Acta Ophthalmologica最新文献

Objective: This study aims to evaluate the performance of the telemedicine retinopathy of prematurity severity score (tROP-SS) across all 14 NICUs in the TELEROP cohort against the modified ROP activity score (mROP-ActS).

Design: Retrospective cohort study.

Subjects: The study included 2037 neonates who underwent ROP screening in 14 NICUs via the TELEROP telemedicine network from November 2017 to January 2025.

Methods: We compared the robustness of tROP-SS and mROP-Act systems across all exams.

Main outcome measures: The primary outcomes studied were the ability to return a score in cases responding to treatment, correlation between the two scores and the ability to assess disease directionality.

Results: The study analysed 192 704 photos from 11 368 ROP exams on 2037 patients. tROP-SS generated scores for 100% of exams, demonstrating significant improvements over mROP-ActS, which scored only 92.3% of all exams (p = 0.0136). All patients who met treatment criteria received treatment in both eyes. Among high-risk and treatment warranted (TW) patients, 100.0% exams had a valid tROP-SS exam compared with only 72.73% and 45.27% with a valid mROP-ActS. Only 20.9% high-risk or TW patients had a valid mROP-ActS across all their exams. Incremental increases in tROP-SS were more strongly related to worsening of disease: OR (95% CI) - 3.37 (2.51-4.53) versus 1.57 (1.46-1.69), both p < 0.0001. tROP-SS also demonstrated improved granularity and accuracy in categorizing patients that would ultimately require treatment (AUC: 0.991 vs. 0.825).

Conclusions: tROP-SS was retrospectively evaluated across 14 NICUs, proving to be a more robust scoring system compared to mROP-ActS. The findings support continued use of tROP-SS, supplemented by standard screening protocols to ensure no cases of treatment-warranted ROP are missed. Future research may focus on integrating additional parameters to enhance predictive models to improve early ROP detection.

After more than 50 years, there still remains a challenge and an interest to know more as well as extend and deepen our understanding of the small rapid wavelets, the oscillatory potentials (OPs), of the electroretinogram (ERG) and the neuronal adaptation of the retina. This paper summarizes the current knowledge of the rapid oscillatory response and its role in the process of neuronal adaptation in the retina. An effort has been made to enhance our ability and possibility, especially in the clinic, to interpret and use this response. The first section in short presents historic aspects, definitions and understanding of neuronal adaptation and the OPs. The second part deals with different and modern techniques and possibilities to record and measure the OPs, ffERG (full-field ERG), mfERG (multifocal ERG), fmERG (focal macular ERG) and optimal adaptational recording conditions. The third section overviews the current apprehension of the origin(s) of the OPs. The fourth part describes the normal development of the OPs from prematurity to old age. The last section enlightens the importance of the OPs as indicators of disturbed retinal, neuronal adaptive function in different diseases in the retina.

Purpose: To examine axial length as a risk factor for pseudophakic rhegmatogenous retinal detachment (pRRD).

Methods: We identified eyes that underwent phacoemulsification between 2 May 2002 and 10 November 2023 and had an axial length registered at the Departments of Ophthalmology in the Capital Region of Denmark or the private clinic Scandinavian Eye Center. The exposure was axial length, and the outcome was time from phacoemulsification to the occurrence of pRRD. The cumulative incidence of pRRD was estimated with the Aalen-Johansen estimator.

Results: We included 129 362 eyes from 75 316 individuals; 601 eyes developed a pRRD. The eyes were distributed in groups based on axial length: <24 mm: 84 226, 24-25 mm: 38 331 and ≥26 mm: 6805. The hazard of pRRD increased with axial length, and this association was most pronounced in males. Compared to female eyes with an axial length of <24 mm (reference), male eyes of ≥26 mm had a higher hazard of pRRD (hazard ratio (HR) 16.3; 11.8-22.5), and likewise for female eyes of ≥26 (HR: 5.2; 3.3-8.1) after adjustment for age and including an interaction between axial length and sex. The 5-year cumulative incidence of pRRD among male eyes of ≥26 mm undergoing phacoemulsification between the ages 40 and 59 was 9.40% (95%CI: 7.10-12.50), and among male eyes aged ≥60 and of ≥26 mm it was 2.00% (95%CI: 1.50-2.70).

Conclusions: The risk of pRRD increased with axial length, and this association was most pronounced in male eyes. The risk of pRRD was high among male eyes that underwent phacoemulsification between ages 40 and 59.

