Clinical and Experimental Ophthalmology最新文献

Background: Repeated low-level red-light (RLRL) therapy is a novel, non-invasive intervention for controlling paediatric myopia progression. Despite increasing clinical use, questions remain regarding the magnitude, durability, and safety of treatment effects. This study evaluated its efficacy and safety based on randomised controlled trial (RCT) evidence.

Methods: PubMed, Embase, and the Cochrane Library were searched through August 2025 for RCTs comparing RLRL with control in children (< 18 years). The primary outcome was spherical equivalent refraction (SER); secondary outcomes included axial length (AL), choroidal thickness (ChT), anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), and uncorrected visual acuity (UCVA). Evidence certainty was assessed using the GRADE framework.

Results: Twenty-eight RCTs (3573 participants) were included. RLRL therapy achieved duration-dependent myopia control (p < 0.05), with pooled improvements versus control at 12 months of +0.68 D in SER, -0.30 mm in AL, and +26.7 μm in ChT. Subgroup analysis showed greater efficacy in children with higher baseline myopia (p < 0.0001), with comparable effects between 5- and 7-day regimens. UCVA was higher with RLRL therapy. ACD, CCT, and LT were unchanged. Reported adverse events were mild and transient, with no consistent structural or functional abnormalities described.

Conclusions: RLRL was associated with duration-dependent reductions in myopia progression up to 1 year. Reported structural parameters remained stable and adverse events were generally mild. Moderate-certainty evidence supports improvement in SER and ChT, whereas evidence for AL remains of lower certainty. Longer-term trials incorporating comprehensive retinal safety assessment are required.

Trial registration: PROSPERO CRD420251112677.

Background: Evaluation of long-term changes in the vitreoretinal interface in patients with retinopathy of prematurity (ROP) using ultrawide-field optical coherence tomography (OCT). This cross-sectional single-centre study included children with a history of ROP treated with either a single dose of intravitreal bevacizumab (IVB), laser photocoagulation (LPC), or those with spontaneous regression (SR).

Methods: Ultrawide-field OCT imaging was performed using an Optos Silverstone Swept Source-OCT device. Vitreoretinal abnormalities, including those in the former ridge area, vitreous veils, tractions, and adhesions, were grouped as 'vitreoretinal interface abnormalities'. The images were evaluated for these abnormalities.

Results: This study enrolled 188 eyes of 94 patients (76 eyes of 38 children, IVB group; 40 eyes of 28 children, LPC group; 72 eyes of 44 children, SR group). The prevalence of vitreoretinal interface abnormalities was 73.2% and 44.4% in the IVB and SR groups, respectively. All the patients in the LPC group showed abnormalities in laser and non-laser retinal areas.

Conclusion: Ultrawide-field OCT revealed various vitreoretinal interface abnormalities in patients with a history of ROP. Long-term follow-up and OCT evaluation of the peripheral retina, even without structural abnormalities on following examinations, may help prevent outcomes such as retinal detachment. Treatment of detected lesions remains uncertain.

Non-arteritic anterior ischaemic optic neuropathy (NAION) is the most common acute optic neuropathy in individuals over 50 years and presents with sudden, painless vision loss. However, due to the limited phenotypic repertoire of optic nerve injury, other conditions can closely mimic NAION, leading to diagnostic uncertainty. This review outlines the key clinical, imaging and systemic features that help differentiate NAION from its major masquerades, including arteritic anterior ischaemic optic neuropathy, demyelinating optic neuritis, autoimmune and granulomatous diseases, hereditary optic neuropathies, incipes and vascular abnormalities. Particular attention is given to the diagnostic pitfalls and red flags that should prompt reconsideration of the diagnosis. A hypothesis-driven approach based on history, examination and targeted investigations is essential to avoid misdiagnosis and inappropriate management. Recognising atypical features early can significantly alter prognosis and guide timely and appropriate therapy.

Background: To evaluate the clinical outcomes of femtosecond laser-created corneal allogenic intrastromal ring segments (femto-CAIRS) in keratoconic eyes using a newly described nomogram.

Methods: This retrospective case series recruited 85 eyes from 75 patients. Corrected and uncorrected visual acuity (CDVA/UDVA), refractive error, corneal topography, and higher-order aberrations were measured prior to surgery and ≥ 3 months postoperatively. All CAIRS were created using a femtosecond laser and the Brisbane nomogram was used to determine segment width, thickness, arc length, implantation axis and channel depth based on individual corneal topography.

