Acta Ophthalmologica最新文献

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.

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.

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.

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.

Purpose: The prevalence of diabetic retinopathy (DR) is low in Greenland. Factors underlying the low prevalence may potentially protect against the development of DR. Comparing Greenlandic and Danish populations, this register-based study explored differences in risk factors that may explain differences in DR prevalence.

Methods: Data on DR and risk factors from Greenlandic (n = 1941) and Danish (n = 110343) patients with diabetes were collected from 2019 to 2023 through the Greenlandic electronic medical health records system Cosmic, the Danish Adult Diabetes Registry and the Danish Registry of Diabetic Retinopathy, respectively. Logistic regression models were used to estimate odds and odds ratio (OR) of selected risk factors by cohort (Greenlandic or Danish). Furthermore, the ethnic difference in age and diabetes duration at DR screening was modelled using natural splines.

Results: The prevalence of DR was 10.2% in the Greenlandic cohort and 20.9% in the Danish cohort. In multivariate analysis, longer DM duration and higher HbA1c were the most important risk factors of prevalent DR in both cohorts. DM duration longer than 15 years was associated with higher OR in the Danish cohort than in the Greenlandic. In the Danish cohort, overweight and obesity were associated with higher OR of DR (OR = 1.20, 95% CI = 1.02; 1.41 and OR = 1.24, 95% CI = 1.04; 1.48, respectively) while lower ORs were observed for overweight (OR 0.57 95% CI = 0.28; 1.15) or obesity (OR 0.56, 95% CI = 0.30; 1.07) in the Greenlandic cohort. High systolic blood pressure was also associated with prevalent DR in the Danish cohort.

Conclusion: Long DM duration was a more prominent risk factor for prevalent DR in the Danish population than in the Greenlandic population. Future studies may address the potentially lower sensitivity to DM duration in the Greenlandic population.

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.