Acta Ophthalmologica最新文献

Purpose: To compare the effect of preoperative Nd:YAG laser peripheral iridotomy (PI) and intraoperative surgical iridectomy on subclinical inflammation before and after Descemet membrane endothelial keratoplasty (DMEK), using validated anterior segment optical coherence tomography (AS-OCT) inflammatory biomarkers.

Methods: Among 132 eyes eligible for analysis, this matched cohort study included 40 eyes (20 per group) undergoing DMEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Patients received either a preoperative laser PI or intraoperative surgical iridectomy. Eyes were matched according to gender, age, presence of preoperative posterior stromal ripples, baseline visual acuity and corneal thickness. Pre- and post-operative inflammation was quantified using AS-OCT measured aqueous-to-air relative intensity (ARI) and anterior chamber (AC) cell reflectivity. Post-operative trends in subclinical inflammation were compared using generalized additive models (GAM). Visual, pachymetric and endothelial outcomes, as well as post-operative complications, were compared.

Results: The laser PI group showed greater baseline ARI (p < 0.001) consistent with higher preoperative subclinical inflammation, while surgical iridectomy eyes exhibited greater cell counts after DMEK and at final follow-up (both p = 0.05). Post-operative inflammatory spikes resolved by 6-8 weeks, with faster normalization and lower peak values in the laser PI group. Visual acuity improvement, central corneal thickness reduction, endothelial cell loss and complication rates were comparable.

Conclusions: Preoperative laser PI was associated with lower early post-operative subclinical inflammation compared with intraoperative surgical iridectomy, without compromising visual or endothelial outcomes. These findings suggest that a less invasive PI approach may mitigate early post-operative immune activation, promoting smoother AC homeostasis after DMEK.

Purpose: To examine the direct and indirect costs associated with declining distance visual acuity (VA).

Methods: A longitudinal approach was applied to a large, nationally representative sample with extensive data, including VA measured at two time points. The data of 3867 eligible participants aged 30 years or older at baseline were linked with national registers to estimate health care utilization from 1999 to 2013. A prevalence-based bottom-up approach was utilized to calculate the direct and indirect costs at the 2019 level. Data were adjusted for age, sex and incident comorbidities using generalized linear modelling (GLM). To estimate the cost-of-illness (COI), observed expenses among individuals whose VA declined during the follow-up were compared to the counterfactual situation where VA had not declined, based on the regression analyses. Both individual and population-level costs were reported.

Results: The annual total direct health care costs per person were €976 for those with non-declining VA and €1838 for those with declining VA (adjusted to match persons without decline in VA). The adjusted indirect costs were €14 579 and €22 631 for the working age subgroups, respectively. In counterfactual analysis, the annual COI associated with declining VA was estimated at €1166 from direct and €6411 from indirect cost sources. At the population level, the direct costs were €0.3 billion and the indirect costs, calculated for the working-age population, were €0.4 billion annually.

Conclusion: In total, 7.6% of the national direct health care costs were attributed to declining VA, highlighting the savings potential if the prevalence of declining VA could be reduced.

Purpose: Fania (Fanny) Kaplan (1890-1918), who was reportedly visually impaired, confessed to the attempted assassination of Soviet leader Vladimir Lenin (1870-1924) in 1918 by shooting him with a pistol. The precise nature of her visual loss is unknown and raises doubts about whether she had sufficient visual function to perform the act.

Methods: Historical documents were reviewed.

Results: The cause of Kaplan's visual loss is uncertain but occurred following a bomb blast in 1906. If the explosion was the cause, then she most likely had bilateral closed-globe, blast-related injuries, perhaps with additional functional visual loss. She reportedly received treatment at a medical centre in Kharkov (now Kharkiv), then led by the prominent ophthalmologist Leonard Girshman (1839-1921). An informal estimate of the minimum visual acuity required to shoot an adult at 10 feet (3 m) with a pistol is approximately 1.2 logMAR (Snellen equivalent 20/320 or 6/96).

Conclusions: Based on available historical documents, Kaplan's visual function was most likely sufficient to carry out the assassination attempt, although her visual impairment may have contributed to the attempt being unsuccessful.

Purpose: To compare preoperative characteristics and postoperative anatomical and functional outcomes of scleral buckle surgery using sponges versus tires, as well as explant-related complications and the frequency of explant removal.

Methods: This retrospective study included patients with primary rhegmatogenous retinal detachment (RRD) who underwent primary scleral buckling at the Manchester Royal Eye Hospital between 2008 and 2023. Preoperative data included age, macula status, type of RRD, ocular comorbidities and best-corrected visual acuity (BCVA). Postoperative outcomes included single-surgery anatomical success (SSAS), BCVA and explant-related complications (extrusion, infection, high intraocular pressure and persistent diplopia).

