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Adherence of glaucoma intervention studies to World Glaucoma Association guidelines. 青光眼干预研究遵循世界青光眼协会指南。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-02-02 DOI: 10.1111/aos.70070
Andrea Servillo, Carlo Alberto Cutolo, Chiara Viganò, Paolo Forte, Riccardo Manocchio, Gus Gazzard, Luca Rossetti, Michele Iester, Francesco Oddone, Gianni Virgili, Stefano De Cillà, Alessandro Rabiolo

Objective: To assess the adherence of glaucoma surgical and laser studies to WGA guidelines for reporting glaucoma surgery studies, analyse trends in adherence over time and explore associations between adherence and study characteristics.

Methods: Systematic review (PROSPERO:CRD42023394477) of glaucoma surgical and laser studies published between 2010 and 2023 in PubMed/MEDLINE and EMBASE. Eligible studies included RCTs, non-randomized comparative and prospective observational designs (>100 eyes). Two reviewers independently extracted data across five domains: Methodology, Definition of success, Ethics, Postoperative complications and Statistical reporting. Temporal trends and associations with study features were analysed using linear regression.

Results: Two hundred and fifty-six studies were included, 75% of which were published in Q1-Q3 journals. Mean overall adherence was 47% ± 9.2%. Domain-level adherence was highest in Ethics (61% ± 20%), followed by Postoperative complications (50% ± 22%), Statistical reporting (48% ± 18%), Methodology (44% ± 12%) and Definition of success (30% ± 13%). No significant differences (p > 0.06) were observed in overall adherence for studies from Europe, Asia, Oceania or the Middle East. Studies involving cataract surgery for angle-closure disease (est. = -10% [-19%, -2.2%], p = 0.014) and laser trabeculoplasty (est. = -7.1% [-11%, -3.5%], p < 0.001) had lower adherence compared with trabeculectomy, while MIGS studies showed no difference (p = 0.45). Visual field progression was reported in only 3% of studies, while various anatomical outcomes (e.g. bleb morphology) were reported in 0%-24% of studies.

Conclusion: Current literature shows poor adherence to WGA guidelines across both traditional and newer glaucoma surgeries, reflecting inadequate reporting and outdated recommendations. Evidence-based updates, broader consensus and stronger implementation are needed to ensure standardized and meaningful reporting.

目的:评估青光眼手术和激光研究对WGA青光眼手术研究报告指南的依从性,分析随时间推移的依从性趋势,并探讨依从性与研究特征之间的关系。方法:系统回顾2010年至2023年在PubMed/MEDLINE和EMBASE上发表的青光眼手术和激光研究(PROSPERO:CRD42023394477)。符合条件的研究包括随机对照试验、非随机比较和前瞻性观察设计(100只眼)。两位审稿人独立提取了五个领域的数据:方法学、成功的定义、伦理学、术后并发症和统计报告。使用线性回归分析时间趋势和与研究特征的关联。结果:纳入256项研究,其中75%发表在Q1-Q3期刊上。平均总体依从性为47%±9.2%。领域水平依从性最高的是伦理学(61%±20%),其次是术后并发症(50%±22%)、统计报告(48%±18%)、方法学(44%±12%)和成功定义(30%±13%)。在欧洲、亚洲、大洋洲和中东的研究中,在总体依从性方面没有观察到显著差异(p < 0.05)。涉及闭角症白内障手术(est. = -10% [-19%, -2.2%], p = 0.014)和激光小梁成形术(est. = -7.1% [-11%, -3.5%], p)的研究。结论:目前的文献显示,在传统和新型青光眼手术中,WGA指南的依从性较差,反映了报告不足和过时的建议。为确保标准化和有意义的报告,需要基于证据的更新、更广泛的共识和更强有力的执行。
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引用次数: 0
Beyond drug price: A comparison of overall costs of anti-vascular endothelial growth factor therapy alternatives for neovascular age-related macular degeneration in Norway. 药物价格之外:挪威抗血管内皮生长因子治疗新血管性年龄相关性黄斑变性的总成本比较。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-02-01 DOI: 10.1111/aos.70069
Jacopo F T Løkken, Morten Carstens Moe, Erik Magnus Sæther, Øystein Kalsnes Jørstad

Purpose: Norwegian guidelines designate off-label Avastin as the first-line intravitreal therapy for neovascular age-related macular degeneration (nAMD) because of its well-documented clinical efficacy and low price. However, this overlooks non-drug costs, which increase with injection frequency. We evaluated whether newer, longer-acting agents offer greater long-term cost-efficiency by reducing total costs despite higher drug prices in a Norwegian setting.

Methods: We developed a 2-year cost-minimization model that included pharmaceutical, consultation and administrative and patient-related costs in Norway; the pharmaceutical cost component incorporated the routine practice of splitting vials into prefilled syringes in hospital pharmacies. The model compared four nAMD monotherapies, Avastin, Eylea 2 mg, Eylea 8 mg and Vabysmo, as well as the common practice of switching treatment-resistant patients from Avastin to Eylea 2 mg. We derived injection frequencies from clinical trials (for monotherapies) or observational data (for switching) and conducted one-way sensitivity analyses to identify key cost drivers.