Background: The development of ophthalmology in Georgia was strongly influenced by physicians who brought European medical education and clinical experience to the region. Among them, Jozef Talko played a significant role in establishing modern ophthalmic practice.

Aims: This paper aims to highlight the professional activity and contributions of Jozef Talko as one of the first practicing ophthalmologists and a key figure in the formation of ophthalmology in Georgia.

Materials and methods: The study is based on the analysis of historical medical literature, archival sources, and secondary historical accounts related to the early development of ophthalmology in Georgia and Talko's professional activity.

Results: Jozef Talko received foreign medical education and subsequently practiced ophthalmology in Georgia from the 1890s onward. He provided specialized eye care, introduced contemporary diagnostic and therapeutic approaches, and actively contributed to the recognition of ophthalmology as an independent medical discipline. His work laid practical foundations for the training and development of future ophthalmologists.

Discussion: Talko's activity represents a transition from general medical eye care to structured ophthalmic practice. His role as a practicing clinician helped establish professional standards and increased public and academic awareness of eye diseases and their treatment.

Conclusion: Jozef Talko is a highly respected and acknowledged figure in the history of Georgian ophthalmology. His clinical work and professional influence created a foundation for the further development of the specialty and for future generations of ophthalmologists.

Purpose: To assess the risk of subretinal fluid (SRF) development in the fellow eye of chronic central serous chorioretinopathy (cCSC) patients with unilateral SRF at baseline.

Methods: Medical records of 334 presumed cCSC patients were retrospectively reviewed. Multimodal imaging was evaluated, and the available optical coherence tomography (OCT) scans were screened for SRF development in the fellow eye during follow-up.

Results: Of 213 confirmed cCSC cases, 74 (35%) had bilateral SRF at baseline. Among 102 patients with unilateral SRF that met all inclusion criteria, 7/102 (7%) developed SRF in the fellow eye over a mean follow-up of 20.4 months. Retinal pigment epithelial (RPE) alterations in the fellow eye were present at baseline in 7/7 (100%) who developed SRF, compared to 59/95 (62%) in those who did not (p = 0.042). Subfoveal choroidal thickness (SFCT) was higher in the SRF-developing group (482.3 vs. 365.9 μm; p = 0.306), although not significantly. Hyperautofluorescence on fundus autofluorescence (FAF) at baseline occurred in 6/7 (86%) of the SRF-developing group versus 25/91 (28%) who did not (p = 0.004). The ellipsoid zone was interrupted in 5/7 (71%) of SRF-developing patients versus 28/95 (30%) who did not develop SRF (p = 0.005).

Conclusion: The risk of SRF development in the fellow eye of cCSC patients with unilateral SRF is relatively low over a follow-up period of almost 2 years. No statistically significant risk factors were identified after correction for multiple testing; however, certain trends were observed.

Purpose: Assessing the 24-month treatment outcome of half-dose photodynamic therapy (PDT) or oral eplerenone in chronic central serous chorioretinopathy (cCSC).

Methods: Multicentre randomized clinical trial included cCSC patients from the SPECTRA trial who were randomized to receive half-dose PDT or oral eplerenone. Outcomes were evaluated at 24 months, including the primary outcome measure of complete resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) and the secondary outcome measures best-corrected visual acuity (BCVA), retinal and foveal sensitivity on microperimetry and the National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ25) score.

Results: At baseline, 107 patients were included, of which 80 patients attended the final visit at 24 months: 40 had been randomized to primary treatment with half-dose PDT and 40 to eplerenone. In the eplerenone group, as many as 36/40 (90%) needed crossover treatment at 3 months with half-dose PDT due to persistent SRF, compared to 8/40 (20%) in the half-dose PDT group. At the final visit, complete SRF resolution was observed in 32/40 (80%) who were primarily treated with half-dose PDT and in 35/40 (88%) who received primary eplerenone treatment (p = 0.609). There were no significant differences in terms of BCVA, foveal sensitivity, retinal sensitivity and NEI-VFQ25 score.

Conclusions: This study provides evidence for the long-term efficacy of half-dose PDT in resolving SRF and improving functional outcomes in cCSC. Even when patients initially received eplerenone treatment that did not result in complete SRF resolution, crossover treatment with half-dose PDT led to similar (long-term) group outcomes compared to half-dose PDT as initial treatment.

