Acta Ophthalmologica最新文献

Central serous chorioretinopathy (CSC) is a chorioretinal disease characterised by serous subretinal fluid (SRF) in the macula, resulting in sudden central vision loss. It predominantly affects working-age adults, particularly men aged 30 to 60 years. Its multifactorial pathophysiology is modulated by systemic factors, such as corticosteroid use, psychological stress, and hypertension. Previous studies suggest that broader environmental influences, including seasonal variation, may contribute to disease onset. This study aimed to systematically review and analyse the evidence on seasonal variation in CSC incidence. A systematic search was conducted across 10 databases (PubMed, Embase, Cochrane Central, Web of Science Core Collection, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI-Korean Journal Database, ProQuest™ Dissertations and Theses Citation Index, and SciELO Citation Index) on 22 June 2025. Eligible studies included observational designs reporting CSC incidence or frequency across seasons; case reports and reviews were excluded. Five studies, with 907 participants in total, met the inclusion criteria. Three studies with sufficient data were included in quantitative meta-analysis, while the remaining two conference abstracts were included in the qualitative synthesis. Seasonal variation in CSC incidence was reported across studies. Meta-analysis using summer as the reference season showed a significantly increased incidence of CSC in spring (OR 1.42; 95% CI: 1.18-1.73; p = 0.0003) and autumn (OR 1.23; 95% CI: 1.02-1.48; p = 0.03). No significant difference was found for winter (OR 0.97; 95% CI: 0.80-1.19; p = 0.80). The remaining 2 studies not included in the meta-analysis also reported seasonal trends consistent with these findings. The findings indicate a significant seasonal variation in CSC incidence, with a consistently increased risk during spring and autumn compared with summer. Further research is needed to examine how seasonal environmental and physiological mechanisms may contribute to CSC development.

Purpose: Assessment of patient preferences for local adverse effects (AEs) of intraocular pressure (IOP)-lowering eye drops.

Methods: A total of 10 000 eye drop-treated patients aged 40-75 years were sampled from the Danish national registries. A discrete choice experiment (DCE) was distributed to each patient to elicit preferences for distinct levels of five representative local AE attributes of IOP-lowering drops: acute discomfort, persistent discomfort, blurred vision, non-persistent cosmetic changes, and persistent cosmetic changes. Preference weights were computed using conditional logistic regression and normalised using profile-based normalisation. The mildest severity levels were used as a reference. Heterogeneity analyses were conducted across patient covariates to examine variation in preference patterns.

Results: A total of 2445 patients (24% response rate; 55% male; median age: 67 years) completed the DCE, with 2096 providing additional covariate data. 95% reported a diagnosis of glaucoma or ocular hypertension. More females than males reported currently experiencing AEs (48% vs. 35%). 25% had previously discontinued treatment with IOP-lowering eye drops due to AEs. The DCE revealed significant differences in the patients' preferences for avoiding AEs. Severe blurred vision, persistent cosmetic changes, and persistent discomfort exhibited the highest levels of disutility. Moderate acute discomfort and non-persistent cosmetic changes were least important. The patients' preferences varied notably by age and gender.

Conclusion: This study provides novel insight into patients' preferences for AEs of IOP-lowering eye drops by identifying the characteristics that most strongly influence treatment choices. These insights support future clinical studies and shared decision-making, facilitating personalised care that can improve adherence, quality of life, and long-term patient outcomes.

Purpose: The TWO-ROP algorithm is a modified screening protocol based on US data for low-risk infants that limits screening to a single outpatient exam at 38 or 40 weeks to reduce the retinopathy of prematurity (ROP) screening burden without compromising safety. The aim of this study was to validate the algorithm on an external data set outside the United States.

Methods: This is a retrospective study of premature infants screened for ROP at a tertiary centre in Greece. Infants with higher birth weight (BW) and greater gestational age (GA) were included and stratified into three groups: group 1 (BW < 1500 g, GA ≥ 32 weeks), group 2 (BW ≥ 1500 g, GA < 32 weeks) and group 3 (BW ≥ 1500 g, GA ≥ 32 weeks). The rate of ROP and type 1 ROP were evaluated.

Results: Five hundred and fifty-three of the 1251 infants (44.2%) met the inclusion criteria. Groups 1, 2 and 3 had 139 (25.1%), 283 (51.2%) and 131 (23.7%) patients. Fourteen patients (2.5%) had ROP, including 7 in group 1, 7in group 2 and 0 in group 3 (p < 0.001). No patient met the criteria for type 1 ROP. No cases of treatment warranted ROP (TW-ROP) were observed in the cohort, indicating no missed cases under the TWO-ROP algorithm. When applying the algorithm, 14.3%-14.9% (mean 14.6%) of ROP examinations were saved.

Conclusion: The TWO-ROP algorithm can reduce examinations while ensuring safety in Greece when using the local screening guidelines. This is the first ex-US validation and supports the potential for risk-stratified screening globally to optimize resources while maintaining safety.

Background: Evaluating keratometric power with Zeiss index (PKZ), paraxial thick cornea power (Gullstrand [PG]) and power referenced to the front (PFV) and back vertex plane (PBV) and raytracing power (PR), and modelling the deviation from PKZ with a multivariable linear prediction model.

Methods: A dataset of 4604 Casia2 measurements from a cataractous population was Copula expanded to N = 30 000 maintaining the individual univariate distributions and interactions. PKZ was compared with paraxial thick lens corneal power PG, PFV, PBV, and PR using measured pupil size and variations of apertures from 1 to 6 mm.

Results: On average, PKZ/PG/PFV/PBV was 43.05/42.74/42.83/43.59 D, and PR was 43.03 D with the measured pupil size. Varying pupil size from 1 (1) 6 mm increased mean PR with aperture size (42.84/42.91/43.02/43.17/43.37/43.62 D). The multivariate linear models predicting the deviation of PG-PKZ, PFV-PKZ, and PBV-PKZ with corneal radii and central thickness performed well, with R² = 0.93 and a root mean squared prediction error of 0.01 D, whereas the equivalent model for PR-PKZ with corneal radii and asphericities, corneal thickness, and aperture sizes performed less well, with R² = 0.79 and a root mean squared prediction error of 0.18 D.

Conclusion: Corneal power derived using the paraxial thick cornea model differs from keratometric power and a linear model performs well in predicting the differences. However, raytracing power differs even more from keratometry with the linear model far less effective.

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.