Acta Ophthalmologica最新文献

Polypoidal choroidal vasculopathy (PCV) is an aneurismal type of macular neovascularization that show similarities with age-related macular degeneration and diseases that are part of the pachychoroid disease spectrum. Exudative changes in PCV can be treated with intravitreal anti-vascular endothelial growth factor monotherapy; however, a combination therapy with photodynamic therapy may be required. In this systematic review and meta-analysis, we evaluated the efficacy of faricimab for PCV. We searched 12 literature databases for eligible studies. All study evaluation and data extraction were made by two authors in duplicate. Studies eligible for analysis were included for a qualitative and quantitative review. We identified seven studies with data from 150 eyes with PCV, five studies were of treatment-naïve eyes who were commenced in faricimab monotherapy, and two studies were of switch-over to faricimab from other anti-VEGF drugs. After faricimab loading dose in treatment-naïve eyes, the best-corrected visual acuity (BCVA) remained stable at -0.09 (95% CI: -0.20-0.03) logMAR, central retinal thickness (CRT) decreased -169 (95% CI: -311--27) μm, and 48.7 (95% CI: 32.5-65.0) % of eyes obtained polyp closure. In switch-over eyes, 57%-67% experienced fluid reduction and 21% were able to extend their treatment interval. In conclusion, faricimab monotherapy for PCV leads to acceptable clinical outcomes in terms of stable BCVA, reduction of CRT, and high incidence of polyp closure. Some cases may benefit from a switch to faricimab. However, long-term efficacy studies and controlled comparative studies are warranted.

Purpose: To evaluate the effectiveness of 12 months of spectacle lens wear incorporating cylindrical annular refractive elements (CARE) in slowing myopia progression compared to single vision (SV) spectacle wear.

Methods: In an ongoing 2-year prospective, double-masked, multi-centre clinical trial, 240 Chinese children aged 6-13 years, spherical equivalent refractive error (SE) -0.75 D to -5.00 D were randomised to one of three groups of 80 participants each to wear: SV spectacle lens (N = 80), CARE spectacles (7 mm central clear zone surrounded by treatment zone incorporating CARE with mean surface power of +4.6 D) and CARE S (9 mm central clear zone surrounded by treatment zone comprising CARE with mean surface power of +3.8 D). Cycloplegic SE and axial length (AL) were measured at 6-month intervals.

Results: Compared to baseline, changes in SE and AL were significantly different between the groups at both 6 and 12 months (p < 0.001, linear mixed model). Adjusting for site, group, parental myopia and age, at 12 months, the estimated change in SE and AL with 95% CI with SV was -0.65 D (CI: -0.56 to -0.74 D)/0.32 mm (CI: 0.29-0.36 mm). In comparison, the estimated change in SE/AL at 12 months with CARE was -0.35 D (-0.26 to -0.44 D)/0.19 mm (0.15-0.22 mm) and with CARE S was -0.36 D (-0.27 to -0.46 D)/0.21 mm (0.18-0.25 mm) at 12 months. Progression was slower with CARE and CARE S compared to SV (p < 0.05) but did not differ from each other (p = 0.793 and 0.336 for SE and AL, respectively).

Conclusions: In children with myopia, after 12 months of lens wear, both CARE and CARE S spectacle lenses significantly slowed myopia progression compared to SV lenses.

Purpose: To provide a historical overview of the various efforts to change eye colour for purely cosmetic reasons, along with the associated potential risks and harms.

Methods: Literature and online search.

Results: Eye drops containing adrenaline were used during World War II on involuntary inmates of concentration camp Auschwitz-Birkenau. Prostaglandin drops, used in glaucoma therapy since 1996, can increase iris pigmentation as an undesired side effect. Commercial drops, available since 2011, are not effective and potentially dangerous. Iris implants, commercially available since 2011, led to serious complications like corneal decompensation, uveitis and glaucoma, and for this reason, implants had to be removed, leaving some patients almost blind. Also commercially in use since 2011 are laser treatments to make brown eyes blue. Among the possible complications are anterior uveitis and (pigmentary) glaucoma. Corneal tattooing has existed for almost 2000 years. Complications of modern, intrastromal keratopigmentation include corneal perforation, bacterial infection, allergic or toxic reaction to pigment, migration of pigment, and functional complications like visual field limitation and light sensitivity. Personal identity and self-esteem are likely contributing factors to undergo this potentially harmful cosmetic eye surgery. In addition to the earlier discussed complications, the artificial layer of colour can obscure ocular pathology of the cornea or iris. As the majority of individuals undergoing these procedures are relatively young, problems may arise in the future when they will need cataract or other eye surgeries.

