Acta Ophthalmologica最新文献

Purpose: To assess associations of macular drusen in a general population, affected by age-related macular degeneration (AMD) or free of any retinal disease.

Methods: Participants of the population-based cross-sectional Beijing Eye Study underwent optical coherence tomography. Macular volume scans were assessed for macular drusen.

Results: The study included 870 eyes (870 participants) (age: 64.7 ± 9.9 years; range: 50-91 years), randomly selected within the groups of early AMD (n = 356 (40.9%) eyes), intermediate AMD (n = 201; 23.1%), late AMD (n = 6; 0.7%) and within eyes without AMD (n = 307; 35.3%). In multivariable analysis, higher drusen count was associated (r² = 25) with older age (beta: 0.08; p = 0.048), higher serum concentration of cholesterol (beta: 0.10; p = 0.008), shorter axial length (beta: -0.09; p = 0.03), thicker subfoveal choroidal thickness (beta: 0.08; p = 0.04), higher prevalences of macular hyperpigmentations (beta: 0.13; p < 0.001), hyperreflective foci (HRFs) (beta: 0.12; p = 0.004) and reticular pseudodrusen (beta: 0.27; p < 0.001), and a lower prevalence of a visible Henle's layer (beta: -0.15; p < 0.001). Larger drusen size was associated with shorter axial length (beta: -0.08; p = 0.03), thicker subfoveal choroidal thickness (beta: 0.18; p < 0.001), higher prevalences of macular hypopigmentations (beta: 0.14; p < 0.001) and HRFs (beta: 0.31; p < 0.001), and lower prevalences of a visible Henle's layer (beta: -0.19; p < 0.001) and of reticular pseudodrusen (beta: -0.09; p = 0.02).

Conclusions: In this population-based study on Chinese, higher macular drusen count was associated with shorter axial length, thicker subfoveal choroidal thickness, higher prevalences of macular hyperpigmentations, HRFs and reticular pseudodrusen and lower prevalence of a visible Henle's layer. These findings may be clinically helpful and etiologically interesting.

Purpose: The purpose of this study was to determine the disease course in patients with tubulointerstitial nephritis and uveitis (TINU) syndrome, focusing on long-term outcome and the incidence of complications such as chronic kidney disease (CKD).

Methods: We retrospectively analysed the recorded clinical characteristics of 32 children with TINU at their first presentation (baseline) and during a follow-up period of up to 27 months (range: 21-27 months).

Results: The majority of patients (27/32; 84.4%) presented initially with ophthalmological symptoms. The most common initial ophthalmological presentation was anterior unilateral or bilateral uveitis, which in 23 patients progressed to chronic bilateral panuveitis. Patients who presented initially to their paediatrician with nephritis developed ocular symptoms within 4 months following the onset of nephritis. Inflammatory markers of active tubulointerstitial nephritis resolved more quickly than markers of active uveitis (p-value = 0.001). At 21-27 months, 7/23 patients (30.4%) had chronic kidney disease (CKD); moreover, these patients with CKD were significantly less likely to have received systemic corticosteroids at the onset of TINU compared to those without CKD (p-value = 0.045).

Conclusion: Due to its heterogeneity in clinical presentation, all paediatric patients presenting with unilateral or bilateral uveitis should be screened for TINU. Likewise, patients who present with tubulointerstitial nephritis should be screened for the development of uveitis within the first several months. Ophthalmological outcome is favourable after long-term treatment with immunosuppressive medications. Finally, identifying tubulointerstitial nephritis early is important, as nearly one-third of cases can develop CKD and may therefore benefit from early treatment with corticosteroids.

Elevated corticosteroid levels are the strongest known risk factor for central serous chorioretinopathy (CSC), and previous studies have explored if alterations in systemic immunity could play a role in CSC. Here, we explored if elevated systemic C-reactive protein (CRP), a marker of systemic low-grade inflammation, is associated with CSC. We systematically searched 12 literature databases on 12 April 2025 for studies in which blood CRP is measured in both patients with CSC and a comparable control group. Studies were reviewed qualitatively. Meta-analysis using the random-effects model was performed on the weighted mean difference in systemic CRP levels between patients with CSC and controls. Six studies comprising 544 patients with CSC and 655 control individuals were eligible for this review. The meta-analysis of the difference in CRP between patients with CSC and controls showed no statistically significant difference at 0.86 mg/L (95% CI: -1.03-2.75 mg/L; p = 0.37). One study reported a very high degree of association between elevated CRP and CSC, which was not reproduced in the other studies. The lack of association remained consistent in the sensitivity analyses. Current evidence does not suggest that elevated systemic CRP levels are associated with CSC. Further studies on CSC pathophysiology are warranted.

