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MFRP, PRSS56, and MYRF account for 60.5% of a Chinese cohort with nanophthalmos. MFRP、PRSS56 和 MYRF 在中国纳米眼病患者中占 60.5%。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-21 DOI: 10.1111/ceo.14465
Jing Tao, Zi-Bing Jin, Ren-Juan Shen

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。
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引用次数: 0
Association of obesity and metabolic syndrome with incident primary open angle glaucoma in the UK Biobank. 英国生物库中肥胖和代谢综合征与原发性开角型青光眼发病率的关系。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-18 DOI: 10.1111/ceo.14467
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.

背景:我们试图研究肥胖、代谢综合征和代谢健康与原发性开角型青光眼(POAG)发病之间的关系:我们纳入了 103 249 名英国生物库参与者,他们在入组时均未被诊断为青光眼或进行过青光眼相关手术。主要结果是通过关联医院住院病人和初级保健数据的诊断编码确定的 POAG。我们使用多变量 Cox 回归评估了体重指数 (BMI) 与代谢综合征 (MetS) 之间的关系,以及代谢健康状况的新定义与发病 POAG 之间的关系。体重指数被模拟为时变系数。多变量分析对年龄、性别、种族、眼压、球面等值、多基因风险评分进行了调整,并根据是否有初级保健数据进行了分层:在 464 117 580 人年和平均 12.6 年的随访中,共发生了 647 例 POAG 事件。在基线(时间 = 0),体重指数每增加一个单位,青光眼的发病风险就会降低 9%(HR 0.91,CI 0.86-0.97,P = 0.0066)。此外,与正常体重指数范围(18.5-24 kg/m2)相比,体重指数≥30 kg/m2与相对危险降低65%有关(HR 0.35,CI 0.16-0.80,p = 0.012)。BMI与代谢综合征或代谢健康之间没有明显的交互作用(均 p > 0.05):结论:体重指数对POAG发病风险的影响随时间而变化。在这一大型前瞻性队列中,较高的体重指数与发生 POAG 的风险降低有关。与全身代谢健康没有明显关系。
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引用次数: 0
Eye diseases in chronic kidney disease: A nationwide longitudinal case-control study in Sweden. 慢性肾脏病患者的眼部疾病:瑞典全国性纵向病例对照研究。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-17 DOI: 10.1111/ceo.14464
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.

