Clinical and Experimental Ophthalmology最新文献

Intraocular metastases represent the most common type of malignant intraocular tumour in adults. These commonly affect the choroid but can also involve the iris, ciliary body, retina, vitreous, optic disc or lens. Breast and lung cancer are the most common origins of intraocular metastases. The diagnosis of intraocular metastases can be particularly challenging in patients without a prior history of cancer. Furthermore, treatment decisions may be complex, especially in individuals already receiving systemic therapy or in those with previous ocular treatment history. Herein, we present a review of the current knowledge regarding the epidemiology, origins, clinical and imaging characteristics, differential diagnosis and treatment of intraocular metastases.

Background: Current evidence on incidence and progression rate of diabetic retinopathy reveals disparities across Australasia, and no pooled estimates are available to guide region-wide planning. This review and meta-analysis assesses the overall incidence, determinants and progression of diabetic retinopathy in Australasia.

Methods: This systematic review followed the Joanna Briggs Institute manual for incidence synthesis. Articles were sourced from Ovid MEDLINE, Scopus, Web of Science, CINAHL, ProQuest and PsycINFO until October 2024. Articles reporting incidence, progression, and determinants of type 2 diabetes in Australia and surrounding islands were included.

Results: Nine cohorts, including seven population-based and two institution-based cohort studies, predominantly from Australia, were analysed. The pooled annual incidence of diabetic retinopathy was 4.22% (95% CI 2.29-6.15), while individual studies reported annual progression from 3.08% to 18.22%. Incident diabetic retinopathy was associated with elevated fasting blood glucose, haemoglobin A1c, systolic blood pressure and increasing connecting peptide levels. Diabetic retinopathy progression was associated with increasing age, higher haemoglobin A1c levels, fasting blood glucose, longer duration of diabetes, an increased albumin-creatinine ratio and no fenofibrate treatment.

Conclusion: Diabetic retinopathy incidence in Australasia is highly variable, highest in institution-based cohorts and among Indigenous Australians. HbA1c is the only determinant consistently and significantly associated with both onset and progression. Because most evidence predates modern diabetes care, future prospective cohorts should adopt standardised, multifactorial designs to generate contemporary, comparable data and reduce persistent inequities in eye-care access.

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionised the treatment of neovascular age-related macular degeneration (nAMD), significantly improving visual outcomes and enhancing the quality of life for affected patients. However, the decision to discontinue anti-VEGF therapy in nAMD management remains complex and lacks consensus, with various criteria being applied. This narrative review examines the available evidence on the cessation of anti-VEGF treatment in nAMD in detail.

Background: The objective of this study was to compare the burden of treatment of different primary treatment modalities for unilateral sporadic retinoblastoma.

Methods: Sixty individuals with unilateral sporadic retinoblastoma were treated at the Royal Children's Hospital Melbourne, Australia, between January 2000 and December 2022. All International Classification of Retinoblastoma (ICRB) staging groups were included for analysis. The total number of anaesthetics and the total number of other hospital visits were calculated. The data was stratified by primary treatment modality and time from diagnosis (less than 12 months vs. beyond 12 months). The minimum follow-up period was 12 months from diagnosis.

Results: Average age at presentation was 24.85 ± 16.47 months. Forty children (66.7%) presented with ICRB Group E disease, 15 (25%) with Group D, 4 (6.7%) with Group C and 1 (1.6%) with Group B Disease. Forty-six (76.7%) children underwent primary enucleation, 9 (15%) underwent primary intravenous chemotherapy (IVC) and 5 (8.3%) were treated with intra-arterial chemotherapy (IAC). In the first 12 months following diagnosis, all measures of treatment burden were higher in children who underwent chemotherapy (intravenous or intra-arterial) compared to enucleation, except the number of ophthalmology outpatient appointments. Beyond 12 months of diagnosis, all measures of treatment burden were higher in children who underwent chemotherapy compared to enucleation alone, except the total number of anaesthetics and the number of day admissions. There were no deaths.

Conclusion: Globe-conserving therapies, such as primary IVC and IAC, are associated with a significantly higher burden of treatment compared to primary enucleation in the management of unilateral sporadic retinoblastoma.

Background: The University of Sydney 'Microsurgical Skills Course' (MSC) was made mandatory to the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Vocational Training Program in 2023. This study evaluates the MSC impact on first-year ophthalmology trainees' cataract surgical performance compared to those who did not complete the MSC.

Methods: This retrospective study analysed de-identified RANZCO surgical logbook data and EyeSi survey responses from first-year trainees across Australia and New Zealand. The intervention cohort (2023-2024 first-year trainees) completed the MSC, while the control cohort (2022 first-year trainees) did not. Data included demographics, prior surgical experience, number of cataract surgeries, surgical role, senior surgeon takeovers and intraoperative complications.

Results: Among 112 trainees (intervention = 77; control = 35), 11 613 cataract surgeries were recorded during the first 12 months of training. By 3 months, trainees in the intervention cohort performed more cataract surgeries (36.2 ± 22.6 vs. 26.0 ± 17.4, p = 0.017), assumed more senior roles in surgery (p < 0.001), required fewer senior surgeon takeovers (p < 0.001) and had a lower rate of posterior capsule tear (PCT) (1.3% vs. 2.9%, p < 0.001) compared to the control cohort. By 12 months, cataract surgery numbers and PCT rates (1.4% vs. 1.8%; p = 0.186) were similar; however, the intervention cohort still held a higher rate of leading surgical roles (p < 0.001) and less senior surgeon takeover (p < 0.001).

Conclusions: The MSC accelerates early surgical proficiency while improving patient safety. This resource will serve as a foundation for assessing surgical outcomes beyond cataract surgery and extending past the first 12 months of training.

Background: Intraocular lens implantation in children with insufficient zonular support can be challenging. Scleral-fixated intraocular lens (SFIOL) implantation can be useful in these cases. We aim to report the visual and refractive outcomes of four-point sutured SFIOL in children.

Methods: A retrospective review of children who underwent primary or secondary four-point SFIOL using Akreos AO60 or Luxgood intraocular lens with polytetrafluoroethylene monofilament (PTFE, Gore-Tex) at Queensland Children's Hospital, Brisbane, Australia.

Results: Fifty-three eyes of 31 children were included for review. The mean age of SFIOL implantation was 7.86 ± 3.71 years. The median follow-up time was 24 months (IQR 35, range 1-77). The majority of children had subluxed crystalline lenses secondary to Marfan syndrome (44 eyes, 83.02%). Best corrected visual acuity (BCVA) was maintained or improved from the preoperative BCVA in 92.6% of eyes. Median postoperative BCVA improved to logMAR 0.2 (IQR 0.16) at 1-year follow-up (p < 0.01). Compared to target refraction, the postoperative refraction was more myopic, but this was not statistically significant. In 33 eyes that had more than 1 year of follow-up, residual refractive error was within 1.00D for 21 eyes, within 2.00D for 7 eyes, within 3.00D for 3 eyes and greater than 3.00D for 2 eyes. Retinal detachment occurred in three eyes (5.66%). Asymptomatic IOL tilt/decentration was noted in one eye (1.88%).

Conclusions: Four-point SFIOL implantation using Gore-Tex suture offered excellent visual and refractive outcomes. Postoperative complications were rare and there were no new cases of amblyopia during the follow-up period.