity of the disease, with particularly high risk of developing retinal diseases and cataracts. Screening for eye disease in CKD should be considered.
{"title":"Eye diseases in chronic kidney disease: A nationwide longitudinal case-control study in Sweden.","authors":"Pablo Ballester Dolz, Karin Ålander, Petra Smedberg, Per Vihlborg, Ing-Liss Bryngelsson, Jessica Westerlund, Karim Makdoumi","doi":"10.1111/ceo.14464","DOIUrl":"https://doi.org/10.1111/ceo.14464","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a growing health issue that is becoming more prevalent globally, increasing financial cost on healthcare systems. The purpose of this study is to investigate the incidence of eye diseases in patients diagnosed with CKD in Sweden and to evaluate which eye diseases are most likely to develop.</p><p><strong>Methods: </strong>A longitudinal population-based retrospective case-control study was conducted including all individuals diagnosed with chronic kidney disease during the time period 2001-2019. A total of 19 455 cases and 38 890 controls were included. For each case, two controls were matched with the same sex, age, and county of residence.</p><p><strong>Results: </strong>CKD patients had a significantly higher risk of contracting any eye disease compared to individuals without kidney disease HR 1.73 (CI 1.67-1.79), with an elevated risk for all blocks of diagnoses except for glaucoma HR 0.95 (CI 0.85-1.06). However, this condition developed earlier in cases than in controls. Subanalyses showed an increased risk for chronic eye disease patients to develop cataract HR 1.70 (CI 1.63-1.78), other retinal disorders HR 1.86 (CI 1.72-2.02), and retinal vascular occlusions HR 2.08 (CI 1.73-2.51). In general, diagnosis of an eye disease occurred earlier in cases than controls.</p><p><strong>Conclusions: </strong>The results from this study suggest that CKD patients have an increased risk to develop eye disease. Ocular disease seems to develop considerably earlier in CKD, even without staging the severity of the disease, with particularly high risk of developing retinal diseases and cataracts. Screening for eye disease in CKD should be considered.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this issue of CEO, Ng et al.<span><sup>1</sup></span> explore ophthalmologists' attitudes to performing immediate sequential bilateral cataract surgery (ISBCS) with a survey of ophthalmologists in Singapore. The study also looks at ophthalmologist's appetite for ISBCS around the world, from a low of 13.9% performing this type of surgery in the United Kingdom to a high of 86% among Kaiser Permanente ophthalmologists in an HMO model in the United States. In Singapore, 27.6% practise ISBCS, and the most commonly cited reason being convenience for patients and faster rehabilitation.</p><p>Well, why not?</p><p>Dr Michael Goggin<span><sup>2</sup></span> in an editorial on the same subject in 2015 concluded ‘when we are at a point where complication rates are as low as can be achieved, when we have access, for instance to a routinely commercially available prophylactic intracameral antibiotic, when surgeons learn that they can trust their biometers and IOL power formulas, then perhaps we may be persuaded to move to ISBCS’.</p><p>Is it reasonable for us, nearly a decade later, to consider whether that time has arrived?</p><p>The most recent data from Australia is a snapshot of current practice from a survey by Sutton and Hodge.<span><sup>3</sup></span> The feedback on this survey was provided by 194 RANZCO Fellows. Only 4.1% of ophthalmologists offered ISBCS, and of those who did perform it, 69% offered it in 5%–10% of their patients. It would appear to be the lowest rate of ISBCS in the world!</p><p>The current RANCZO guidelines<span><sup>4</sup></span> question the quality of evidence regarding ISBCS and leaves the decision with the surgeon and the patient without giving specific advice.