Results: Among 562 patients (mean age 36 ± 12 years), 183 received sponges and 379 received tires. Sponges were more commonly used in dialysis-related RRD (54% vs. 10%; p < 0.01) and macula-off eyes (52% vs. 36%; p < 0.01), and associated with worse preoperative BCVA (logMAR 0.84 ± 0.81 vs. 0.57 ± 0.72; p < 0.01). SSAS rates were similar between groups (86.0% vs. 83.4%; p = 0.44) and mean BCVA improvement (ΔBCVA) did not differ significantly (0.39 ± 0.57 vs. 0.29 ± 0.58 logMAR; p = 0.29). In multivariable analysis adjusting for relevant clinical covariates, explant type was not independently associated with postoperative BCVA (B = -0.10; p = 0.28) or SSAS (aOR = 0.79; p = 0.71). Buckle extrusion occurred more frequently in the sponge group (12.6% vs. 3.4%; p < 0.01), leading to higher explant removal rates (14.8% vs. 6.1%; p < 0.01).

Conclusions: Sponges were preferentially used in dialysis-related RRD cases and were associated with worse preoperative BCVA and a higher proportion of macula-off RRDs. SSAS rates and ΔBCVA improvement were similar between groups. Sponges had significantly higher extrusion rates, resulting in more frequent explant removal.

Background: Metal welding generates ultraviolet radiation (UVR) of cataractogenic wavelengths, and UVR emitted during welding has been associated with cataract formation, but results from prior studies are conflicting.

Methods: We conducted a systematic review and meta-analysis of epidemiological studies addressing associations between occupational metal welding and cataract. The literature search was conducted on November 15, 2023, across seven literature databases. Studies comparing age-adjusted occurrence of cataract among welders and control groups were included. Two reviewers extracted data, which were combined using random-effects meta-analyses.

Results: We identified nine studies with a total of 5165 welders and 513 026 controls. There was considerable heterogeneity among studies (I² statistics: 39), and possible publication bias in favour of higher risk estimates. Stratified meta-analyses revealed a summary OR of 1.22 (n = 3, 95% CI 0.79-1.90; p = 0.374) for cataract among welders in high-income countries, whereas the OR was 2.95 (n = 9, 95% CI 1.68-5.19; p = 0.00017) in lower-middle-income countries.

Conclusion: An increased risk of cataract among welders was found in studies from lower-middle-income countries, but not in studies from high-income countries. The disparity could reflect differences in occupational safety adherence and study methodology and may also involve effect modification by cumulative solar UVR. Although a causal link between UVR from metal welding and cataract is biologically plausible, epidemiological evidence is still limited. More studies are needed to quantify the exact risk of cataract among welders in various populations.

Purpose: This study characterized and assessed vision-related quality of life (VRQoL) in patients with neovascular age-related macular degeneration (nAMD) who discontinued treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF), comparing them to those undergoing treatment. Secondarily, it explored reasons for treatment discontinuation against medical advice.

Methods: This survey-based cross-sectional study used data collected for the Danish study, "Identification of Patient-Reported Barriers in Treatment for nAMD" (I-OPTA) at Odense University Hospital, Denmark. I-OPTA included a self-developed questionnaire and the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Main outcomes were demographics, treatment details, NEI-VFQ-25 scores, and reasons for treatment discontinuation against medical advice. Linear regression models investigated the impact of variables on the composite NEI-VFQ-25 score.

Results: The study included 172 (32.6%) patients who had discontinued treatment and 356 (67.4%) patients who were undergoing treatment; 10 (5.8%) discontinued against medical advice. Discontinued patients were older (median 81.0 years, p-value = 0.004), had lower best-corrected visual acuity (BCVA) in the worse-seeing eye (p-value<0.001), had a shorter treatment duration (p-value = 0.001) and lived alone (p-value = 0.044). Discontinued patients showed lower scores in all NEI-VFQ-25 domains except ocular pain. Higher BCVA correlated with a higher composite score of NEI-VFQ-25. Reasons for discontinuation against medical advice included treatment burden and perceived inefficacy.

Conclusion: Patients who discontinued treatment for nAMD report lower VRQoL, with lower BCVA in the worse-seeing eye, older age, living alone, and unilateral treatment possibly contributing to treatment discontinuation. Future studies on visual acuity and retinal fluid in this group could guide decisions on treatment discontinuation, emphasizing patients' quality of life.