Results: Over 2 years, the switching regimen had the highest per-patient cost (146 722 NOK), followed by Eylea 2 mg (100 481 NOK), Vabysmo (93 207 NOK), Avastin (86 262 NOK) and Eylea 8 mg (68 738 NOK). Avastin had the lowest drug cost, but its high injection frequency increased non-drug costs. Sensitivity analyses showed that injection frequency strongly influenced total costs for high-priced drugs, while patient time had a substantial impact for Avastin.

Conclusion: In our model, longer-acting agents reduced injection frequency and decreased overall treatment costs. These findings suggest that adopting longer-acting monotherapy could improve cost-efficiency in long-term nAMD management in Norway.

目的:挪威指南将未核准的阿瓦斯汀(Avastin)指定为治疗新生血管性年龄相关性黄斑变性(nAMD)的一线玻璃体内治疗药物,因为其临床疗效良好且价格低廉。然而,这忽略了非药物成本,非药物成本随着注射频率的增加而增加。我们评估了在挪威环境中,尽管药品价格较高,但较新的长效药物是否通过降低总成本来提供更高的长期成本效益。方法:我们开发了一个2年成本最小化模型,包括挪威的药品、咨询、行政和患者相关费用;药品成本部分包括医院药房将小瓶分成预充注射器的常规做法。该模型比较了四种nAMD单药治疗,Avastin, Eylea 2mg, Eylea 8mg和Vabysmo,以及将治疗耐药患者从Avastin切换到Eylea 2mg的常见做法。我们从临床试验(单一疗法)或观察数据(转换疗法)中获得注射频率,并进行了单向敏感性分析,以确定关键的成本驱动因素。结果:2年内,转换方案的人均成本最高(146 722 NOK),其次是Eylea 2 mg (100 481 NOK)、Vabysmo (93 207 NOK)、Avastin (86 262 NOK)和Eylea 8 mg (68 738 NOK)。阿瓦斯汀的药物成本最低,但其注射频率高,增加了非药物成本。敏感性分析显示,注射频率强烈影响高价药物的总成本,而患者时间对阿瓦斯汀有实质性影响。结论:在我们的模型中,长效药物减少了注射频率,降低了总体治疗成本。这些发现表明,在挪威,采用长效单药治疗可以提高长期nAMD治疗的成本效益。
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引用次数: 0
Validity assessment for technical skills and stress management of the HelpMeSee® Manual Small Incision Cataract Surgery module. HelpMeSee®手动小切口白内障手术模块的技术技能和压力管理有效性评估。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-31 DOI: 10.1111/aos.70083
Lea Dormegny, Marion Schaeffer, Nicole Neumann, Remi Yaïci, Lauriana Solecki, Gauthier Dechriste, Emilia Koestel, David Gaucher, Arnaud Sauer, Van Charles Lansingh, Anne Lejay, Nabil Chakfé, Tristan Bourcier

Purpose: To assess the validity of the HelpMeSee Manual Small Incision Cataract Surgery (MSICS) module as a virtual reality training tool for technical skills and stress management in ophthalmology.

Methods: This prospective study enrolled 47 volunteer surgeons from five groups: four groups of eye surgeons with increasing experience (novice, junior, senior and expert) and a fifth group of experts from other specialties. Participants completed two standardized MSICS training runs on the HelpMeSee simulator. Performance scores, penalties and completion time were recorded. Ergonomics were assessed via the Rapid Upper Limb Assessment (RULA) score, and stress was evaluated subjectively and objectively using the State-Trait Anxiety Inventory-Y (STAI-Y) and the Analgesia Nociception Index (ANI) score. Data from the two runs were analysed and compared across groups.

Results: Overall scores increased significantly from novice residents (32.4 ± 10.7 out of 72) to the expert ophthalmic surgeons (50.1 ± 9.41) (p < 0.001). Non-ophthalmic experts had a lower mean score (16.8 ± 18.0). Total penalties, particularly in the second run, decreased with experience among eye surgeons, while experts from other specialties incurred the highest penalties. Time analysis did not differ between groups, as for RULA or STAI-Y scores. The mean ANI score decreased with experience, suggesting higher stress levels in more experienced participants.

Conclusions: The HelpMeSee MSICS module effectively differentiates surgical experience levels, confirming its validity as a tool for technical skills training. The ANI score demonstrated modified behaviour in expert surgeons, suggesting the simulator's potential for assessing non-technical skills. These findings support the use of this virtual reality simulator for objective, skills-based surgical education.