</p><p>There are essentially three arguments against ISBCS. The first is the risk of bilateral simultaneous postoperative endophthalmitis, and the second is the risk of bilateral simultaneous toxic anterior segment syndrome. The third is possible inaccurate intraocular lens selection in the first eye, implying that lens selection in the second eye can be improved with knowledge of the result from the first eye. This could involve the power of the IOL (spherical and/or toric error) or the type of IOL, for example, is the patient going to tolerate a presbyopia correcting IOL with complex optics such as a trifocal or EDOF in the first eye before deciding whether to implant a similar or different IOL in the second eye. I argued that the IOL power issue could no longer be taken seriously in a chapter written in a textbook on ISBCS.<span><sup>6</sup></span> If this was a serious argument, the time between surgeries would be a minimum of 6 weeks to be truly certain of the refractive result in the first eye. Even surgeons who are opposed to ISBCS do not argue for this time interval between surgeries. With modern formulae, tear film optimisation, and better surgical techniques for toric intraocular lens orientation, the delay on accuracy grounds, for the majority of routin
{"title":"Is it time to consider how we approach bilateral same-day cataract surgery?","authors":"Michael Lawless FRANZCO","doi":"10.1111/ceo.14436","DOIUrl":"10.1111/ceo.14436","url":null,"abstract":"<p>In this issue of CEO, Ng et al.<span><sup>1</sup></span> explore ophthalmologists' attitudes to performing immediate sequential bilateral cataract surgery (ISBCS) with a survey of ophthalmologists in Singapore. The study also looks at ophthalmologist's appetite for ISBCS around the world, from a low of 13.9% performing this type of surgery in the United Kingdom to a high of 86% among Kaiser Permanente ophthalmologists in an HMO model in the United States. In Singapore, 27.6% practise ISBCS, and the most commonly cited reason being convenience for patients and faster rehabilitation.</p><p>Well, why not?</p><p>Dr Michael Goggin<span><sup>2</sup></span> in an editorial on the same subject in 2015 concluded ‘when we are at a point where complication rates are as low as can be achieved, when we have access, for instance to a routinely commercially available prophylactic intracameral antibiotic, when surgeons learn that they can trust their biometers and IOL power formulas, then perhaps we may be persuaded to move to ISBCS’.</p><p>Is it reasonable for us, nearly a decade later, to consider whether that time has arrived?</p><p>The most recent data from Australia is a snapshot of current practice from a survey by Sutton and Hodge.<span><sup>3</sup></span> The feedback on this survey was provided by 194 RANZCO Fellows. Only 4.1% of ophthalmologists offered ISBCS, and of those who did perform it, 69% offered it in 5%–10% of their patients. It would appear to be the lowest rate of ISBCS in the world!</p><p>The current RANCZO guidelines<span><sup>4</sup></span> question the quality of evidence regarding ISBCS and leaves the decision with the surgeon and the patient without giving specific advice.</p><p>There are essentially three arguments against ISBCS. The first is the risk of bilateral simultaneous postoperative endophthalmitis, and the second is the risk of bilateral simultaneous toxic anterior segment syndrome. The third is possible inaccurate intraocular lens selection in the first eye, implying that lens selection in the second eye can be improved with knowledge of the result from the first eye. This could involve the power of the IOL (spherical and/or toric error) or the type of IOL, for example, is the patient going to tolerate a presbyopia correcting IOL with complex optics such as a trifocal or EDOF in the first eye before deciding whether to implant a similar or different IOL in the second eye. I argued that the IOL power issue could no longer be taken seriously in a chapter written in a textbook on ISBCS.<span><sup>6</sup></span> If this was a serious argument, the time between surgeries would be a minimum of 6 weeks to be truly certain of the refractive result in the first eye. Even surgeons who are opposed to ISBCS do not argue for this time interval between surgeries. With modern formulae, tear film optimisation, and better surgical techniques for toric intraocular lens orientation, the delay on accuracy grounds, for the majority of routin","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":"52 8","pages":"795-796"},"PeriodicalIF":4.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ceo.14436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Continuing Professional Development","authors":"","doi":"10.1111/ceo.14458","DOIUrl":"10.1111/ceo.14458","url":null,"abstract":"","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":"52 8","pages":"897-899"},"PeriodicalIF":4.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fred K. Chen PhD, FRANZCO, Rachael C. Heath Jeffery MPH, MChD, Adrian T. Fung MMed, FRANZCO
