Clinical and Experimental Ophthalmology最新文献

Background: To develop and validate various models to predict total keratometry (TK) power vector components TKC0 and TKC45 from classical keratometry (K) KC0 and KC45 based on a large dataset of pre cataract surgery IOLMaster 700 measurements.

Methods: Retrospective cross-sectional multicentric study evaluating a dataset containing 13 6378 IOLMaster 700 measurements including K and TK. Left eyes were mirrored about the facial axis. Based on 80% training data, we developed a global and segmented constant model (CM and CMS), a global and segmented (according to the angle A1 of the flat keratometric meridian) linear model (LM and LMS), a harmonic model (HM) and compared these to a classical constant (CMR) and linear models (LMR) segmented into with-the-rule, against-the-rule and oblique astigmatism. The performance was cross-validated using the root-mean-squared model fit error (RMSE).

Results: In the 20% test data, RMSE was 0.173 D before correction and was reduced by 40%-42% to 0.100 and 0.104 D with the correction models. The segmented models performed slightly better than the global models, and the linear models performed slightly better than the constant models. With the individually adjusted changepoints, the CMS and LMS performed slightly better than the reference models CMR and LMR. There was no systematic difference between the RMSE with training and test data, indicating no overfit of the models.

Conclusion: As the performance is quite similar for all tested correction models, we recommend using a simple global constant model to predict TK vector components. This could easily be implemented in any consumer software.

Background: To compare the anatomical and functional outcomes of internal limiting membrane (ILM) flap and conventional ILM peeling in idiopathic full-thickness macular holes (FTMHs).

Methods: Retrospective cohort study of all eyes treated with vitrectomy and ILM peeling (ILM-P) with or without ILM flap (ILM-F) for primary idiopathic FTMH repair in the Australian and New Zealand Society of Retinal Specialists (ANZSRS) Registry between 2006 and 2023. Propensity score weighting and multivariable regression analysis adjusted for baseline characteristics and covariates, including surgeon grade, lens status, and follow-up duration, were used to evaluate hole closure rate and best corrected visual acuity (BCVA) change at 3 months.

Results: Two thousand nine hundred ninety eyes of 2905 patients were included (mean age 69 ± 9 years). One Hundred Ninety-nine eyes underwent ILM-F and 2871 underwent ILM-P. On weighted multivariable regression analysis, ILM-F showed higher odds of hole closure compared to ILM-P (OR = 2.97, 95% CI: 1.08-8.20, p = 0.04). The adjusted closure rate was > 95% across all hole sizes in the ILM-F group, while only falling below 90% for X-large + holes (> 550 μm) in the ILM-P group. No significant difference in BCVA gain was observed between the two groups at 3 months (p = 0.08). The effects of ILM-F compared to ILM-P were consistent across all hole sizes.

Conclusions: Although the ILM-F technique was more effective in idiopathic FTMH closure, visual acuity outcomes were comparable to conventional ILM peeling. These findings suggest that ILM-F is not required for the treatment of small and medium FTMHs.

Background: Both age-related macular degeneration (AMD) and inherited retinal disease (IRD) can present with outer retinal atrophy at the macula. Distinguishing between IRD and geographic atrophy (GA) secondary to AMD is important for appropriate management, particularly as disease-specific treatments become available. This study investigates the utility of genetic testing for suspected IRDs in individuals with atypical macular atrophy.

Methods: Twenty-four participants aged over 50, presenting with macular atrophy atypical for AMD, underwent clinical assessments, multimodal retinal imaging and exome-based sequencing covering known IRD genes. Three retinal ophthalmologists reviewed genetic and clinical data to reach a consensus for the underlying cause of macular atrophy and identified a set of features that challenge an AMD diagnosis and suggest a higher likelihood of an IRD.

Results: The panel judged 58% of atypical atrophy cases as likely being an IRD. Of these suspected cases, 57% (33% of the entire cohort) received IRD genetic confirmation (PRPH2, ABCA4 or MT-TL1 [m.3243A>G]-related IRD). The remaining cases were classified as GA (29%) or did not reach consensus on the likely diagnosis (13%). Clinical features aiding in the differentiation of IRD from GA included symptom onset before age 50, family history, distinctive autofluorescence patterns (speckled, reticular or widespread), extensive atrophy and absence of subretinal drusen.

Conclusion: IRD genetic testing is valuable if a positive identification is achieved, but negative results neither rule out IRD nor confirm AMD. Limitations in our ability to robustly differentiate IRD-related atrophy from GA, especially in advanced lesions, need further research to improve diagnostic accuracy.

Background: To assess financial disclosures of American ophthalmology society board members by comparing self-reported disclosures with industry-reported payments and examining characteristics linked to larger financial relationships.

Methods: In this retrospective, cross-sectional study, we assessed all governance board members from American ophthalmology societies in December 2022. Board composition was identified from society websites, payment data from the Open Payments database, and conflict of interest (COI) policies from IRS Form 990 filings. Outcomes included concordance between self- and industry-reported disclosures, payment values, gender and subspecialty differences and academic characteristics.

Results: Among 871 board members from 66 societies, 566 (65.0%) had industry-reported relationships, yet only 22 (2.5%) disclosed COIs on society websites. In 2022, 13 187 payments totaling $57.8 million were reported, with 79.5% related to research. Most societies reported internal COI policies (77.8%) and annual disclosure requirements (75.6%) via IRS filings. Men received significantly higher median payments than women ($217.5 vs. $43.3; p < 0.001). Retina specialists accounted for the largest share of payment value (55.3%), while paediatric ophthalmologists received the least (0.4%). Board members with research payments had higher academic productivity (median h-index: 19 vs. 8; p < 0.001).

Conclusions: Public reporting of board members' financial relationships on ophthalmology society websites was uncommon, likely reflecting differences in society-level disclosure practices rather than individual nondisclosure. These findings underscore an opportunity for societies to enhance transparency by adopting more consistent, transparent COI reporting practices in ophthalmology governance.

Geographic atrophy (GA) causes significant vision impairment and reduction in vision-related quality of life. Fundus autofluorescence (FAF) is the gold standard of structural assessment of GA but is a surrogate marker for vision loss, which can be assessed by tests of visual function and functional vision. Best corrected visual acuity (BCVA), the most commonly used visual function test in ophthalmology, is a poor metric for assessing GA progression. This is because GA usually only affects the fovea in its late stage, grows slowly, and spared areas of retina may not 'fit' larger reading chart letters, confounding measurements. For this reason, tests of visual function have been developed, including low luminance visual acuity (LLVA), reading speed, contrast sensitivity, microperimetry, flicker perimetry, and dark adaptation. Functional vision measures are approximated through patient-reported outcomes using various questionnaires. This review explores the strength of association between FAF and tests of visual function in patients with GA. A range of targeted, prespecified endpoints of visual function testing should be included in future clinical trials for treatments of GA, focusing on GA lesion phenotypes that are known to progress rapidly in order to maximise the likelihood of identifying positive results. This is critical in jurisdictions where proof of functional benefit is required for regulatory approval of treatments for GA.

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.