Purpose: To describe the treatment rate for retinopathy of prematurity (ROP) at a tertiary referral neonatal intensive care unit (NICU) in the south-western region of the Netherlands. In addition, we evaluated the impact of outsourcing laser treatment, implemented in 2018, by comparing treatment characteristics from 3 years prior and 3 years following this organisational change.

Methods: This retrospective observational cohort study evaluated data of preterm infants born between 2015 and 2020 who were admitted to our NICU and met the eligibility criteria for ROP screening. ROP treatment rate was calculated for infants screened in our NICU. The impact of outsourcing laser treatment was evaluated based on ROP type at treatment decision, time between treatment decision and treatment, and adverse outcomes, including additional treatments and retinal detachment.

Results: A total of 358 infants were screened at our NICU between 2015 and 2020; complete data were available for 343 infants, of whom 15% (51/343) required treatment. Since outsourcing treatment, additional treatment secondary to laser was performed less frequently (25%, 5/20 versus 7%, 2/31). However, the mean number of days between treatment decision and treatment increased since outsourcing treatment (p = 0.014), and 32% (9/28) of cases were treated prior to reaching the criteria of type 1 ROP.

Conclusion: The treatment rate among infants screened at our tertiary referral NICU exceeds previous national and hospital-level reports, likely due to early transfer of low-risk cases. Outsourcing ROP treatment might have led to improved primary treatment success; however, possible disadvantages include treatment delays and over-treatment.

Purpose: X-linked retinoschisis (XLRS) is an inherited vitreoretinal disorder characterized by macular retinoschisis. In a subgroup of patients, peripheral retinoschisis can occur, potentially leading to complications such as vitreous haemorrhage (VH) and retinal detachment (RD). Limited data exist on the optimal management of these complications. This retrospective cohort study evaluates clinical characteristics and outcomes of VH and RD in XLRS patients.

Methods: We included 49 patients diagnosed with XLRS who developed VH and/or RD. Collected data included demographics, best-corrected visual acuity (BCVA), retinal findings, treatment strategies and anatomical and functional outcomes.

Results: The median follow-up was 19.0 years (IQR 11.4-35.6) with 12 visits (IQR 6-19). Median age at first VH was 15.3 years (IQR 5.5-16.3) and 7.5 years (IQR 2.4-15.9) for RD. Peripheral retinoschisis was present in 94% of VH eyes and 80% of RD eyes. Of 39 patients with VH, 10 (26%) had bilateral VH; only 1 (3%) presented with concurrent bilateral VH. VH resolved without intervention in 42 of 49 eyes (86%), although recurrence occurred in 22 eyes (45%). RD was observed in 25 eyes of 21 patients, with rhegmatogenous RD in 16 eyes (64%), tractional in 7 (28%) and exudative in 3 (12%), with one eye showing mixed features. Surgery was performed in 21 eyes (84%), achieving retinal reattachment in 43% after primary surgery and in 90% after multiple procedures. In 15 eyes operated on after 2005, final reattachment was achieved in 93%. BCVA improved postoperatively in 10 of 21 eyes (48%), was stable in 5 (24%) and declined in 2 (10%); 4 (19%) lacked follow-up BCVA.

Conclusion: VH in XLRS is often self-limiting with favourable functional and anatomical outcomes, but recurrence is common. RD typically requires surgical repair, often multiple procedures, with guarded visual prognosis despite anatomical reattachment. Regular follow-up, particularly in young XLRS patients with peripheral retinoschisis, is essential for early detection and management of these potential complications.