Conclusion: Permanently changing eye colour in healthy eyes for purely cosmetic reasons is a risky procedure.

Purpose: The aim of the present study was to determine the incidence, patient characteristics, and risk factors for severe, contact lens-related keratitis in patients in need of hospitalization.

Methods: Keratitis was defined as severe when the disease required hospitalization. All patients with contact lens-related keratitis hospitalized at our department between 1 January 2018 and 31 December 2020 were interviewed with a questionnaire, about their use of contact lenses and knowledge of complications. Clinical information was collected from the medical records.

Results: A total of 41 patients (42 eyes) were hospitalized with severe keratitis during the 3-year period. The yearly incidence was 2.52 per 10 000 contact lens users over the age of 15 for extended-wear lenses used overnight, and 0.52 per 10 000 for users of daily disposable contact lenses. Pseudomonas aeruginosa was the most frequently isolated microbe. The median age was 50 years (range 15-66 years). Twenty-three patients (56%) were female, 28 patients (66%) used extended-wear contact lenses and 12 patients (29%) used daily disposable lenses. Nineteen patients (45%) admitted improper use. The median duration of contact lens use was 11.5 years. Only 15 patients (37%) had knowledge of keratitis as a potential complication.

Conclusion: Most patients were experienced contact lens users. Users of extended-wear contact lenses worn overnight had a significantly higher risk of severe microbial keratitis. More focus on information and education of the risk of keratitis in contact lens users is needed.

Purpose: To quantify ellipsoid zone (EZ) loss during anti-VEGF therapy for neovascular age-related macular degeneration (nAMD) and correlate these findings with nAMD disease activity using artificial intelligence-based algorithms.

Methods: Spectral domain optical coherence tomography (Spectralis, Heidelberg Engineering) images from nAMD treatment-naïve patients from the Fight Retinal Blindness! (FRB!) Registry from Zürich, Switzerland were processed at baseline and over 3 years of follow-up. An approved deep learning algorithm (Fluid Monitor, RetInSight) was used to automatically quantify intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED). An ensemble U-net deep learning algorithm was used to automated quantify EZ integrity based on EZ layer thickness. The impact of fluid volumes on EZ thickness and late-stages outcomes were calculated using Wilcoxon rank-sum tests, a linear mixed model and a longitudinal panel regression model.

Results: Two hundred and eleven eyes from 158 patients were included. The mean ± SD EZ loss area in the central 6 mm was 1.81 ± 2.68 mm² at baseline and reached 6.21 ± 6.15 mm² at month 36. Higher fluid volumes (top 25%) of IRF and PED in the central 1 and 6 mm of the macula were significantly associated with more advanced EZ thinning and loss compared to the low fluid volume subgroup. The high SRF subgroup in the linear regression model showed no statistically significant association with EZ integrity in the central macula; however, the longitudinal analysis revealed an increased EZ thickness with no additional loss.

Conclusions: Intraretinal fluid and PED volumes and their resolution pattern have an impact on alteration of the underlying EZ layer. AI-supported quantifications are helpful in quantifying early signs of macular atrophy and providing individual risk profiles as a basis for tailored therapies for optimized visual outcomes.

Purpose: To evaluate the feasibility and acceptability of self-tonometry by glaucoma patients using iCare® Home2 (ICH2) and a smartphone application, without healthcare personnel supervision.

Methods: After downloading a smartphone application, participants learned to handle the ICH2 via an instruction film, measured their intraocular pressure (IOP) and transferred the data to the caregiver via the application. Participants' measurements were compared to healthcare personnel measurements using Goldmann applanation tonometry (GAT). Participants answered questionnaires about their experience of self-tonometry.

Results: Twenty-eight participants were included in the study and three of them dropped off. There was no statistically significant difference between the last measurements obtained with ICH2 by the participants and the GAT measurements for the right and the left eye, p = 0.781 and p = 0.888 respectively. The inter-user agreement was good to excellent between the last measurements obtained with ICH2 by the participants and the GAT measurements for the right and the left eye (ICC 0.907 and 0.830 respectively). The overall impression of the participants was very positive, with 92% happy (a lot or completely) with the instruction film and 88% happy (a lot or completely) with the smartphone application. Thirty-six percent would have preferred to have an instructor by their side.

Conclusion: Our study showed the feasibility and acceptability of self-tonometry with iCare® Home2 and a smartphone application without the supervision of a healthcare provider in a group of motivated glaucoma patients.