目的:评估HelpMeSee手册小切口白内障手术(msic)模块作为眼科技术技能和压力管理的虚拟现实培训工具的有效性。方法:本前瞻性研究招募了来自五组的47名志愿外科医生:四组经验越来越丰富的眼科医生(新手、初级、高级和专家)和第五组来自其他专业的专家。参与者在HelpMeSee模拟器上完成了两次标准化的msic训练。记录成绩、罚分和完成时间。通过快速上肢评估(RULA)评分评估人体工效学,使用状态-特质焦虑量表- y (STAI-Y)和镇痛伤害感觉指数(ANI)评分主观和客观评估应激。对两组的数据进行分析和比较。结果:从住院医师新手(32.4±10.7分,72分)到眼科专家(50.1±9.41分),总得分显著提高(p)。结论:HelpMeSee msic模块有效区分了手术经验水平,证实了其作为技术技能培训工具的有效性。ANI评分证明了专业外科医生的行为有所改变,表明该模拟器在评估非技术技能方面具有潜力。这些发现支持将虚拟现实模拟器用于客观的、基于技能的外科教育。
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引用次数: 0
Prognostic factors of optical coherence tomography angiography in intermediate and advanced primary open-angle glaucoma: A systematic review and meta-analysis. 中晚期原发性开角型青光眼的光学相干断层血管造影预后因素:系统回顾和荟萃分析。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-30 DOI: 10.1111/aos.70075
Kamya Katarya, Victor A de Vries, João Barbosa-Breda, Luisa Sanchez Brea, Danilo Andrade De Jesus, Wishal D Ramdas

Conventional optical coherence tomography (OCT) has a floor effect in patients with severe visual field loss, such as seen in advanced primary open-angle glaucoma (POAG). OCT angiography (OCTA) does not suffer from such a floor effect. However, which OCTA parameters are most useful for monitoring longitudinal progression is unclear. We conducted a systematic review and meta-analysis to investigate the clinical use of OCTA in monitoring the progression of intermediate and advanced POAG by searching four databases (Medline, Embase, Web of Science and Cochrane Database of Systematic Reviews) for longitudinal studies on POAG and OCTA. For each meta-analysed OCTA parameter, we calculated a pooled effect estimate with a 95% confidence interval (95% CI). Parameters that could not be meta-analysed were compared narratively. A total of 18 studies were included in the systematic review and seven in the meta-analyses. In the meta-analyses, a lower baseline peripapillary vessel density (VD) significantly increased the risk of visual field (VF) progression (HR [95% CI]: 1.05 [1.02, 1.07] for each percentage decrease in peripapillary VD per year). Baseline parafoveal VD and risk of VF progression showed no significant association. The inferior hemifield foveal avascular zone parameters and the presence of peripapillary choroidal microvascular dropout were significantly associated with the risk of VF progression in the systematic review. Peripapillary VD may be a useful predictor of VF progression in intermediate and advanced glaucoma patients. Although FAZ and MvD also seem to be potential predictors, longitudinal studies on advanced POAG are limited and heterogeneous, highlighting the need for more consistent and comprehensive research.

传统的光学相干断层扫描(OCT)在严重视野丧失的患者中具有地板效应,例如晚期原发性开角型青光眼(POAG)。OCT血管造影(OCTA)没有这种底效应。然而,哪些OCTA参数对监测纵向进展最有用尚不清楚。我们通过检索四个数据库(Medline, Embase, Web of Science和Cochrane系统评价数据库)对POAG和OCTA的纵向研究进行了系统回顾和荟萃分析,以调查OCTA在监测中晚期POAG进展中的临床应用。对于每个荟萃分析的OCTA参数,我们计算了具有95%置信区间(95% CI)的合并效应估计。不能进行meta分析的参数进行叙述比较。系统综述共纳入18项研究,荟萃分析纳入7项研究。在荟萃分析中,较低的基线乳头周围血管密度(VD)显著增加了视野(VF)进展的风险(HR [95% CI]: 1.05[1.02, 1.07] /每年乳头周围血管密度每降低一个百分比)。基线中凹旁VD与VF进展风险无显著关联。在系统评价中,下半视野中央凹无血管区参数和乳头周围脉络膜微血管脱落的存在与VF进展的风险显著相关。乳突周围VD可能是中晚期青光眼患者VF进展的有用预测因子。虽然FAZ和MvD似乎也是潜在的预测因素,但对晚期POAG的纵向研究是有限的和异质性的,强调需要更一致和全面的研究。
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引用次数: 0
Patient-reported outcome measures after non-diffractive extended range of field IOL implantation: PureSee versus Vivity. 患者报告的无衍射大范围人工晶状体植入术后的结果:PureSee vs Vivity。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-30 DOI: 10.1111/aos.70076
Kyungmin Koh, Raimo Tuuminen, Dong Gyu Na, Sohee Jeon

Purpose: To perform a head-to-head comparison of two extended range of field intraocular lenses (IOLs) for their patient-reported outcome measures.

Setting: Keye Eye Hospital, Seoul, Korea.

