Clinical and Experimental Ophthalmology最新文献

Artificial intelligence (AI) has comparable accuracy to ophthalmologists for diabetic retinopathy (DR) screening, yet its cost-effectiveness is crucial for implementation. Our review of 18 health economic analyses of AI versus manual grading for DR found significant methodological variation, with cost-utility analysis and Markov modelling being the commonest evaluation and modelling approaches, respectively. We identified three key considerations when appraising health economic analyses of AI-enabled DR screening: the importance of contextualised parameters including subgroup analysis, real-world data on adherence to ophthalmology follow-up, and the trade-off between diagnostic accuracy and cost-effectiveness. 39% of studies followed standardised reporting guidelines, and most did not consider improved follow-up after AI screening, potentially underestimating its economic value. Future evaluations should incorporate contextualised parameters, including adherence and regional data, and recognise that the most accurate diagnostic screening may not reflect the most cost-effective. Studies should follow updated reporting guidelines such as CHEERS-AI or PICOTS-ComTeC to improve methodological transparency.

Background: The PAUL glaucoma implant (PGI) is a novel valveless glaucoma drainage device featuring a large endplate surface area to enhance aqueous absorption, as well as a smaller internal and external tube diameter to minimise postoperative hypotony and corneal endothelial damage, particularly in eyes with refractory glaucoma. This is the first meta-analysis on the clinical efficacy and safety of the PGI.

Methods: Medline, Embase and CENTRAL databases were searched for articles on the use of the PGI. A meta-analysis of single means and binary outcomes was conducted to assess clinical endpoints.

Results: A total of 15 studies with 640 eyes were analysed. At the 12 months postoperatively, the mean reduction in IOP and IOP-lowering medications from baseline were 16.11 mmHg (k = 13, n = 550, 95% CI: 12.91-19.31 mmHg, I² = 96.10%, p < 0.001) and 2.34 (k = 12, n = 482, 95% CI: 1.99-2.69, I² = 91.90%, p < 0.001), respectively. The mean complete and qualified success rates at 12 months postoperatively were 50.22% (k = 8, n = 209, 95% CI: 38.73%-61.70%, I² = 80.30%) and 92.40% (k = 11, n = 490, 95% CI: 88.83%-95.40%, I² = 41.40%), respectively. Postoperative complications such as hypotony (k = 13, n = 39, 6.05%, 95% CI: 2.81%-10.16%, I² = 57.70%) and hyphema (k = 13, n = 33, 5.63%, 95% CI: 2.52%-9.61%, I² = 56.60%) were uncommon, and sight-threatening complications such as corneal decompensation and endophthalmitis were rare. There was no statistically significant difference in mean visual acuity compared to baseline (k = 7, n = 312, MD: -0.03 logMAR, 95% CI: -0.09-0.04 logMAR, I² = 0.00%, p = 0.43).

Conclusions: This meta-analysis provides quantitative evidence supporting the clinical efficacy and safety of the PGI in patients with refractory glaucoma.

The prevalence of myopia has increased significantly in recent decades. Myopia has become one of the most common vision impairments globally, driven by genetic and environmental factors, including increased near work and reduced time outdoors. Reducing myopia progression is critical to mitigating its associated long-term risks. A substantial body of research has demonstrated the efficacy of various methods in slowing myopia progression, However, there is no clear consensus on myopia management as publications frequently present conflicting evidence. This narrative review aims to provide evidence-informed clinical guidance by summarising current strategies for managing myopia progression in the context of a rapidly evolving evidence base. It highlights practical, evidence-based approaches, including pharmacological treatments, optical interventions, lifestyle and environmental modifications, and emerging therapies and discusses the role of public health campaigns and policy initiatives.

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: 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: Tattoo-associated uveitis is a potentially sight-threatening condition driven by a presumed immune reaction to tattoo ink. Case numbers may be rising as tattooing becomes more popular. Australian uveitis specialists collaborated to collect cases and better define this entity and its implications.

Methods: Multicentre retrospective case review of collaborating uveitis specialists from January 2023 to January 2025. Following literature review, patients were recruited from public and private practices in Australian cities. Demographic information, clinical findings, investigations, treatment and disease course were collected.

Results: The majority of affected individuals (21/40, 52.5%) were young adults of Caucasian or European ethnicity (28/40, 70%) with a predominance of bilateral (38/40, 95%) and anterior (28/40, 70%) uveitis. Inflammation within tattoos was present in all cases, most commonly associated with black ink. Systemic treatment was needed in 27/40 (67.5%) of whom 25/40 (62.5%) required steroid-sparing immunosuppression, most commonly methotrexate. Biological DMARDs were required in 17/40 (42.5%). Only 10 (25%) patients were adequately treated with topical treatment alone and just 11/40 (27.5%) had enduring remission off treatment during the reporting period. Complications included cataracts, cystoid macular oedema, and glaucoma. Only 3 patients had no visual loss during the course of their care.

Conclusions: Forty cases of tattoo-associated uveitis were identified, indicating that this previously rare condition has become a regular entity in Australian uveitis clinics in a population where 25% of people have tattoos. Vision was commonly affected, and 63% required long-term immunosuppression, including with biological DMARDs in 42%, making this a public eye health issue of concern.