Purpose: Cataract, the leading cause of blindness worldwide, is a multifactorial disease involving oxidative stress mechanisms. The aim of our study was to investigate the relationship between air pollution exposure and the incidence of cataract surgery.

Methods: The 3C-Alienor study is a population-based cohort of residents of Bordeaux, France, aged 65 years or more, recruited in 1999-2000 and followed every 2-3 years until 2017. Cataract surgery was self-reported and checked at slit-lamp by trained professionals. Average air pollution exposure (particulate matter ≤2.5 μm (PM_2.5), black carbon (BC), nitrogen dioxide (NO₂)) in the 10 years preceding baseline was estimated at the participants' geocoded residential address, using temporally adjusted land use regression. Associations of 10-year average air pollution exposure with incidence of cataract were estimated using Cox proportional hazard models adjusted for confounders.

Results: The study included 829 subjects without cataract surgery prior to inclusion; the mean age at inclusion was 72.6 years (standard deviation (SD): 4.2) and 61% were women. The median (Interquartile-range (IQR)) follow-up duration was 14.1 (6.4) years during which 507 participants underwent cataract surgery. Exposure to a concentration ≥40 μg/m³ of NO₂ (the current regulatory limit value in Europe) was associated with incident cataract surgery (HR = 1.46, CI (1.16, 1.84), p = 0.001). No statistically significant association was found with PM_2.5 and BC.

Conclusion: Long-term exposure to a NO₂ concentration ≥ 40 μg/m³ was associated with an increased incidence of cataract surgery. Complying with current European air pollution standards could reduce cataract surgery costs and improve population quality of life.

Purpose: To analyse graft detachment rates after Descemet stripping automated endothelial keratoplasty (DSAEK) using surgeon-cut grafts and pre-cut grafts transported in different mediums.

Methods: A retrospective study of graft detachment rates including 265 surgeries (240 patients) performed between 2019 and 2023. The DSAEK grafts were either surgeon-cut (n = 135) or pre-cut and transported in a dextran-containing medium (n = 82) or in a dextran-free medium (n = 48). All surgeries were performed by a single surgeon (I.G.). The surgeries were categorised according to whether the recipients' eyes had, or did not have, factors associated with an increased risk of graft detachment. Detachment rates were compared for all patients receiving the different kinds of graft, and only for those without risk factors.

Results: A significantly higher detachment rate was found among patients receiving pre-cut grafts transported in a dextran-containing medium (32.9%), compared to surgeon-cut grafts (14.1%, p = 0.002), and pre-cut grafts transported in a dextran-free medium (6.3%, p = 0.002) for all recipients (those with and without risk factors for graft detachment). When analysing recipients without risk factors for graft detachment, the detachment rate was still significantly higher with pre-cut tissue transported in a dextran-containing medium (26.9%), compared to surgeon-cut tissue (8.3%, p = 0.002) and pre-cut tissue transported in a dextran-free medium (3.6%, p = 0.01).

Conclusions: The use of pre-cut DSAEK tissue transported in a dextran-containing medium significantly increases the risk of graft detachment requiring re-bubbling.

Purpose: To investigate clinical characteristics of postoperative supraciliary effusion (SCE) development following gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with pseudoexfoliation glaucoma (PEXG).

Methods: In this prospective and observational study, 64 eyes (64 patients) with PEXG were examined with spectral-domain optical coherence tomography (SD-OCT) after GATT over a 12-month follow-up. Outcomes were surgical success, intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications (AGM) and complications of the SCE (+) group with those of SCE (-) group.

Results: SCE was observed in 39 eyes (60.9%) within the first postoperative week. Probability of complete success was significantly higher in the SCE (+) group than in the SCE (-) group (25.6% vs. 16.0%, p = 0.009). IOP was significantly lower at postoperative first day in the SCE (+) group than in the SCE (-) group (p = 0.04), but it was similar thereafter during follow-up (p > 0.05). Postoperative BCVA did not show significant difference at the end of the follow-up (p > 0.05). Postoperative number of AGM was found to be significantly lower in the SCE (+) group compared to the SCE (-) group (p < 0.05). A significant IOP rise was observed after SCE resolution (p = 0.002).

Conclusion: Presence of SCE accompanied with significantly lower IOP during the early postoperative period after GATT surgery for PEXG. SCE might have a favourable impact on postoperative AGM use. SCE can easily be examined by SD-OCT, and be used as a prognostic indicator.