Purpose: To evaluate the surgery-induced changes of astigmatism after Descemet membrane endothelial keratoplasty (DMEK) in eyes with failed previous penetrating keratoplasty (PK).

Design: Retrospective, interventional cohort study based on prospective DMEK database.

Methods: Evaluation of 15 eyes after DMEK surgery for endothelial decompensation after PK. Astigmatic changes before decompensation and after DMEK surgery were compared using anterior and posterior keratometry and True Net Power (TNP) in corneal tomography (Pentacam, Oculus). The differences in magnitude of astigmatism and axis of steep meridian were calculated by algebraic and vectorial methods, and significant differences to specified thresholds were determined by the non-parametric Wilcoxon rank test.

Results: Surgically induced changes (SIC) in magnitude of astigmatism at anterior surface, posterior surface and TNP were -1.4dpt ± 3.7, -0.2dpt ± 0.8 and -1.3dpt ± 3.9, respectively. No significant changes in astigmatism and axis difference by algebraic method in comparison with a hypothetical median of 0dpt and 10° were observed. Calculation of astigmatism difference by vectorial method showed a significant deviation in anterior surface (observed median = 4.4dpt, p < 0.001), posterior surface (observed median 1.0dpt, p = 0.012) and TNP (observed median = 3.6dpt, p < 0.001).

Conclusion: Even if no significant change in magnitude and axis of astigmatism to acceptable thresholds could be shown after DMEK in failed PK using the algebraic method, there is a significant and relevant change in magnitude of astigmatism using the vectorial calculation. Based on these results, caution is advised when using toric intraocular lenses in PK eyes, as astigmatic change is expected when performing DMEK on eyes with failed PK.

In this study, we systematically review and synthesize the evidence on the association between central serous chorioretinopathy (CSC) and personality types, and quantify the relationship between Type A behaviour and CSC. We systematically searched 12 literature databases on 5 October 2025 for studies in which personality types were evaluated in patients with CSC. Data extraction and risk-of-bias assessment followed standardized protocols. Studies were reviewed qualitatively. Random-effects meta-analysis was performed for the association between Type A behaviour and CSC. Twelve studies of 2176 participants (949 patients with CSC, 1227 controls) were included. Across studies, patients with CSC exhibited personality profiles marked by time urgency, competitiveness, emotional tension and maladaptive affect regulation, including higher neuroticism-anxiety, aggression-hostility and alexithymia scores. A significant association was found between Type A behaviour and CSC (pooled OR 3.43; 95% CI 1.94-6.07; p = 0.00002) in the four studies that evaluated this relationship. Sensitivity analysis confirmed robustness of the association. In conclusion, certain personality traits, particularly Type A behaviour, are associated with CSC. The relationship between personality and CSC appears biologically plausible given the role of stress-related hypothalamic-pituitary-adrenal axis activation and elevated cortisol levels, both recognized in CSC pathophysiology. However, complex biopsychosocial interactions without a direct causal pathway may also be the case. Understanding psychological predispositions may contribute to a more comprehensive view of CSC risk and care. Further longitudinal and mechanistic studies are warranted.

The global demand for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy continues to rise, straining ophthalmic capacity worldwide. Task shifting from physicians to trained non-physician healthcare professionals has emerged as a potential strategy to expand service delivery. This systematic review summarizes current evidence on the safety, implementation, training and patient experiences associated with non-physician-delivered intravitreal injection services. We systematically searched 13 scientific literature databases for studies of anti-VEGF injections performed by non-physicians. Data were extracted on safety outcomes, implementation, training, supervision and patient-reported experience. Results from individual studies were qualitatively reviewed according to these four organizational themes. Sixteen studies comprising 100 150 injections were included, primarily from the United Kingdom and Scandinavia. All injectors completed structured training under an ophthalmologist's supervision. Complication rates were very low, including 0.015%-0.07% for endophthalmitis which were comparable to physician-led benchmarks. Implementation of non-physician-delivered intravitreal injection services increased clinical capacity by 25%-85%, reduced waiting times and costs, and maintained safety and efficiency. Patients reported high satisfaction, confidence and acceptance of non-physician-delivered injections. Non-physician-delivered intravitreal injection services are safe, feasible and well accepted when supported by structured training and robust governance frameworks. This task-shifting model offers a scalable solution to meet growing global demand for anti-VEGF therapy. Standardized international training and certification frameworks may further enhance safety and sustainability.