Clinical and Experimental Ophthalmology最新文献

Background: The bleb-forming surgical spectrum in open-angle glaucoma has recently been expanded by novel surgical approaches. Through a medical device implantation (Xen Gel Stent (XGI) or Preserflo Microshunt (PMI)), these procedures aim at more standardised aqueous humour shunting and an intra- and postoperative risk reduction. Postoperatively, however, XEN, PMI and trabeculectomy share their dependence on the proper function of the filtration bleb. This review summarises available literature on anterior segment optical coherence tomography (AS-OCT)- and AS-OCT angiography (AS-OCTA)-based bleb parameters with an emphasis on their association with bleb function.

Methods: A systematic PubMed search was performed to identify the available evidence.

Results: A total of 52 suitable reports were identified and are presented in a structured manner.

Conclusion: The retrieved literature demonstrates that there exists a broad body of evidence for the use of AS-OCT and AS-OCTA after TE, XGI and PMI with the potential for AS-OCT and AS-OCTA enhanced follow-up plans. Their implementation in clinical routine is, however, currently impaired by highly variable and impractical study endpoints, lacking transferability of available evidence between different surgical procedures and missing evidence from prospective interventional trials.

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: We analysed 12-month real-world outcomes of treatment of eyes with neovascular age-related macular degeneration switched to brolucizumab from a first-generation VEGF inhibitor to determine whether switching chronically active eyes that required frequent treatment improved control of the disease safely with fewer injections.

Methods: Retrospective analysis of Australian and Italian data from the prospectively designed observational Fight Retinal Blindness! registry. We studied eyes that switched to brolucizumab and received at least two injections with 12 months of follow-up.

Results: Of the 81 eligible eyes, the proportion of inactive lesions increased from 5% at baseline to 37% 12 months after switching to brolucizumab (p < 0.001). Mean (95% CI) visual acuity (VA) was stable (0.6 [-1.5, 2.8] letters, p = 0.55), while median treatment intervals increased from 44 to 63 days (p < 0.001). Nearly a third (30%) of eyes switched back to another VEGF inhibitor within 12 months. Eyes that stayed on brolucizumab had a significantly longer mean treatment interval at 12 months than eyes that switched off it (66.1 [Q1, Q3: 56, 91] vs. 49 [28, 63.2] days, p ≤ 0.001) while VA change and inactivation rates were similar. Intraocular inflammation (IOI) was recorded in 7 (9%) eyes receiving at least one injection of brolucizumab.

Conclusions: Eyes that switched from a first generation VEGF inhibitor to brolucizumab in routine clinical practice achieved a clinically significant extension of their treatment interval, with more than a third becoming inactive but with a relatively high rate of IOI.

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: While the association between obstructive sleep apnoea (OSA) and glaucoma has been well studied, the long-term effects of continuous positive airway pressure (CPAP) therapy on intraocular pressure (IOP) and glaucoma progression are less known. This study aims to systematically synthesise evidence to clarify the association between CPAP therapy and IOP.

Methods: PubMed, Embase, The Cochrane Library, CINAHL, Scopus and Web of Science were searched through 26 March 2025 for interventional studies evaluating the effect of CPAP therapy on IOP among OSA adult patients. Two independent authors selected relevant articles, extracted data and evaluated the quality of evidence using the Newcastle-Ottawa scale (NOS), Cochrane Risk-of-Bias Tool for Randomised Trials (RoB 2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Inverse variance meta-analyses were conducted using random effects. I² values were used to evaluate heterogeneity.

Results: This study included 16 studies, pooling a cohort of 602 patients. The risk of bias of studies ranged from low to moderate, and the quality of evidence was moderate on GRADE. CPAP therapy significantly increased IOP levels overnight (MD: -4.14; 95% CI: -7.76, -0.52; I² = 76%; p = 0.04), and within 1 month (MD: -0.78; 95% CI: -1.21, -0.35; I² = 0%; p = 0.60). IOP levels remained unchanged with CPAP therapy of more than 1 month from baseline.

Conclusions: While short-term CPAP therapy of 1 month or less in OSA patients was associated with elevated IOP, minimal long-term effects were observed. Nonetheless, these findings underscore the importance of exercising caution when administering CPAP therapy on IOP especially in glaucomatous patients.

RANZCO Fellows can claim CPD points by reading the following two articles which appear in this issue, and answering the five questions. Half an hour is awarded for each set of five questions answered. Please remember to claim your points.

Answers to questions published in previous issue.

A: c. No increased incidence was identified. Despite long-term intravitreal injections, no significant rise in serious ocular adverse events (e.g., endophthalmitis, retinal detachment) was noted. However, the potential link between anti-VEGF therapy and geographic atrophy remains unresolved and warrants further investigation.

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.