The development of effective therapeutics for dry eye disease (DED) is challenging due to its complex pathophysiology, heterogeneous patient presentation and the significant failure rate of previous clinical development programs. This underlines the importance of the selection of appropriate endpoints for clinical trials. The presented systematic review retrospectively analyzes the endpoints used in controlled clinical trials in studies of DED. Published clinical trials in the field of DED were reviewed from 2000 to 2023 and the used clinical endpoints were recorded by type and frequency of use. All studies that met the primary keyword search across various databases (PubMed, Embase, The Cochrane Library, Web of Science and Medline) were imported into Rayyan which was used to facilitate the screening process and support the collaboration between the reviewers. 93 876 studies were found of which 33 908 remained after duplicates were removed. All abstracts were screened for eligibility independently by two reviewers. 355 articles remained for full-text review, of which 194 were included in the present systematic review. The most frequently investigated product was topical medicinal products (88 studies), followed by topical lubricants (57 studies) and nutritional supplements (22 studies). Corneal fluorescein staining (45 studies) and the ocular surface disease index (OSDI; 96 studies) were the most frequently used primary objective and subjective outcome parameters. However, a sustainable number of studies failed to show statistically significant differences between treatment and control groups, despite improvements from baseline. Our findings show that corneal fluorescein staining and OSDI are the most frequently used endpoints in clinical studies, although they frequently are not able to detect differences between the treatment and control groups. Therefore, to enhance the efficiency and reliability of DED clinical trials, a consensus on optimal outcome measures is crucial, and the exploration of novel endpoints should be prioritized. PROSPERO Registration Number: CRD42022350817.

Purpose: To compare the inflammatory response in the eye after trabeculectomy to after phacoemulsification, focusing on anterior chamber flare (AC flare) and central macular thickness (CMT).

Methods: Data from 436 participants in two randomized controlled trials were analysed. Anterior chamber flare was measured in 69 participants undergoing trabeculectomy and 367 participants undergoing phacoemulsification preoperatively. Postoperative assessments were made on day 7 in trabeculectomy participants and on day 3 in phacoemulsification participants. CMT was assessed at baseline and 3 months postoperatively in both groups and 4 weeks postoperatively for trabeculectomy participants and 3 weeks postoperatively for phacoemulsification participants.

Results: At baseline, AC flare and CMT were comparable between the groups. Early postoperatively, AC flare was 22.1 ph/ms [95% CI 19.1, 25.7] for trabeculectomy and 18.9 ph/ms [95% CI 17.8, 20.2] for phacoemulsification. Both groups significantly increased in AC flare from their baseline values, but the difference in increase between them was not significant (p = 0.46). In the trabeculectomy group, CMT showed no significant increase at 4 weeks but a significant rise of 2.3 microns from baseline to 3 months from 241 microns [95% CI 235.9, 246.1] to 243.3 microns [95% CI 237.6, 249.1] (p = 0.038). In the phacoemulsification group, CMT was significantly increased at 3 weeks and remained significantly elevated at 3 months from 242.6 microns [95% CI 240.4, 244.8] to 249.8 microns [95% CI 247.3, 252.4], increased by 7.2 microns (p < 0.0001). CMT increased significantly more after phacoemulsification compared to trabeculectomy at 3 to 4 weeks (p = 0.014) and 3 months (p < 0.0001) with respect to baseline values.

Conclusion: No significant difference in AC flare was found between trabeculectomy and phacoemulsification participants at baseline and early postoperatively. CMT did not increase at 4 weeks but increased significantly at 3 months after trabeculectomy. Phacoemulsification led to a significantly higher CMT increase at both 3 weeks and 3 months with respect to baseline compared to trabeculectomy.

Purpose: To compare bleb morphology after trabeculectomy using a visual grading system, the Indiana Bleb Appearance Grading Scale (IBAGS) and anterior segment optical coherence tomography (AS-OCT).

Methods: Fifty-seven patients who underwent trabeculectomy were included in this study. Clinical evaluations of the bleb and imaging with anterior segment OCT were conducted 12 months postoperatively. Bleb assessments were performed using a slit-lamp microscope with the IBAGS and a 3D AS-OCT CASIA2.

Results: Bleb height evaluations from IBAGS and AS-OCT measurements showed a moderate positive correlation (p = 0.03), indicating alignment between the two systems. IBAGS variables explained about 16% of the variance in IOP, with a significant negative relationship between bleb height and IOP (for each unit increase in bleb height, IOP decreased by 1.9 mmHg; p = 0.03). The overall model fit was significant for IBAGS (p = 0.03) but not for AS-OCT (p = 0.2), suggesting that IBAGS may be more relevant for predicting IOP.

Conclusion: IBAGS demonstrated a stronger association with IOP, suggesting its greater relevance in assessing trabeculectomy bleb morphology for predicting surgical success. Additionally, we found a significant correlation between bleb height measurements obtained from IBAGS and the AS-OCT system. By integrating both systems, a more comprehensive approach to monitoring bleb function can be achieved, ultimately improving the accuracy of postoperative glaucoma management.