Acta Ophthalmologica最新文献

Purpose: This systematic review and meta-analysis aim to evaluate the efficacy and safety of further lowering intraocular pressure (IOP) to single-digit levels in treated patients with progressive normal-tension glaucoma (NTG).

Methods: A literature search was conducted in MEDLINE (via PubMed), Scopus and Web of Science. We selected studies that reported quantitative visual field (VF) data on the efficacy of the interventions. Study outcomes include VF progression rates, changes in IOP and IOP-lowering medication use. Meta-analysis was conducted for VF mean deviation (MD) slope (db/year) using R, with paired mean differences and 95% confidence intervals (CI) calculated.

Results: Nine observational studies, including 270 eyes, were analysed. Trabeculectomy was performed across all studies. One study compared trabeculectomy with prostaglandin analogues. On average, IOP decreased from 14.77 ± 0.95 mmHg preoperatively to 9.82 ± 1.55 mmHg postoperatively, reflecting a mean reduction of 33.65 ± 10.37%. This reduction slowed glaucoma progression, as indicated by a change in the mean VF MD slope from -0.91 ± 0.27 dB/year preoperatively to -0.25 ± 0.16 dB/year postoperatively. Meta-analysis showed a significant change in VF MD slope following trabeculectomy, with a pooled mean difference of 0.59 dB/year (95% CI: 0.38 to 0.80; p < 0.0001). Single-digit IOP levels were shown to be both achievable and sustainable. The most common postoperative complications included hypotony-related complications and hyphema.

Conclusions: Achieving single-digit IOP levels is associated with a significant reduction in visual field progression rates. However, the balance between efficacy and safety must be considered, as aggressive IOP reduction is also associated with a higher risk of hypotony-related complications. Postoperative hypotony was relatively frequent but generally transient and did not appear to have a significant impact on long-term visual acuity. Copyright © 2026 Acta Ophthalmologica Scandinavica Foundation.

Purpose: To identify associations between systemic drugs and cataract surgery in Finland.

Methods: A historic cohort study based on administrative data. Endpoint event was cataract surgery. Use of drugs in question was based on redeemed prescriptions and consisted of 156 drugs. Study population consisted of 106 127 individuals aged ≥50 years without diabetes originating from the 1996-2017 Fin-CARING population. We constructed a nested case-control study design comparing 17 811 cases undergoing cataract surgery to 76 532 age-, sex- and hospital district-matched controls without cataract surgery. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs) based on conditional logistic regression models.

Results: Use of ramipril (1.14; 1.04-1.25), losartan (1.20; 1.07-1.35), bisoprolol (1.24; 1.18-1.31), amlodipine (1.16; 1.07-1.25), diltiazem (1.26; 1.06-1.49), isosorbide mononitrate (1.56; 1.44-1.70), furosemide (1.31; 1.18-1.45), simvastatin (1.17; 1.11-1.24), atorvastatin (1.17; 1.06-1.29), prednisolone (2.00; 1.64-2.42), allopurinol (1.47; 1.24-1.75), pramipexole (1.45; 1.13-1.86), testosterone (1.62; 1.03-2.55), estradiol (1.13; 1.03-1.24), oxazepam (1.26; 1.07-1.47), sertraline (1.74; 1.13-2.67) and zopiclone (1.31; 1.20-1.43) showed some evidence for an association with cataract surgery. Use of memantine (OR 0.24; 0.15-0.40), risperidone (0.72; 0.51-1.00), rivastigmine (0.35; 0.21-0.58) and donepezil (0.55; 0.40-0.76) was associated with a lower risk of cataract surgery.

Conclusions: Our large nested case-control study suggests that certain systemic medications may increase the incidence of surgically treated cataract, but with the possibility of residual confounding.

Purpose: To assess in Royal College of Surgeons (RCS) rats if the combination of two previously documented neuroprotective strategies: minocycline administration and bone marrow-derived mononuclear cells (BM-MNCs) intravitreal transplantation, offers enhanced neuroprotection compared with each treatment alone.

Methods: Forty-eight homozygous pigmented RCS rats were divided into four groups: control, intravitreal BM-MNC transplantation, systemic minocycline treatment or combined therapy. Treatments were administered at postnatal day (P) 27-28. Animals were evaluated in vivo by spectral domain optical coherence tomography (SD-OCT) at P28, P35 and P51. Retinal sections were analysed for photoreceptor survival (outer nuclear layer [ONL] cell counts), synaptic preservation (Bassoon immunoreactivity), microglial activation (Iba-1+ cells) and macroglial reactivity (glial fibrillary acidic protein [GFAP] expression).