Design: Clinical cohort study.

Methods: Eighty-five emmetropic bilaterally operated patients (PureSee [N = 34] vs. AcrySof Vivity [N = 51]) were compared for their visual outcomes, dysphotopsia (scale 0-100), and spectacle-independent visual function index (VF)-14 questionnaire scores at the 6-month timepoint.

Results: Baseline patient and ophthalmic variables were comparable between the groups. Acrysof Vivity provided better uncorrected near (0.21 ± 0.10 vs. 0.28 ± 0.07 LogMAR units, p < 0.001) and intermediate visual acuities (0.08 ± 0.09 vs. 0.22 ± 0.08 LogMAR units, p < 0.001) compared with PureSee. In contrast, contrast sensitivities in photopic (1.57 ± 0.14 vs. 1.45 ± 0.17 LogCWeber, p = 0.024) and mesopic conditions (1.30 ± 0.12 vs. 1.19 ± 0.17 LogCWeber, p = 0.025) were greater for PureSee than Acrysof Vivity. PureSee was associated with overall mean dysphotopsia scores (1.3 ± 3.2 vs. 5.8 ± 9.3, p = 0.009) significantly less than for Acrysof Vivity. Spectacle-independent VF-14 scores for visual acuities at near, specifically reading small print (76.0 ± 20.0 vs. 65.9 ± 22.4, p = 0.046), newspaper or a book (94.8 ± 11.5 vs. 80.3 ± 19.5, p < 0.001), and large-print or numbers on a telephone (88.0 ± 15.4 vs. 79.5 ± 18.2, p = 0.030) were significantly greater for Acrysof Vivity than PureSee, whereas overall mean spectacle-independent VF-14 scores remained statistically non-significant for the two IOLs (92.6 ± 5.7 vs. 89.3 ± 9.7, respectively; p = 0.115).

Conclusions: Acrysof Vivity was associated with greater spectacle-independent near visual acuity and visual function for reading, while PureSee outperformed in photopic and mesopic contrast sensitivities, glare, starburst, and overall dysphotopsia. Based on these pros and cons, optimal extended range of field IOL selection should be aligned with the individual's needs and concerns.

目的:对两种大范围视野人工晶状体(iol)患者报告的结果进行比较。地点:韩国首尔Keye眼科医院。设计:临床队列研究。方法:比较85例双侧直视手术患者(PureSee [N = 34] vs. AcrySof Vivity [N = 51]) 6个月时的视力状况、视力障碍(评分0-100)和非眼镜视功能指数(VF)-14问卷得分。结果:两组之间的基线患者和眼科变量具有可比性。Acrysof Vivity提供了更好的未矫正的近距离视力(0.21±0.10比0.28±0.07 LogMAR单位,p)。结论:Acrysof Vivity与更大的不依赖于眼镜的近视力和阅读的视觉功能相关,而PureSee在光和介观对比灵敏度、眩光、星裂和整体失光症方面表现更好。基于这些优点和缺点,最佳的人工晶状体扩展范围的选择应与个人的需要和关注保持一致。
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引用次数: 0
Longitudinal corneal thickness changes and their relation to ocular and systemic cardiovascular risk factors: Results from the Gutenberg Health Study. 纵向角膜厚度变化及其与眼部和全身心血管危险因素的关系:来自古腾堡健康研究的结果。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-29 DOI: 10.1111/aos.70067
P Wolfrum, A M Welzel, E W Böhm, J Wasielica-Poslednik, P S Wild, I Schmidtmann, J Weinmann-Menke, M E Beutel, K Geschke, K J Lackner, N Pfeiffer, A K Schuster

Purpose: This study aimed to evaluate 5-year longitudinal changes in both central and peripheral corneal thickness and to explore associations with ocular characteristics as well as systemic cardiovascular risk factors (CVRF).

Methods: The Gutenberg Health Study is a prospective population-based cohort study comprising 15 010 participants aged 35-74 years at baseline. Scheimpflug tomography (Pentacam, Oculus, Wetzlar, Germany) was performed during both the 5-year (2012-2017) and 10-year (2017-2022) follow-up examinations. Longitudinal changes in central corneal thickness (CCT) and in concentric rings at 2 mm (D2), 4 mm (D4), 6 mm (D6), 8 mm (D8) and 10 mm (D10) were evaluated in eyes with available measurements at both time points. Additionally, associations between changes in CCT and ocular characteristics as well as systemic CVRFs at the 5-year FU as well as its 5-year changes (Δ) were investigated by multivariable linear regression analyses using generalized estimating equations.