背景:慢性肾脏病(CKD)是一个日益严重的健康问题,在全球范围内越来越普遍,增加了医疗系统的经济成本。本研究的目的是调查瑞典被诊断为慢性肾脏病患者的眼部疾病发病率,并评估哪些眼部疾病最有可能发生:方法:我们开展了一项基于人群的纵向回顾性病例对照研究,研究对象包括 2001-2019 年期间被诊断为慢性肾脏病的所有患者。共纳入 19 455 例病例和 38 890 例对照。每个病例有两个性别、年龄和居住地相同的对照组:结果:与无肾脏病的人相比,慢性肾脏病患者罹患任何眼病的风险都明显较高,HR 为 1.73(CI 为 1.67-1.79),除青光眼外,其他所有诊断风险都较高,HR 为 0.95(CI 为 0.85-1.06)。然而,病例中青光眼的发病时间早于对照组。子分析表明,慢性眼病患者患白内障的风险增加 HR 1.70(CI 1.63-1.78),患其他视网膜疾病的风险增加 HR 1.86(CI 1.72-2.02),患视网膜血管闭塞的风险增加 HR 2.08(CI 1.73-2.51)。总体而言,病例比对照组更早诊断出眼部疾病:本研究结果表明,慢性肾脏病患者罹患眼部疾病的风险增加。即使不对疾病的严重程度进行分期,慢性肾脏病患者的眼部疾病似乎也会更早发生,尤其是视网膜疾病和白内障的发病风险更高。应考虑对慢性肾脏病患者进行眼部疾病筛查。
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引用次数: 0
Is it time to consider how we approach bilateral same-day cataract surgery? 现在是考虑如何进行双侧当天白内障手术的时候了吗?
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-11 DOI: 10.1111/ceo.14436
Michael Lawless FRANZCO
<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
我认为,迈克尔-戈金博士在 2015 年理智地提出的论点已在很大程度上得到了解决,现在要做的是改变经济激励措施,鼓励而不是阻止 ISBCS,并就最佳方案达成共识,以指导我们如何开展此类手术,造福患者和我们更广泛的社会。
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引用次数: 0
Continuing Professional Development 继续职业发展。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-11 DOI: 10.1111/ceo.14458
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引用次数: 0
Bringing Mohammad to the mountain: New strategies for intravitreal therapy service delivery 把默罕默德带到山上:提供玻璃体内治疗服务的新策略。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-11 DOI: 10.1111/ceo.14457
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
玻璃体内注射抗血管内皮生长因子(VEGF)药物是治疗新生血管性老年黄斑变性(nAMD)1、糖尿病性黄斑水肿(DMO)2 和视网膜静脉闭塞(RVO)3 的一种行之有效的方法。4 这一增长的部分原因是适应症的扩大和患者就医途径的改善。随着需求的快速增长,治疗方法和护理模式的进步对于为需要进行玻璃体内治疗(IVT)的患者提供充足的服务至关重要。从广义上讲,IVT 服务的考虑因素可分为药剂、治疗方案、给药、人员配备、治疗设置和并发症管理。6 Aflibercept 8 毫克(Eylea HD)可使 70% 的 nAMD 患者和 84% 的 DMO 患者在治疗 2 年后维持 16 周的治疗间隔,其中 28% 的 nAMD 患者甚至达到了 24 周治疗间隔的标准。这两种药物之间无法进行直接比较,因为真正的头对头研究尚未进行,而且这两种药物的关键性 III 期研究的治疗和延长标准也不尽相同。与固定剂量相比,治疗和延长(T&amp;E)方案已被证明可在不影响疗效的情况下减轻需要使用抗血管内皮生长因子药物治疗 nAMD 的患者的治疗负担。口腔给药系统(PDS)至少可以 6 个月更换一次填充物,9 但眼内炎的发生率比玻璃体内注射高,约为 2%,10 而且不一定能减轻就诊负担,因为该装置本身需要对局部并发症进行监测。眼内基因治疗(玻璃体内、视网膜下或脉络膜上)有望实现终生治疗11 ,但与载体相关的葡萄膜炎发生率高达 21%-45%12 。这种模式在英国和新加坡的一些中心有所不同,在这些中心,护士可以在眼科医生的监督下进行玻璃体内注射。英国 60% 以上的眼科部门都采用了虚拟 AMD 诊所。13 家庭监控与人工智能相结合,有可能将治疗方式转变为 PRN 方案,从而减轻就诊负担。为此,Notal Vision Home OCT SCANLY® 于 2024 年 5 月获得了美国食品药品管理局 (FDA) 的批准。在本期杂志中,Lee 等人14 报道了我们为西澳大利亚农村地区的初级医务人员提供玻璃体内注射的新方法。静脉注射率相当于每千人年注射 6 次;明显低于 2022 年全国和州平均水平(分别为每千人年 24 次和 19 次)。为了解决西澳大利亚偏远地区缺乏眼科医生进行静脉注射的问题,由Lions Outback Vision(LOV)培训的非眼科专科培训项目初级医务人员进行了玻璃体内注射。LOV 初级医务人员的注射程序与 Lee 等人在澳大利亚和新西兰从业人员调查中描述的程序相似15。所有患者均使用结膜下木质素卡因(64% 的 Lee 等人调查对象使用过)。15 不使用窥器、卡钳和抗生素,从而减少了碳足迹和 IVT 设置的浪费,16, 17 尽管有证据表明使用窥器可降低眼内炎的发生率18。本系列报告中的治疗适应症是以总注射次数的比例而非眼球或患者的数量来表示的。因此,很难确定 DMO 占主导地位(46%)是否反映了在 LOV 服务区就诊的糖尿病患者人数较多,或者由于每月进行 IVT 和频繁的双侧疾病,每位糖尿病患者需要进行更多的治疗。
{"title":"Bringing Mohammad to the mountain: New strategies for intravitreal therapy service delivery","authors":"Fred K. Chen PhD, FRANZCO,&nbsp;Rachael C. Heath Jeffery MPH, MChD,&nbsp;Adrian T. Fung MMed, FRANZCO","doi":"10.1111/ceo.14457","DOIUrl":"10.1111/ceo.14457","url":null,"abstract":"&lt;p&gt;Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is a well-established therapeutic option for neovascular age-related macular degeneration (nAMD),&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; diabetic macular oedema (DMO)&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and retinal vein occlusion (RVO).&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;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&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; and DMO.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;Monthly administration is not feasible nor necessary in all patients. Compared with fixed dosing, a treat-and-extend (T&amp;E) regimen has been shown to reduce the treatment burden without compromising efficacy in patients requiring anti-VEGF agents for nAMD.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; There is less consensus for treatment regimens in treating DMO, although a recent systematic review supports the use of T&amp;E in this disease too.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The port delivery system (PDS) allows at least a six monthly refill-exchange,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; but has a higher rate of endophthalmitis than intravitreal injections at around 2%,&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; 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,&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; but this has been associated with up to a 21%–45% rate of vector-related uveitis.&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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}
引用次数: 0
Safety of and chorioretinal circulation during repeated low-level red-light therapy for myopic children. 近视儿童反复接受低强度红光治疗的安全性和脉络膜循环。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-11-05 DOI: 10.1111/ceo.14462
Zhaoxin Jiang, Shuyu Chen, Renchun Wang, Jin Ma

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.

