Acta Ophthalmologica最新文献

Background: Imaging of the retina is accompanied by distortions so that positions in fundus photographs cannot be linearly translated to positions in the retinal fundus. The purpose of this study was to describe an algorithm and evaluate its reproducibility in identifying points on the retina from their representation on serial fundus photographs.

Methods: A mathematical formalism was derived to describe how the location of the fovea and the optic disc in fundus photographs, together with the centre-nodal point distance (d) and the curvature radius (r) of the eye, can be used to calculate spatial coordinates on the retina that correspond to given locations in the photograph. The effect of manual markings of the fovea and the optic disc as reference points was evaluated, and the formalism was tested on 105 photographs recorded with different image modalities and centring from 10 different patients.

Results: Retinal locations could be identified in serial fundus photographs with a reproducibility of at least 50 μm when the centre-nodal point distance and the curvature radius were set to those in Gullstrand's standard eye. A main source of the variability was the manual identification of the fovea and optic disc used as reference points.

Conclusions: The reproducibility in the identification of locations on the retina from serial fundus photographs depends on the accuracy in the definition of the fovea and optic disc used as reference points. This affects the potential for describing locations, distances, areas and changes in retinal lesions on serial photographs over time.

Purpose: Immune checkpoint inhibitors (ICI) have revolutionised the treatment of several malignancies. However, the results of ICI therapy remain unsatisfactory in metastatic uveal melanoma (UM). We analysed the expression of PD1, PD-L1, T-cell and macrophage markers in a set of matched primary and metastatic UM in an attempt to better understand the low effectiveness of ICI in metastatic UM.

Methods: Thirty-two samples (19 metastases and 13 primary UM) were stained for PD-L1, PD1, CD3, CD4, CD8, CD68, CD163, HLA class I and BAP1. T-cell markers were scored quantitatively, while PD-L1, CD68, CD163 and BAP1 were scored semiquantitatively. The immunohistochemical (IHC) scores were compared between all primary and metastatic UM samples and between matched cases.

Results: Both the general and the matched analyses revealed that the IHC scores for PD-L1 expression on tumour cells were lower in metastatic UM than in primary UM. Conversely, T-cell markers, including PD1, were significantly higher in UM metastases than primary UM, while macrophages did not show a difference. Metastases with a low HLA Class I expression lacked PD-L1 and PD1 expression. BAP-1 loss was associated with increased lymphocytic infiltration.

Conclusions: While UM metastases had higher lymphocytic infiltrates than primary UM, PD-L1 showed a lower expression in metastases. We believe that the low effectiveness of ICI in the treatment of metastatic UM may be partly explained by the low PD-L1 expression. We propose that primary tumours may be more responsive to ICI therapy than metastases and could be targeted in a (neo)adjuvant setting for patients at high risk of developing metastases.

The first successful corneal transplantation, performed by Eduard Zirm in 1905, marked a turning point in treating corneal blindness. This breakthrough was preceded by centuries of conceptual development, dating back to Galen's theoretical approach to corneal transparency restoration in ancient Rome. Erasmus Darwin later proposed corneal trephination in the 18th century, though without practical implementation. The 19th century saw a surge in experimental keratoplasty, with Karl Himley suggesting cross-species corneal transplants and Franz Reisinger coining the term 'keratoplasty'. Johann Dieffenbach and Samuel Bigger further explored transplantation in animal models. Arthur von Hippel's innovations in trephination laid the foundation for Zirm's success, who performed the first human-to-human corneal transplant using strict aseptic techniques. Subsequent advancements, including the establishment of eye banks, immunosuppressive therapies and modern lamellar keratoplasty techniques like DSAEK and DMEK, have significantly improved graft survival and visual outcomes. This historical perspective highlights the continuous evolution of corneal transplantation, underscoring the contributions of numerous pioneers whose innovations have shaped modern ophthalmology.

Purpose: To examine the presence of secretory autophagy and epithelial-mesenchymal transition (EMT) in the macular retinal pigment epithelium (RPE) of human cadaver eyes with different forms of age-related macular degeneration (AMD).

Methods: Human cadaver macula samples representing dry and wet AMD, as well as age-matched controls, were analyzed using immunohistochemistry. Markers of secretory autophagy, EMT, and inflammation were evaluated in RPE cells.

Results: Increased expression of proteins associated with secretory autophagy and EMT was detected in the RPE of AMD samples compared to controls. These changes were observed in both dry and wet AMD forms.

Conclusion: Secretory autophagy and EMT are elevated in the macular RPE of AMD-affected eyes. These observations offer novel insight into AMD progression and potential therapeutic approaches.

Background: Intraocular lenses (IOLs) employing extending focus and multifocality technologies are becoming increasingly popular in cataract and lens surgeries. However, research on the preoperative factors affecting subjective surgical outcomes remains elusive.

Methods: 188 emmetropic bilaterally operated patients were analysed. We compared the outcomes of non-diffractive enhanced monofocal Tecnis Eyhance (N = 86) and non-diffractive extended depth-of-focus AcrySof Vivity (N = 102) IOLs in terms of visual acuities, dysphotopsia (graded from 0 to 100) and spectacle-independent visual function index (VF)-14 questionnaire scores. Next, we analysed correlations between the baseline ocular parameters and refractive outcomes with the dysphotopsia and VF-14 scores. Multivariable linear regression analyses were adjusted for patient age, sex and IOL type.

Results: Acrysof Vivity provided better uncorrected near (0.19 ± 0.12 vs. 0.27 ± 0.13 LogMAR units, p < 0.001) and uncorrected intermediate visual acuities (0.11 ± 0.10 vs. 0.15 ± 0.10 LogMAR units, p = 0.033), and better spectacle-independent VF-14 scores (93.2 ± 5.7 vs. 80.9 ± 12.2; p < 0.001), but higher glare scores (8.60 ± 17.2 vs. 2.16 ± 5.74; p = 0.035) compared to Tecnis Eyhance. Photopic (r = 0.283; B 9.39, 95% CI 4.66 to 14.1; p = 0.006) and mesopic pupil size (r = 0.263; B 6.35, 95% CI 2.91 to 9.79; p = 0.045) were associated with overall dysphotopsia scores. The axial length of the eye (r = -0.374; B -3.47, 95% CI -4.73 to -2.22; p < 0.001), total corneal irregular astigmatism (r = -0.388; B -27.3, 95% CI -39.2 to -15.5; p < 0.001), and corneal higher-order aberrations (r = -0.219; B -14.3, 95% CI -26.5 to -1.98; p = 0.023) inversely associated with VF-14 scores. Angles kappa and alpha were not associated with the levels of dysphotopsia or VF-14 scores.

Conclusions: Patient-related factors, including corneal irregularity, pupil size and axial length of the eye, may explain the high patient-reported outcome measures variability after the implantation of non-diffractive extending focus IOLs.