Results: 8755 eyes of 4857 participants were included and a significant reduction in CCT was observed across all age groups over 5 years. Peripheral corneal thickness remained stable over time. Multivariable analyses identified associations with a change in CCT and ocular characteristics including corneal diameter (B = -0.06, p < 0.0001), axial length (B = 0.04, p < 0.008), pseudophakia at the 5-year examination (B = -0.18, p < 0.03) as well as systemic CVRF including age (B = -0.04, p < 0.008), HbA1c (B = 0.03; p < 0.040), ΔHbA1c (B = 0.05; p < 0.001), ΔLDL (B = -0.03, p < 0.047), ΔHDL (B = -0.05, p = 0.0006), ΔMAP (B = -0.04, p < 0.01) and a continuous smoking status (B = 0.08, p < 0.035).

Conclusion: While observing a 5-year decline in CCT, peripheral corneal thickness remained relatively stable. We observed longitudinal associations between CCT changes and HbA1c, lipid profile, mean arterial pressure and smoking, suggesting that corneal thickness changes may be influenced by cardiovascular and metabolic health and thus may be taken into consideration in glaucoma risk stratification.

目的:本研究旨在评估中央和周围角膜厚度的5年纵向变化,并探讨其与眼部特征和系统性心血管危险因素(CVRF)的关系。方法:古登堡健康研究是一项基于人群的前瞻性队列研究,包括15010名年龄在35-74岁的参与者。在5年(2012-2017年)和10年(2017-2022年)随访检查期间进行了Scheimpflug断层扫描(Pentacam, Oculus, Wetzlar,德国)。在两个时间点用可用的测量方法评估角膜中央厚度(CCT)和同心圆在2mm (D2)、4mm (D4)、6mm (D6)、8mm (D8)和10mm (D10)处的纵向变化。此外,通过使用广义估计方程的多变量线性回归分析,研究了CCT变化与眼部特征以及5年FU时全身cvrf及其5年变化之间的关系(Δ)。结果:4857名参与者的8755只眼睛被纳入研究,在5年以上的时间里,所有年龄组的CCT都显著降低。周围角膜厚度随时间保持稳定。多变量分析确定了CCT变化与角膜直径等眼部特征的相关性(B = -0.06, p)。结论:在观察到CCT 5年下降的同时,角膜外周厚度保持相对稳定。我们观察到CCT变化与HbA1c、血脂、平均动脉压和吸烟之间的纵向关联,表明角膜厚度变化可能受到心血管和代谢健康的影响,因此可能在青光眼风险分层中被考虑在内。
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引用次数: 0
Mesopic microperimetry in Stargardt disease: Application and reliability. 介观显微术在Stargardt病中的应用与可靠性。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-29 DOI: 10.1111/aos.70072
Sybren H Kootstra, Jeroen A A H Pas, Patty P A Dhooge, Steffen Schmitz-Valckenberg, Maurizio Battaglia Parodi, Philipp Herrmann, Frank G Holz, Andrew J Lotery, Katarina Stingl, Thomas H Wheeler-Schilling, Camiel J F Boon, Carel B Hoyng

Purpose: Mesopic microperimetry (mMP) is a promising functional endpoint in clinical trials for Stargardt disease type 1 (STGD1). This study evaluated the test-retest variability of mMP and influencing factors, which is essential for ensuring reliability in future STGD1 trials.

Methods: One hundred and fifteen eyes from 68 patients enrolled in the prospective, tertiary, multicentre STArgardt Remofuscin Treatment Trial (STARTT) underwent mMP testing using the macular integrity assessment (MAIA) microperimeter (CenterVue, Padova, Italy) at both the screening (first) and baseline (second) visits of the trial. Test-retest variability was assessed using Bland-Altman analyses and coefficients of repeatability (CoR). Retinal sensitivity metrics included mean sensitivity (MS) and pointwise sensitivity (PWS). Other factors including fixation stability, exam duration and learning effect were analysed.

Results: MS demonstrated the lowest variability (CoR: 3.53 dB, 95% CI: 3.07-3.99), while PWS exhibited the highest (CoR: 12.69 dB, 95% CI: 12.47-12.91). Variability decreased in sensitivity ranges from -1 to 3 dB and 16 to 32 dB and from central to peripheral regions. Test duration (Spearman's ρ = 0.609, p < 0.001) and fixation losses (Spearman's ρ = 0.284, p = 0.003) were significantly associated with increased variability. Other fixation stability metrics showed no correlation. No learning effect was observed.

Conclusions: Given its high variability, PWS should be used cautiously. MS offers lower variability but may mask localised functional changes. A parafoveal ring strategy may improve reliability but requires validation. Limiting test duration to ≤450 seconds and comprehensive operator training are recommended to minimise potential bias.