背景:评估儿童反复接受低强度红光治疗的安全性以及脉络膜和视网膜血流的动态演变:评估儿童重复低强度红光(RLRL)治疗的安全性,以及脉络膜和视网膜血流的动态演变:这是一项单中心、随机、单盲、平行组临床试验。70 名近视儿童被随机分配到干预组(接受 RLRL 治疗和单视眼镜 (SVS))或对照组(佩戴 SVS)。参加者在首次接受照射、连续接受 RLRL 治疗 9 个月和停止治疗后接受了全面的眼科检查。通过光学相干断层血管造影术对脉络膜和视网膜微循环进行了定量分析:在 9 个月的治疗过程中,RLRL 治疗与 SVS 治疗相比,屈光不正和轴长的增加明显较少(PS 0.05)。单次红光照射对脉络膜厚度的影响不大(ps > 0.05)。持续治疗后,RLRL 组在 9 个月时达到了这些循环的峰值(ps 0.05)。随着红光照射频率的增加,这些环路的数值也在持续飙升(ps 结论:红光照射对视网膜厚度有显著影响(ps > 0.05):连续接触红光照射 9 个月不会对视网膜或视神经功能产生毒副作用,脉络膜和视网膜循环的累积反应与时间有关。
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引用次数: 0
Unnecessary duplication of human leukocyte antigen testing for uveitis in an Australian tertiary hospital. 澳大利亚一家三级医院对葡萄膜炎进行不必要的重复人类白细胞抗原检测。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-10-27 DOI: 10.1111/ceo.14459
Mark B Beecher, Carmelo Macri, Pravin Hissaria, Weng Onn Chan
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引用次数: 0
Drug-associated glaucoma: A real-world study based on the Food and Drug Administration adverse event reporting system database. 药物相关性青光眼:基于食品药品管理局不良事件报告系统数据库的真实世界研究。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-10-25 DOI: 10.1111/ceo.14454
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.

背景:本研究旨在利用真实世界的数据评估药物相关性青光眼的风险并追踪其流行病学特征:本研究旨在利用真实世界的数据评估药物相关性青光眼的风险并追踪其流行病学特征:方法:分析食品药品管理局不良事件报告系统(FAERS)2004年1月至2023年12月的不良事件报告。采用了比例失调分析和贝叶斯置信度传播神经网络算法。研究对与青光眼有关的药物进行了分类,评估了风险水平,并比较了不同类别药物的诱发时间:结果:FAERS 数据库中有 85 种药物与青光眼有关。比例失调分析确定了46种具有重大风险的药物,主要是肾上腺素能药物(丙酸氯倍他索、氟西诺龙醋酸酯)、降压药(氢氯噻嗪)、胰岛素(人胰岛素)、抗胆碱能药物(乌甲素、达非那新)、血管内皮生长因子抑制剂(brolucizumab、法利西单抗)和精神药物(托吡酯、齐拉西酮)。前三种高风险药物是丙酸氯倍他索、乌甲素和氟西酮缩丙酮。茚达特罗、沙美特罗和乌美利铵的药效时间最短。在所有类别中,抗胆碱能药物的药物诱导时间最短。受影响的主要是女性(62.5%)和老年人(平均年龄为 63.5 ± 16.8 岁)。药物相关性青光眼的报告逐年增加:结论:预防药物性青光眼比治疗更有效。结论:预防药物性青光眼比治疗更有效。识别全身用药和眼科用药的风险和药物诱发时间可降低发生风险。临床医师应提高警惕,告知患者这些风险。
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引用次数: 0
Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective single centre cohort study. 儿童中度眶周蜂窝织炎和家庭疗法评估(EPOCH 研究,第二部分):前瞻性单中心队列研究。
IF 4.9 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-10-23 DOI: 10.1111/ceo.14455
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.

背景:小儿眶周蜂窝织炎是一种常见的眼部疾病,由于担心眼眶扩散,通常需要住院静脉注射抗生素。本研究旨在评估门诊治疗中度眶周蜂窝织炎患儿的安全性和有效性:在 24 个月的时间里,我们对 84 名在急诊科就诊的 1-16 岁中度眶周蜂窝织炎患儿进行了前瞻性登记。我们收集了人口统计学和临床数据。根据基于指南的决策树,符合条件的患儿接受了静脉注射抗生素治疗,出院后在门诊和眼科诊所接受外周插管随访。数据采用描述性统计:结果:在 84 名儿童中,62 名(73.8%)通过非住院治疗模式进行了治疗。在中度POC类别中,入院治疗的患儿CRP或白细胞计数并不高,接受静脉注射抗生素的时间也相同。非住院治疗诊所每天共提供 132 剂静脉注射抗生素。在该路径下接受治疗的两名患儿因临床症状恶化而需要住院治疗,其中一名患儿需要接受眼科手术治疗。本研究中没有出现死亡或危及视力的并发症:结论:事实证明,对患有中度眶周蜂窝织炎的儿童实施非住院治疗路径是一种有效而安全的管理策略。这种方法在减少医院床位紧张的同时,也促进了以社区为基础的患者护理。
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Clinical and Experimental Ophthalmology
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