Clinical and Experimental Ophthalmology最新文献

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.

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.