目的:在Stargardt病1型(STGD1)的临床试验中,介观显微测量(Mesopic microperimetry, mMP)是一个很有前景的功能终点。本研究评估了mMP的重测变异性及其影响因素,这对于确保未来STGD1试验的可靠性至关重要。方法:参加前瞻性、三级、多中心STArgardt remfuscin治疗试验(STARTT)的68名患者中的115只眼睛在试验的筛选(第一次)和基线(第二次)就诊时使用黄斑完整性评估(MAIA)微周(CenterVue, Padova, Italy)进行了mMP测试。使用Bland-Altman分析和可重复性系数(CoR)评估重测变异性。视网膜灵敏度指标包括平均灵敏度(MS)和逐点灵敏度(PWS)。其他因素包括注视稳定性、考试时间和学习效果。结果:MS表现出最低的变异性(CoR: 3.53 dB, 95% CI: 3.07-3.99),而PWS表现出最高的变异性(CoR: 12.69 dB, 95% CI: 12.47-12.91)。变异性的灵敏度从-1到3db和16到32db,从中心到外围区域下降。试验持续时间(Spearman’s ρ = 0.609, p)结论:鉴于PWS的高变异性,应谨慎使用。多发性硬化症的可变性较低,但可能掩盖局部功能变化。准中央环策略可以提高可靠性,但需要验证。建议将测试持续时间限制在≤450秒,并对操作人员进行全面培训,以尽量减少潜在的偏差。
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引用次数: 0
Impact of mono- or multitherapy on ocular surface health and quality of life after 5 years of follow-up in the Glaucoma Intensive Treatment Study (GITS). 青光眼强化治疗研究(GITS)中,单药或多药治疗对5年后眼表健康和生活质量的影响
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-29 DOI: 10.1111/aos.70078
Gauti Jóhannesson, Christina Lindén, Johan Aspberg, Sabina Andersson-Geimer, Anders Heijl, Boel Bengtsson, Dorothea Peters

Aim: To evaluate the impact of initial mono- versus multitherapy on the ocular surface and related quality of life after 5 years follow-up in the Glaucoma Intensive Treatment Study (GITS).

Method: The study included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma who completed 5-year follow-up in GITS. Assessment of ocular surface disease (OSD) symptoms was done using a Swedish Translation of the OSD Index (OSDI). Signs of OSD were assessed with tear break-up time (BUT), Schirmer I test and staining using Lissamine green. Rasch analysis was used to analyse OSDI results.

Results: Data on OSD symptoms were available at 5 years in 90% (219/242) of all participants initially included in GITS. Subjective or objective OSD findings did not differ significantly between mono- and multitherapy. More than 90% of patients in both arms reported no or little subjective ocular surface problems and showed no or minimal staining with Lissamine green at the 60-month visit. Furthermore, 46% had normal BUT and 60% normal Schirmer tests. Use of preservative-free drops or need for additive lubricating tear drops did not differ between the arms.

Conclusion: We found no differences in objective or subjective impact on ocular surface between the two randomization arms. However, a subgroup of glaucoma patients had more severe OSD irrespective of the amount of topical glaucoma treatment received, and this should be considered when choosing glaucoma therapy treatment in this subgroup by considering laser treatment or non-preserved eye drops.

目的:评价青光眼强化治疗研究(GITS)中初始单药与多药治疗对眼表及相关生活质量的影响。方法:对在GITS中完成5年随访的原发性开角型青光眼和假脱落型青光眼患者进行研究。使用瑞典语翻译的眼表疾病指数(OSDI)评估眼表疾病(OSD)症状。采用泪液破裂时间(BUT)、Schirmer I试验和丽丝胺绿染色评估OSD症状。采用Rasch分析法对OSDI结果进行分析。结果:在最初纳入GITS的所有参与者中,90%(219/242)在5年时可获得OSD症状的数据。主观或客观的OSD结果在单药和多药治疗之间没有显著差异。在60个月的随访中,超过90%的两组患者报告没有或很少有主观眼表问题,没有或很少有丽丝胺绿染色。此外,46%的患者有正常的BUT, 60%的患者有正常的Schirmer试验。使用不含防腐剂的泪滴或需要添加剂润滑泪滴在手臂之间没有差异。结论:我们发现两个随机分组组对眼表的客观或主观影响没有差异。然而,与局部青光眼治疗剂量无关的青光眼患者亚组出现了更严重的OSD,在选择该亚组青光眼治疗时应考虑激光治疗或非保存眼药水治疗。
{"title":"Impact of mono- or multitherapy on ocular surface health and quality of life after 5 years of follow-up in the Glaucoma Intensive Treatment Study (GITS).","authors":"Gauti Jóhannesson, Christina Lindén, Johan Aspberg, Sabina Andersson-Geimer, Anders Heijl, Boel Bengtsson, Dorothea Peters","doi":"10.1111/aos.70078","DOIUrl":"https://doi.org/10.1111/aos.70078","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the impact of initial mono- versus multitherapy on the ocular surface and related quality of life after 5 years follow-up in the Glaucoma Intensive Treatment Study (GITS).</p><p><strong>Method: </strong>The study included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma who completed 5-year follow-up in GITS. Assessment of ocular surface disease (OSD) symptoms was done using a Swedish Translation of the OSD Index (OSDI). Signs of OSD were assessed with tear break-up time (BUT), Schirmer I test and staining using Lissamine green. Rasch analysis was used to analyse OSDI results.</p><p><strong>Results: </strong>Data on OSD symptoms were available at 5 years in 90% (219/242) of all participants initially included in GITS. Subjective or objective OSD findings did not differ significantly between mono- and multitherapy. More than 90% of patients in both arms reported no or little subjective ocular surface problems and showed no or minimal staining with Lissamine green at the 60-month visit. Furthermore, 46% had normal BUT and 60% normal Schirmer tests. Use of preservative-free drops or need for additive lubricating tear drops did not differ between the arms.</p><p><strong>Conclusion: </strong>We found no differences in objective or subjective impact on ocular surface between the two randomization arms. However, a subgroup of glaucoma patients had more severe OSD irrespective of the amount of topical glaucoma treatment received, and this should be considered when choosing glaucoma therapy treatment in this subgroup by considering laser treatment or non-preserved eye drops.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in choroidal and retinal thickness 6 months before and during 18 months of orthokeratology lens treatment in myopic children. 近视儿童角膜塑形镜治疗前6个月及18个月脉络膜及视网膜厚度的变化。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-28 DOI: 10.1111/aos.70084
P O Hansen, F Møller, T M Jakobsen