Results: Both BM-MNC and minocycline monotherapies significantly preserved total and outer retinal thicknesses and increased ONL nuclei counts compared with controls. Combined treatment yielded superior protection at both P35 and P51. Minocycline alone or in combination significantly reduced microglial cell activation, while BM-MNCs alone or in combination significantly reduced GFAP expression. Synaptic integrity in the outer plexiform layer, assessed via Bassoon labelling, was significantly better preserved in treated animals, with the highest levels observed in the combined therapy group.

Conclusions: Minocycline and BM-MNCs provide complementary neuroprotective effects in the RCS rat model. While minocycline reduces microglial activation, BM-MNCs modulate macroglial response. Their combination enhances photoreceptor survival and synaptic preservation more effectively than either treatment alone. These findings support the therapeutic potential of combining pharmacological and cell-based interventions in hereditary retinal degenerations.

Purpose: Diabetic retinopathy (DR) is a leading cause of blindness in the working-age population. Screening is essential to identify and treat sight-threatening stages prior to irreversible visual loss. This study aimed to train and validate an automated algorithm to identify no or minimal DR, potentially saving resources for specialist evaluation.

Methods: We included 307 wide-field images (Optomap, Dunfermline, Scotland) classified by a certified retinal expert according to the International Clinical Diabetic retinopathy (ICDR) scale. The expert manually annotated 26 995 diabetic-related retinal lesions using the Computer Vision Annotation Tool (CVAT). A segmentation model was trained to detect lesions using a 70/15/15 split for training, tuning, and validation. A classification model used the outputs of the segmentation model as input features for a decision tree classifier, categorizing patients into Group 0 (DR level 0-1) or Group 1 (DR level 2-4). Classifier hyperparameters and input feature selection were optimized based on binary classification performance using cross-validation. The classifier was evaluated on 48 validation images and further validated with 200 images graded by up to four independent certified graders.

Results: The area under the curve was 0.94 for the 48 validation images, with specificity, sensitivity, and kappa values of 0.89, 0.93, and 0.83, respectively. For the 200 expert-validated images, the values were 0.91, 0.98, 0.82, and 0.79, respectively.

Conclusion: The combined method of segmentation followed by feature count analysis shows promising results for binary DR classification in Optomap wide-field images without requiring a large dataset for model development.

Purpose: To measure the progression of geographic atrophy (GA) in subjects with age-related macular degeneration (AMD) in a natural history study.

Methods: We analysed fundus autofluorescence (FAF) images using a semiautomatic method (RegionFinder) to quantify the GA area in a monocentric study. Three independent graders analysed each eye. Patient visits were scheduled at baseline, 12, 24 and 48 weeks. The primary endpoint was the progression of GA area per eye. Potential correlations with clinical and imaging-based parameters were analysed.

Results: The annual GA progression rate was 1.16 mm²/year (95% CI: 0.76-1.56; p < 0.001), with faster growth in eyes with larger baseline lesions (R² = 0.74). After square root transformation, the progression rate was 0.34 mm/year (95% CI: 0.26-0.43; p < 0.001), and the size dependency was reduced (adjusted R² = 0.16). Multivariable mixed-effects models identified a significant association between larger GA lesion sizes per eye and the number of smoking pack-years (p = 0.017), the presence of perilesional hyperautofluorescence (p = 0.044) and a multifocal configuration of the GA lesions (p = 0.038). Intermediate AMD in the fellow eye was significantly associated with faster GA progression (p = 0.041).

Conclusion: GA progression in AMD is significantly influenced by baseline lesion size and a larger number of smoking pack-years is associated with larger GA lesions. The marked variability between individuals underscores the multifactorial nature of GA dynamics. Quantitative FAF analysis is a reliable method for assessing lesion progression and may inform risk-based monitoring strategies.

Purpose: To evaluate the accuracy of intraocular lens (IOL) power calculation formulas in aphakic eyes undergoing simultaneous silicone oil removal (SOR) and IOL implantation, including in-the-bag implantation and ciliary sulcus implantation, and assess the effect of 'Rule of 9s' adjustment for ciliary sulcus implantation.