<p>Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is a well-established therapeutic option for neovascular age-related macular degeneration (nAMD),<span><sup>1</sup></span> diabetic macular oedema (DMO)<span><sup>2</sup></span> and retinal vein occlusion (RVO).<span><sup>3</sup></span> The number of Medicare claims for intravitreal injections (item#42738) has increased from 181 140 to 621 001 per annum from 2012 to 2022; the equivalent of 8–24 injections per 1000 population-year.<span><sup>4</sup></span> This is increase is due to, in part, the expanding indications and improved patient access. With the rapidly growing demand, advances in treatments and models of care are essential to provide sufficient service delivery to patients requiring intravitreal therapy (IVT). Broadly, the considerations of an IVT service can be divided into pharmacologic agents, treatment regimens, drug delivery, staffing, treatment setup and complications management.</p><p>Newer pharmacological agents show promise for increased durability. Faricimab (Vabysmo) allows treatment intervals of up to 16 weeks in around 60% of patients after 2 years of treatment for nAMD<span><sup>5</sup></span> and DMO.<span><sup>6</sup></span> Aflibercept 8 mg (Eylea HD) allows for maintenance of 16 week treatment intervals in 70% of nAMD patients and 84% of DMO patients after 2 years of treatment, with 28% of nAMD patients even meeting criteria for 24 week intervals. A direct comparison between these two agents cannot be made, as true head-to-head studies are yet to be conducted and the treatment and extension criteria for their pivotal phase III studies differed.</p><p>Monthly administration is not feasible nor necessary in all patients. Compared with fixed dosing, a treat-and-extend (T&E) regimen has been shown to reduce the treatment burden without compromising efficacy in patients requiring anti-VEGF agents for nAMD.<span><sup>7</sup></span> There is less consensus for treatment regimens in treating DMO, although a recent systematic review supports the use of T&E in this disease too.<span><sup>8</sup></span></p><p>The port delivery system (PDS) allows at least a six monthly refill-exchange,<span><sup>9</sup></span> but has a higher rate of endophthalmitis than intravitreal injections at around 2%,<span><sup>10</sup></span> and does not necessarily reduce visit burden as the device itself requires surveillance for local complications. Intraocular gene therapy (intravitreal, subretinal or suprachoroidal) holds the promise of lifelong treatment,<span><sup>11</sup></span> but this has been associated with up to a 21%–45% rate of vector-related uveitis.<span><sup>12</sup></span></p><p>Worldwide, the vast majority of intravitreal injections are still performed by ophthalmologists. Variances in this model are seen in some centres in the UK and Singapore, where nurses can administer intravitreal injections under ophthalmology supervision. Virtual AMD cl
{"title":"Bringing Mohammad to the mountain: New strategies for intravitreal therapy service delivery","authors":"Fred K. Chen PhD, FRANZCO, Rachael C. Heath Jeffery MPH, MChD, Adrian T. Fung MMed, FRANZCO","doi":"10.1111/ceo.14457","DOIUrl":"10.1111/ceo.14457","url":null,"abstract":"<p>Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is a well-established therapeutic option for neovascular age-related macular degeneration (nAMD),<span><sup>1</sup></span> diabetic macular oedema (DMO)<span><sup>2</sup></span> and retinal vein occlusion (RVO).<span><sup>3</sup></span> The number of Medicare claims for intravitreal injections (item#42738) has increased from 181 140 to 621 001 per annum from 2012 to 2022; the equivalent of 8–24 injections per 1000 population-year.