Purpose: To investigate changes in choroidal and retinal thickness before and during myopia control treatment with orthokeratology lenses (OKL) in myopic children.

Methods: This was a sub-study of CONTROL and CONTROL2 studies. The present study was a 2-year, prospective, single-group interventional study consisting of a 6-month pre-treatment observation period followed by 18-month OKL treatment. Choroidal and retinal thicknesses were measured using a 3D macula scan with swept-source optical coherence tomography. All thickness measures were corrected for magnification using the Imagenet6 software. Axial length was measured using Lenstar LS900 and corrected for change in central corneal thickness. Data were collected at three pre-treatment visits and seven post-treatment visits (from Day 3 up to 18 months).

Results: The 20 study participants had a mean age of 11.2 ± 1.9 years, median cycloplegic spherical equivalent refractive error of -2.58 diopters (range - 4.75 to -1.00) and mean axial length of 24.56 ± 0.63 mm. During the pre-treatment period, there was a statistically significant decrease in retinal thickness of -1.44 μm (p = 0.038, SE 0.70, 95% CI -2.82 to -0.08), but a significant increase was seen after initiation of OKL treatment. Thickness peaked at 2.54 μm (p < 0.001, SE 0.72, 95% CI 1.13 to 3.95) at the 6-month follow-up. We observed a tendency for the choroidal thickness to decrease during the pre-treatment period (-5.96 μm, p = 0.12, SE 3.78, 95% CI -13.37 to 1.46) and then a statistically significant increase after treatment initiation with a peak of 11.95 μm after 1 month of treatment (p = 0.003, SE 4.08, 95% CI 3.94 to 19.96). Short-term change in choroidal thickness after treatment initiation did not correlate with change in overall eye length defined as subfoveal choroidal thickness plus axial length adjusted for post-treatment change in central corneal thickness. For each individual participant, the choroidal thickness and retinal thickness were highly positively correlated at each visit throughout the study (p < 0.001, 95% CI 0.69 to 2.09, linear mixed model).

Conclusion: Treatment with OKL increased both retinal and choroidal thickness in myopic children. Short-term change in choroidal thickness was not a predictor for growth of the overall eye length. Further studies of the presumed structural changes in the choroid and the retina are warranted.

目的:探讨近视儿童角膜塑形镜控制近视治疗前后脉络膜和视网膜厚度的变化。方法:本研究是CONTROL和CONTROL2研究的一个子研究。本研究是一项为期2年的前瞻性单组干预研究,包括6个月的治疗前观察期和18个月的OKL治疗。脉络膜和视网膜厚度测量使用三维黄斑扫描与扫描源光学相干断层扫描。所有厚度测量都使用Imagenet6软件进行放大校正。使用Lenstar LS900测量眼轴长度,并校正角膜中央厚度的变化。数据收集于3次治疗前访问和7次治疗后访问(从第3天到18个月)。结果:20名研究参与者的平均年龄为11.2±1.9岁,中位睫状体麻痹的球等效屈光度为-2.58屈光度(范围为- 4.75至-1.00),平均轴长为24.56±0.63 mm。治疗前视网膜厚度下降-1.44 μm,差异有统计学意义(p = 0.038, SE 0.70, 95% CI -2.82 ~ -0.08),但OKL治疗开始后视网膜厚度显著增加。结论:OKL治疗可使近视儿童的视网膜和脉络膜厚度增加。脉络膜厚度的短期变化并不能预测整个眼长的增长。对脉络膜和视网膜的推定结构变化的进一步研究是必要的。
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引用次数: 0
Corneal tomography and endothelial cell density after Paul glaucoma implant surgery. 保罗青光眼植入术后角膜断层扫描和内皮细胞密度。
IF 2.8 3区 医学 Q1 OPHTHALMOLOGY Pub Date : 2026-01-28 DOI: 10.1111/aos.70063
Jyri-Pekka Koskinen, Mika Harju, Juha Välimäki

Purpose: To evaluate changes in corneal tomography, pachymetry and endothelial cell density (ECD) following Paul Glaucoma Implant (PGI) surgery.