Purpose: To analyse the frequency and type of coexisting systemic disorders in children operated on for cataract in Sweden.

Methods: Data were retrieved from the Swedish National Pediatric Cataract Register (PECARE) for children operated between January 1, 2007, and December 31, 2023 (n = 975), including follow-ups at age 1, 2, 5 and 10. Cataracts due to uveitis, trauma or radiation, and lens extraction due to luxation were excluded. Genetic screening was not mandatory during this period.

Results: Of the 872 children who remained after exclusions, 466 (53.4%) had unilateral cataracts and 406 (46.6%) had bilateral cataracts. Coexisting systemic disorders were found in 132/872 (15.1%), of which 5/132 (3.8%) were strongly suspected, 64/132 (48.5%) defined and 63/132 (47.7%) undefined. Overall, 20/872 (2.3%) were developmentally delayed without any systemic disorder diagnosis. Systemic disorder was present in 20/466 (4.3%) with unilateral cataracts, 112/406 (27.6%) with bilateral cataracts, 22/138 (15.9%) with bilateral inherited cataracts and 11/32 (34.4%) with parental consanguinity.

Conclusion: Coexisting systemic disorders were present regardless of laterality, but more common among children with bilateral cataracts. Prevalence was similar among children with consanguineous parents, and lower among children with hereditary cataracts. National consensus regarding genetic screening for systemic disorders is needed.

Purpose: To assess the longitudinal change of choroidal thickness (ChT) and tessellated fundus progression in Chinese adults over 4 years.

Methods: In this population-based longitudinal cohort study, 1646 right eyes of 1646 participants were examined. Fundus photographs were obtained and ChT was measured using swept-source optical coherence tomography. Participants were categorized into high-myopia, low-myopia, and non-myopia groups, and the tessellated fundus was graded 0-3 based on the fundus photographs.

Results: The mean baseline age, refractive error, axial length (AL), and macular ChT were 62.51 ± 9.89 years, -0.48 ± 3.18 D, 23.71 ± 1.58 mm, and 199.7 ± 77.3 μm, respectively. At the 4-year follow-up, a significant reduction in macular ChT of 4.05 ± 6.24, 4.44 ± 6.87, and 3.51 ± 5.17 μm per year was observed in the non-myopia, low-myopia, and high-myopia groups, respectively. Age, baseline ChT, and AL changes (with β^non-M = -78.439, β^HM = -56.505) were independently related to the rate of macular ChT change (all p < 0.05). Furthermore, the decrease in the ChT distribution pattern varied with different refractive groups. Moreover, 4.31% of the participants had tessellated fundus progression; these participants had more ChT reduction over 4 years than those without tessellated fundus progression (p < 0.001).

Conclusions: Choroidal thinning was found to be associated with age and AL elongation. For every 1 mm increase in AL, the decrease rate of ChT in the high-myopia group was slower than that in the non-myopia group. Progression of tessellated fundus was associated with a faster decrease in ChT, highlighting its potential as a biomarker for myopia progression.

Purpose: To investigate the prevalence, developmental stages, and factors affecting the progression of subfoveal nodules (SFN) in Coats' disease.

Methods: A retrospective review of medical records and multimodal images was conducted for patients with Stage 2A-3A Coats' disease in a tertiary university setting. SFN development was classified into five stages: Stage 0 - macular exudation without subfoveal hard exudate; Stage 1 - subfoveal exudation; Stage 2 - consolidation of exudation; Stage 3- vascularization of SFN; Stage 4 - scarring and subfoveal fibrotic nodule. Factors influencing the formation and progression of SFN were analysed.

Results: The study included 44 eyes of 43 patients, with a mean age of 6.9 ± 4.1 years and a mean follow-up of 33 months. SFN prevalence was 48% initially and 91% at final follow-up. No differences were noted in baseline demographics or clinical characteristics across SFN stages. Patients developing SFN earlier than 9 months were significantly younger than those developing in a longer period (>9 months) (5.9 ± 2.7 vs. 8.9 ± 3.6, p = 0.037), and the mean number of intravitreal (IV) anti-VEGF/steroid injections applied per year was lower in the latter group (3.69 ± 1.29 vs. 1.12 ± 1.21, p = 0.001). The risk of early SFN development was 2.4 times higher in patients under 7 years and four times higher in those receiving three or fewer IV anti-VEGF/steroid injections per year.

Conclusion: The prevalence of SFN (91%) in this study was found to be higher compared with the literature. More frequent anti-VEGF/steroid injections, compared with conventional treatment, may slow the progression of SFN.