Results: The mean follow-up time was 7.5 ± 5.0 months; 18 eyes had prior cross-linking (CXL), 30 underwent simultaneous CXL, and 37 had no CXL. Postoperatively, UDVA improved by 0.4 logMAR (p < 0.001) and CDVA by 0.2 logMAR (p < 0.001). There was an improvement of 5 or more lines in 31 eyes (43.7%), 8 eyes (11.3%) had no change in UDVA, 1 eye lost 1 line, and 1 eye lost 2 lines. There was a significant reduction in the mean spherical equivalent, refractive astigmatism, flat K, steep K, mean K, and KMax, and an improvement in total higher order aberrations and vertical coma (all p < 0.001). Reduction in KMax was greater in eyes that underwent simultaneous CXL compared to those without CXL (-4.28D vs. -0.70D; p = 0.018). No significant complications occurred.

Conclusions: Femto-CAIRS guided by the Brisbane nomogram provides a tailored treatment approach that improved visual acuity and regularisation of the central cornea. Further studies are required to validate our nomogram and clarify the effect of cross-linking on CAIRS.

Background: The retina, part of the central nervous system, reflects brain pathology. In Alzheimer's disease (AD), it shows changes like amyloid beta (Aβ) accumulation and vascular alterations. Pericytes modulate the glymphatic system, crucial for Aβ clearance, but their role in the ocular glymphatic system is unclear. This study explores pericytes' impact on the glymphatic system and AD-related retinal pathology.

Methods: APP/PS1 mice, a model of progressive Aβ deposition, were crossed with Pdgfr-β^+/- mice, which exhibit pericyte dysfunction due to haploinsufficiency of platelet-derived growth factor receptor β (Pdgfr-β), generating four littermate genotypes: wild type, Pdgfr-β^+/-, APP/PS1 and APP/PS1:Pdgfr-β^+/-. Retinal pericytes were assessed by PDGFR-β and NG 2 labelling, vascular complexity by OCTA and CD31 immunostaining and glymphatic-related regulation by laminin-211 and perivascular aquaporin-4 (AQP-4) expression. Retinal Aβ and p-Tau pathology was evaluated by immunofluorescence. Retinal Aβ clearance was assessed in wild type and Pdgfr-β^+/- mice using intravitreal FAM-Aβ (1-42) injection followed by quantification of tracer efflux along the optic nerve to the deep cervical lymph nodes.

Results: Pdgfr-β knockdown exacerbated retinal pericyte loss, leading to reduced laminin-211 expression, disrupted perivascular AQP-4 polarisation and impaired ocular glymphatic Aβ clearance. Consequently, this disruption is associated with increased Aβ and p-Tau pathology, reduced vascular complexity and thinning of the retinal layers in APP/PS1 mice.

Conclusions: The loss of retinal pericytes is one of the major factors in retinal pathology associated with AD. It exacerbates Aβ and p-Tau pathology and causes retinal vascular and structural damage by affecting the function of the ocular glymphatic system.

Background: To compare the efficacy of repeated low-level red light (RLRL) and high-concentration atropine (HCA, 1%) in myopia control and evaluate rebound effects after cessation.

Methods: In this 15-month, prospective, single-blinded randomized controlled trial, 136 myopic children (6-12 years) were randomly assigned to RLRL or HCA (1:1). Treatment lasted 12 months followed by a 3-month washout. Outcomes included change in axial length (AL), spherical equivalent refraction (SER), subfoveal choroidal thickness (SFChT), and safety.

Results: A total of 116 children completed ≥ 1 follow-up (RLRL: 65, HCA: 51). At 12 months, RLRL showed superior efficacy: AL regressed by -0.014 mm (95% CI: -0.067 to 0.039) versus a 0.094 mm increase with HCA (95% CI: 0.046-0.141; p = 0.005). SER decreased by 0.24 D (95% CI: 0.093-0.387) in RLRL and increased by 0.035 D (95% CI: -0.154 to 0.083) in HCA (p = 0.008), while SFChT increased by 26.000 μm (95% CI: 18.082-33.918) and 12.761 μm (95% CI: 3.867-21.655; p = 0.032), respectively. During the 3-month washout, AL elongation was slightly greater in RLRL (0.163 mm) compared to HCA (0.115 mm; p = 0.014). Higher compliance (≥ 75%) with RLRL correlated with better 12-month efficacy (AL: -0.064 mm vs. 0.084 mm; p = 0.011) but worse rebound (AL: 0.183 mm vs. 0.122 mm; p = 0.02). No severe adverse events were reported.

Conclusions: RLRL exhibited superior 12-month efficacy over HCA (1%) but was associated with slightly higher rebound. Optimizing RLRL regimens, including implementing reduced dosing and tapered withdrawal, could sustain benefits while limiting rebound.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2100051940.