Methods: Seventy-three patients were prospectively examined. Repeated measures anova was used to analyse corneal tomography, corneal thickness and ECD at baseline, 6 and 12 months.

Results: PGI surgery was not associated with clinically meaningful changes in corneal tomography parameters. Simulated astigmatism and posterior astigmatism remained stable over 12 months. Simulated average keratometry showed a small but statistically significant flattening (≈0.3 diopters), whereas posterior average keratometry remained unchanged. Although some changes reached statistical significance, their magnitude was minimal and unlikely to be clinically relevant. Central corneal thickness remained stable, but pachymetry in the tube quadrant increased in the operated eyes, while adjusted pairwise comparisons were non-significant. Central ECD did not change significantly after surgery (p = 0.67). In contrast, paracentral (-2.9%) and peripheral (-4.7%) ECD values declined significantly over 12 months (p = 0.03 and p = 0.001, respectively) and study eyes consistently showed lower values than contralateral control eyes. However, PGI surgery did not accelerate the rate of cell loss, as the time × eye interaction was not significant.

Conclusions: PGI surgery did not induce progressive changes in corneal astigmatism or pachymetry during the first postoperative year. Central ECD remained stable, while paracentral and peripheral regions showed a moderate decline. PGI did not increase the rate of endothelial cell loss and the observed reduction was lower than previously reported for other glaucoma drainage implants.

目的:评价保罗青光眼植入术(PGI)后角膜断层扫描、厚度测量和内皮细胞密度(ECD)的变化。方法:对73例患者进行前瞻性检查。在基线、6个月和12个月时,采用重复测量方差分析角膜断层扫描、角膜厚度和ECD。结果:PGI手术与角膜断层扫描参数的临床意义变化无关。模拟散光和后向散光在12个月内保持稳定。模拟平均角膜屈光度显示小而有统计学意义的变平(≈0.3屈光度),而后验平均角膜屈光度保持不变。虽然有些变化达到统计学意义,但其幅度很小,不太可能具有临床相关性。角膜中央厚度保持稳定,但手术眼管象限的厚度增加,而调整后的两两比较无显著性。手术后中枢性ECD无显著变化(p = 0.67)。相比之下,中心旁(-2.9%)和周围(-4.7%)的ECD值在12个月内显著下降(分别为p = 0.03和p = 0.001),研究眼的ECD值始终低于对侧对照眼。然而,PGI手术并没有加速细胞丢失的速度,因为时间×眼相互作用不显著。结论:PGI手术在术后一年内没有引起角膜散光或视厚测量的进行性变化。中心ECD保持稳定,而中心旁和周边地区则出现中度下降。PGI没有增加内皮细胞的损失率,并且所观察到的减少比先前报道的其他青光眼引流植入物要低。
{"title":"Corneal tomography and endothelial cell density after Paul glaucoma implant surgery.","authors":"Jyri-Pekka Koskinen, Mika Harju, Juha Välimäki","doi":"10.1111/aos.70063","DOIUrl":"https://doi.org/10.1111/aos.70063","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate changes in corneal tomography, pachymetry and endothelial cell density (ECD) following Paul Glaucoma Implant (PGI) surgery.</p><p><strong>Methods: </strong>Seventy-three patients were prospectively examined. Repeated measures anova was used to analyse corneal tomography, corneal thickness and ECD at baseline, 6 and 12 months.</p><p><strong>Results: </strong>PGI surgery was not associated with clinically meaningful changes in corneal tomography parameters. Simulated astigmatism and posterior astigmatism remained stable over 12 months. Simulated average keratometry showed a small but statistically significant flattening (≈0.3 diopters), whereas posterior average keratometry remained unchanged. Although some changes reached statistical significance, their magnitude was minimal and unlikely to be clinically relevant. Central corneal thickness remained stable, but pachymetry in the tube quadrant increased in the operated eyes, while adjusted pairwise comparisons were non-significant. Central ECD did not change significantly after surgery (p = 0.67). In contrast, paracentral (-2.9%) and peripheral (-4.7%) ECD values declined significantly over 12 months (p = 0.03 and p = 0.001, respectively) and study eyes consistently showed lower values than contralateral control eyes. However, PGI surgery did not accelerate the rate of cell loss, as the time × eye interaction was not significant.</p><p><strong>Conclusions: </strong>PGI surgery did not induce progressive changes in corneal astigmatism or pachymetry during the first postoperative year. Central ECD remained stable, while paracentral and peripheral regions showed a moderate decline. PGI did not increase the rate of endothelial cell loss and the observed reduction was lower than previously reported for other glaucoma drainage implants.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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