<span><sup>4</sup></span> This is increase is due to, in part, the expanding indications and improved patient access. With the rapidly growing demand, advances in treatments and models of care are essential to provide sufficient service delivery to patients requiring intravitreal therapy (IVT). Broadly, the considerations of an IVT service can be divided into pharmacologic agents, treatment regimens, drug delivery, staffing, treatment setup and complications management.</p><p>Newer pharmacological agents show promise for increased durability. Faricimab (Vabysmo) allows treatment intervals of up to 16 weeks in around 60% of patients after 2 years of treatment for nAMD<span><sup>5</sup></span> and DMO.<span><sup>6</sup></span> Aflibercept 8 mg (Eylea HD) allows for maintenance of 16 week treatment intervals in 70% of nAMD patients and 84% of DMO patients after 2 years of treatment, with 28% of nAMD patients even meeting criteria for 24 week intervals. A direct comparison between these two agents cannot be made, as true head-to-head studies are yet to be conducted and the treatment and extension criteria for their pivotal phase III studies differed.</p><p>Monthly administration is not feasible nor necessary in all patients. Compared with fixed dosing, a treat-and-extend (T&E) regimen has been shown to reduce the treatment burden without compromising efficacy in patients requiring anti-VEGF agents for nAMD.<span><sup>7</sup></span> There is less consensus for treatment regimens in treating DMO, although a recent systematic review supports the use of T&E in this disease too.<span><sup>8</sup></span></p><p>The port delivery system (PDS) allows at least a six monthly refill-exchange,<span><sup>9</sup></span> but has a higher rate of endophthalmitis than intravitreal injections at around 2%,<span><sup>10</sup></span> and does not necessarily reduce visit burden as the device itself requires surveillance for local complications. Intraocular gene therapy (intravitreal, subretinal or suprachoroidal) holds the promise of lifelong treatment,<span><sup>11</sup></span> but this has been associated with up to a 21%–45% rate of vector-related uveitis.<span><sup>12</sup></span></p><p>Worldwide, the vast majority of intravitreal injections are still performed by ophthalmologists. Variances in this model are seen in some centres in the UK and Singapore, where nurses can administer intravitreal injections under ophthalmology supervision. Virtual AMD cl","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":"52 8","pages":"797-799"},"PeriodicalIF":4.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ceo.14457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To evaluate the safety of repeated low-level red-light (RLRL) therapy in children, and the dynamic evolution of choroidal and retinal blood flow.
Methods: This is a single-centre, randomised, single-blind, parallel-group clinical trial. Seventy myopic children were randomly assigned to either the intervention group [receiving RLRL therapy plus single-vision spectacle (SVS)] or the control group (wearing SVS). Participants underwent comprehensive ophthalmic examinations following their first irradiation, 9 months continuous RLRL therapy and stop of treatment. Quantitative analyses of choroidal and retinal microcirculation were analysed via optical coherence tomography angiography.
Results: Over 9 months of treatment, while the RLRL treatment demonstrated significantly less increases in refractive error and axial length compared with the SVS treatment (ps < 0.05), no abnormalities in fundus structure or visual function (mfERG, VEP and microperimetry) were detected (ps > 0.05). A single red-light exposure did not exert a significant influence on choroidal thickness (ps > 0.05). Upon continuous treatment, the RLRL group achieved peak values in these circulations at 9 months (ps < 0.05). Following cessation of exposure, all circulations exhibited a declining trend, reaching similar levels in both groups (ps > 0.05). As the frequency of red-light exposures intensified, there was a consistent surge in these circulations (ps < 0.05).
Conclusions: Nine months of continuous RLRL exposure does not cause toxic side effects on retinal or optic nerve functions, and there is a time-dependent cumulative response in choroidal and retinal circulation.
