Acta Ophthalmologica最新文献

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.

Purpose: To describe the treatment rate for retinopathy of prematurity (ROP) at a tertiary referral neonatal intensive care unit (NICU) in the south-western region of the Netherlands. In addition, we evaluated the impact of outsourcing laser treatment, implemented in 2018, by comparing treatment characteristics from 3 years prior and 3 years following this organisational change.

Methods: This retrospective observational cohort study evaluated data of preterm infants born between 2015 and 2020 who were admitted to our NICU and met the eligibility criteria for ROP screening. ROP treatment rate was calculated for infants screened in our NICU. The impact of outsourcing laser treatment was evaluated based on ROP type at treatment decision, time between treatment decision and treatment, and adverse outcomes, including additional treatments and retinal detachment.

Results: A total of 358 infants were screened at our NICU between 2015 and 2020; complete data were available for 343 infants, of whom 15% (51/343) required treatment. Since outsourcing treatment, additional treatment secondary to laser was performed less frequently (25%, 5/20 versus 7%, 2/31). However, the mean number of days between treatment decision and treatment increased since outsourcing treatment (p = 0.014), and 32% (9/28) of cases were treated prior to reaching the criteria of type 1 ROP.

Conclusion: The treatment rate among infants screened at our tertiary referral NICU exceeds previous national and hospital-level reports, likely due to early transfer of low-risk cases. Outsourcing ROP treatment might have led to improved primary treatment success; however, possible disadvantages include treatment delays and over-treatment.

Purpose: X-linked retinoschisis (XLRS) is an inherited vitreoretinal disorder characterized by macular retinoschisis. In a subgroup of patients, peripheral retinoschisis can occur, potentially leading to complications such as vitreous haemorrhage (VH) and retinal detachment (RD). Limited data exist on the optimal management of these complications. This retrospective cohort study evaluates clinical characteristics and outcomes of VH and RD in XLRS patients.

Methods: We included 49 patients diagnosed with XLRS who developed VH and/or RD. Collected data included demographics, best-corrected visual acuity (BCVA), retinal findings, treatment strategies and anatomical and functional outcomes.

Results: The median follow-up was 19.0 years (IQR 11.4-35.6) with 12 visits (IQR 6-19). Median age at first VH was 15.3 years (IQR 5.5-16.3) and 7.5 years (IQR 2.4-15.9) for RD. Peripheral retinoschisis was present in 94% of VH eyes and 80% of RD eyes. Of 39 patients with VH, 10 (26%) had bilateral VH; only 1 (3%) presented with concurrent bilateral VH. VH resolved without intervention in 42 of 49 eyes (86%), although recurrence occurred in 22 eyes (45%). RD was observed in 25 eyes of 21 patients, with rhegmatogenous RD in 16 eyes (64%), tractional in 7 (28%) and exudative in 3 (12%), with one eye showing mixed features. Surgery was performed in 21 eyes (84%), achieving retinal reattachment in 43% after primary surgery and in 90% after multiple procedures. In 15 eyes operated on after 2005, final reattachment was achieved in 93%. BCVA improved postoperatively in 10 of 21 eyes (48%), was stable in 5 (24%) and declined in 2 (10%); 4 (19%) lacked follow-up BCVA.

Conclusion: VH in XLRS is often self-limiting with favourable functional and anatomical outcomes, but recurrence is common. RD typically requires surgical repair, often multiple procedures, with guarded visual prognosis despite anatomical reattachment. Regular follow-up, particularly in young XLRS patients with peripheral retinoschisis, is essential for early detection and management of these potential complications.