Methods: The performance of six formulas (BUII, EVO, LSF, Hoffer Q, Holladay 1, SRK/T) was evaluated. Outcomes were assessed using mean prediction error (ME) for trueness, standard deviation (SD) for precision, and median absolute error (MedAE) for accuracy. Ciliary sulcus implantation was analysed with and without the 'Rule of 9s' adjustment.

Results: This study included 282 eyes (143 in-the-bag, 139 sulcus). For in-the-bag implantation, new-generation formulas (EVO, LSF, BUII) demonstrated higher precision (SD: 0.58 D) and accuracy (MedAE: 0.46-0.47 D) compared to traditional formulas (SD: 0.62-0.71 D; MedAE: 0.50-0.62 D; p < 0.05). Unadjusted sulcus implantation showed low trueness with a significant myopic shift (ME: -0.88 D to -1.12 D). The 'Rule of 9s' adjustment significantly improved trueness (ME: -0.32 D to -0.54 D). Post-adjustment, EVO achieved the best accuracy (MedAE: 0.53 D), significantly better than traditional formulas.

Conclusions: New-generation formulas provide improved precision and accuracy in combined SOR-IOL surgery. The 'Rule of 9s' adjustment optimized trueness for sulcus-placed IOLs, where new-generation formulas maintained higher accuracy and precision.

Purpose: To explore whether threshold perimetry can predict fulfilment of the current Swedish and current Norwegian Esterman perimetry standards for Group 1 driver's licence, and differences in compliance between the former and current Swedish visual field standards.

Methods: This study included perimetry examinations from individuals aged ≥18 years who underwent threshold perimetry (24-2 or 30-2) and binocular Esterman visual field testing on the same day during September 2010 to December 2022. Data were collected over 12 years from three Departments of Ophthalmology in Region Örebro County, Sweden. Threshold perimetry data were used to predict fulfilment of the current Swedish and current Norwegian Esterman visual field standards.

Results: In all, 798 individuals were included. Altogether (33%) failed the Swedish visual field standards for a Group 1 driver's licence in the past; by comparison, a significantly smaller proportion would have failed the current Swedish standards today, (18%) (p < 0.001; McNemar's test). Threshold perimetry, if all test points within the central 20° had values of ≥10 dB, could predict compliance with a sensitivity of 89% and 88% and a specificity of 73% and 78% for the current Swedish and current Norwegian Esterman standards, respectively.

Conclusion: Threshold perimetry may predict compliance with the current Swedish and current Norwegian Esterman visual field test standard for driving. A larger proportion of individuals may meet the current Swedish visual field standard for a Group 1 driver's licence compared with the former Swedish standard.

Purpose: To examine retinal nerve fibre layer (RNFL) characteristics in relation to prenatal and postnatal smoking exposure in three independent birth cohorts: two Danish and one Australian cohort.

Methods: A combined meta-analysis of peripapillary retinal nerve fibre thickness in the Copenhagen Prospective Studies on Asthma in Childhood 2000 cohort (COPSAC2000), the Copenhagen Child Cohort 2000 (CCC2000), and Generation 2 of the Raine Study, utilizing optical coherence tomography.

Results: Compared with participants not exposed to smoking (COPSAC2000 = 209, CCC2000 = 1008, Raine Study Gen2 = 991), 35 COPSAC2000 participants exposed to smoking throughout pregnancy had the most prominent deficits in peripapillary RNFL thickness in the inferior (-10.4% (-16.7; -4.2%), p = 0.001) and nasal (-10.0% (-18.3; -1.7%), p = 0.02) sectors, while 221 CCC2000 participants exposed to smoking had the most prominent deficit in the inferonasal sector (-8.4% (-11.3; -5.4%), p < 0.001), and 112 Raine Study Gen2 participants exposed to smoking (more than 10 cigarettes per day) had the most prominent deficit in the inferonasal sector (-8.9% (-13.0; -4.8%), p < 0.001). In a combined meta-analysis of the three cohorts, deficits in both the global and sectoral (superior, nasal, inferior and temporal) RNFL were observed from exposure to prenatal smoking.

Conclusions: Prenatal smoking was associated with deficits in the peripapillary RNFL both globally and sectorally in combined meta-analyses of the three cohorts, which suggest an overall adverse effect of early life smoking exposure on later RNFL status.