{"title":"Safety of and chorioretinal circulation during repeated low-level red-light therapy for myopic children.","authors":"Zhaoxin Jiang, Shuyu Chen, Renchun Wang, Jin Ma","doi":"10.1111/ceo.14462","DOIUrl":"https://doi.org/10.1111/ceo.14462","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the safety of repeated low-level red-light (RLRL) therapy in children, and the dynamic evolution of choroidal and retinal blood flow.</p><p><strong>Methods: </strong>This is a single-centre, randomised, single-blind, parallel-group clinical trial. Seventy myopic children were randomly assigned to either the intervention group [receiving RLRL therapy plus single-vision spectacle (SVS)] or the control group (wearing SVS). Participants underwent comprehensive ophthalmic examinations following their first irradiation, 9 months continuous RLRL therapy and stop of treatment. Quantitative analyses of choroidal and retinal microcirculation were analysed via optical coherence tomography angiography.</p><p><strong>Results: </strong>Over 9 months of treatment, while the RLRL treatment demonstrated significantly less increases in refractive error and axial length compared with the SVS treatment (ps < 0.05), no abnormalities in fundus structure or visual function (mfERG, VEP and microperimetry) were detected (ps > 0.05). A single red-light exposure did not exert a significant influence on choroidal thickness (ps > 0.05). Upon continuous treatment, the RLRL group achieved peak values in these circulations at 9 months (ps < 0.05). Following cessation of exposure, all circulations exhibited a declining trend, reaching similar levels in both groups (ps > 0.05). As the frequency of red-light exposures intensified, there was a consistent surge in these circulations (ps < 0.05).</p><p><strong>Conclusions: </strong>Nine months of continuous RLRL exposure does not cause toxic side effects on retinal or optic nerve functions, and there is a time-dependent cumulative response in choroidal and retinal circulation.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mark B Beecher, Carmelo Macri, Pravin Hissaria, Weng Onn Chan
{"title":"Unnecessary duplication of human leukocyte antigen testing for uveitis in an Australian tertiary hospital.","authors":"Mark B Beecher, Carmelo Macri, Pravin Hissaria, Weng Onn Chan","doi":"10.1111/ceo.14459","DOIUrl":"https://doi.org/10.1111/ceo.14459","url":null,"abstract":"","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shi-Nan Wu, Xiao-Dong Chen, Dan Yan, Yu-Qian Wang, Shao-Pan Wang, Wen-Ying Guan, Caihong Huang, Jiaoyue Hu, Zuguo Liu
Background: This study aims to assess the risk of drug-associated glaucoma and track its epidemiological characteristics using real-world data.
Methods: Adverse event reports from the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to December 2023 were analysed. Disproportionality analysis and the Bayesian Confidence Propagation Neural Network algorithm were used. The study classified drugs associated with glaucoma, assessed risk levels, and compared drug-induced times across different categories.
Results: Eight hundred and five drugs were linked to glaucoma in the FAERS database. Disproportionality analysis identified 46 drugs with significant risk, mainly adrenergic medications (clobetasol propionate, fluocinolone acetonide), antihypertensives (hydrochlorothiazide), insulin (insulin human), anticholinergics (umeclidinium, darifenacin), VEGF inhibitors (brolucizumab, faricimab), and psychotropics (topiramate, ziprasidone). The top three high-risk drugs were clobetasol propionate, umeclidinium, and fluocinolone acetonide. The shortest drug-induced times were observed with indacaterol, salmeterol, and umeclidinium. Anticholinergic medications had the shortest drug-induced time among all categories. Females (62.5%) and the elderly (average age 63.5 ± 16.8 years) were predominantly affected. Reports of drug-associated glaucoma increased over the years.
Conclusion: Preventing drug-associated glaucoma is more effective than treatment. Identifying the risk and drug-induced times of systemic and ophthalmic drugs can reduce occurrence risk. Clinical practitioners should be vigilant and inform patients of these risks.
{"title":"Drug-associated glaucoma: A real-world study based on the Food and Drug Administration adverse event reporting system database.","authors":"Shi-Nan Wu, Xiao-Dong Chen, Dan Yan, Yu-Qian Wang, Shao-Pan Wang, Wen-Ying Guan, Caihong Huang, Jiaoyue Hu, Zuguo Liu","doi":"10.1111/ceo.14454","DOIUrl":"https://doi.org/10.1111/ceo.14454","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the risk of drug-associated glaucoma and track its epidemiological characteristics using real-world data.</p><p><strong>Methods: </strong>Adverse event reports from the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to December 2023 were analysed. Disproportionality analysis and the Bayesian Confidence Propagation Neural Network algorithm were used. The study classified drugs associated with glaucoma, assessed risk levels, and compared drug-induced times across different categories.</p><p><strong>Results: </strong>Eight hundred and five drugs were linked to glaucoma in the FAERS database. Disproportionality analysis identified 46 drugs with significant risk, mainly adrenergic medications (clobetasol propionate, fluocinolone acetonide), antihypertensives (hydrochlorothiazide), insulin (insulin human), anticholinergics (umeclidinium, darifenacin), VEGF inhibitors (brolucizumab, faricimab), and psychotropics (topiramate, ziprasidone). The top three high-risk drugs were clobetasol propionate, umeclidinium, and fluocinolone acetonide. The shortest drug-induced times were observed with indacaterol, salmeterol, and umeclidinium. Anticholinergic medications had the shortest drug-induced time among all categories. Females (62.5%) and the elderly (average age 63.5 ± 16.8 years) were predominantly affected. Reports of drug-associated glaucoma increased over the years.</p><p><strong>Conclusion: </strong>Preventing drug-associated glaucoma is more effective than treatment. Identifying the risk and drug-induced times of systemic and ophthalmic drugs can reduce occurrence risk. Clinical practitioners should be vigilant and inform patients of these risks.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zachary McPherson, Deepali Thosar, Amie Donnelly, Nadine Shaw, Julia Starte, Michael Jones, Shefali Jani
Background: Paediatric periorbital cellulitis, a common eye condition, typically requires inpatient admission for intravenous antibiotics due to concerns about orbital spread. This study aimed to assess the safety and effectiveness of ambulatory management for children with moderate periorbital cellulitis.
Methods: Over a 24-month period, we prospectively enrolled 84 children aged 1 to 16 years who presented with moderate periorbital cellulitis to the emergency department. Demographic and clinical data were collected. Following a guideline-based decision tree, eligible children received intravenous antibiotics and were discharged with a peripheral cannula for follow-up in ambulatory care and ophthalmology clinics. Descriptive statistics were used for data presentation.
Results: Among the 84 children, 62 (73.8%) were managed through the ambulatory care model. Within the category of moderate POC, those who were admitted to the hospital did not have higher CRP or White Cell counts and received IV antibiotics for the same length of time. The ambulatory care clinic provided a total of 132 daily doses of intravenous antibiotics. Two children treated on this pathway required inpatient admission due to clinical deterioration, one of whom required ophthalmic surgical intervention. There was no mortality or sight-threatening complications in this study.
Conclusions: Implementing a directed ambulatory care pathway for children with moderate periorbital cellulitis proved to be an effective and safe management strategy. This approach reduces the strain on hospital bed occupancy while promoting community-based patient care.
{"title":"Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective single centre cohort study.","authors":"Zachary McPherson, Deepali Thosar, Amie Donnelly, Nadine Shaw, Julia Starte, Michael Jones, Shefali Jani","doi":"10.1111/ceo.14455","DOIUrl":"https://doi.org/10.1111/ceo.14455","url":null,"abstract":"<p><strong>Background: </strong>Paediatric periorbital cellulitis, a common eye condition, typically requires inpatient admission for intravenous antibiotics due to concerns about orbital spread. This study aimed to assess the safety and effectiveness of ambulatory management for children with moderate periorbital cellulitis.</p><p><strong>Methods: </strong>Over a 24-month period, we prospectively enrolled 84 children aged 1 to 16 years who presented with moderate periorbital cellulitis to the emergency department. Demographic and clinical data were collected. Following a guideline-based decision tree, eligible children received intravenous antibiotics and were discharged with a peripheral cannula for follow-up in ambulatory care and ophthalmology clinics. Descriptive statistics were used for data presentation.</p><p><strong>Results: </strong>Among the 84 children, 62 (73.8%) were managed through the ambulatory care model. Within the category of moderate POC, those who were admitted to the hospital did not have higher CRP or White Cell counts and received IV antibiotics for the same length of time. The ambulatory care clinic provided a total of 132 daily doses of intravenous antibiotics. Two children treated on this pathway required inpatient admission due to clinical deterioration, one of whom required ophthalmic surgical intervention. There was no mortality or sight-threatening complications in this study.</p><p><strong>Conclusions: </strong>Implementing a directed ambulatory care pathway for children with moderate periorbital cellulitis proved to be an effective and safe management strategy. This approach reduces the strain on hospital bed occupancy while promoting community-based patient care.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}