Acta Ophthalmologica最新文献

Background: Large lower eyelid defects resulting from tumour removal are frequently reconstructed using a tarsoconjunctival flap from the upper eyelid together with an overlying free skin graft, the so-called Hughes procedure. One disadvantage of this technique is that the tarsoconjunctival flap occludes the eye during the revascularization of the graft, which is particularly troublesome for patients with poor vision in the other eye. Another alternative method for reconstructing large lower eyelid defects is the use of a free bilamellar eyelid graft with the advantage that it is a single-stage procedure and that the vision is not occluded during the healing process. However, both these methods require extensive surgery, which is time-consuming and might be too much effort for the frail and elderly. In these specific cases, where one wishes to avoid extensive surgery, laissez-faire treatment, so-called self-healing, might be an alternative.

Methods: 46 patients undergoing laissez-faire treatment for periocular tumour defects were included. Surgical defects were in the medial canthal area (n = 10) and the lower eyelid (n = 28), with the latter classified as proportional (n = 21) or disproportional (n = 7) based on the anterior to posterior lamellae ratio. Cases requiring repeated surgical excisions due to tumour-positive margins (n = 8) were analysed separately. Wound contraction was assessed through serial photography after 1 week, 3 weeks, 6-8 weeks, and 5 months to 2 years. Defect size was standardized using corneal area measurements.

Results: Proportional lower eyelid defects exhibited predictable healing, with rapid wound contraction the first 6-8 weeks and minimal complications. Disproportional defects showed uneven healing, resulting in ectropion or significant tissue loss in 6 of 7 cases. Medial canthal defects generally healed well, but larger defects (>50% of corneal area) took longer to contract and were associated with traction-related complications in isolated cases. Repeated surgical excisions were associated with a higher prevalence of complications, including ectropion, entropion, and residual defects.

Conclusions: Defect geometry is crucial in the healing process and clinical outcomes of periocular defects treated with laissez-faire. Medial canthal defects and proportional lower eyelid defects heal more reliably, while disproportional and large medial canthal defects, as well as cases requiring repeated surgical excisions, pose a higher risk of complications. These findings emphasize the importance of careful patient selection and defect analysis to optimize outcomes.

Purpose: To compare the surgical efficacy and safety of partial and complete gonioscopy-assisted transluminal trabeculotomy (GATT) in open-angle glaucoma.

Methods: This retrospective comparative study included 206 eyes with primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEXG) who underwent partial GATT (superior 180°, inferior 180°, or 270°) or complete GATT (360°) at a tertiary centre with at least 12 months of follow-up. Surgical success (qualified and complete) was defined across three intraocular pressure (IOP) criteria: A (<18 mmHg), B (<15 mmHg), and C (<12 mmHg), each requiring a ≥30% reduction from baseline. Additional outcomes included best-corrected visual acuity (BCVA), number of anti-glaucoma medications (AGMs), extent of episcleral venous fluid wave (EVFW) and postoperative complications.

Results: Mean follow-up was 19.7 ± 9.6 months. Baseline demographics, glaucoma type and surgical indications were comparable between groups. At final follow-up, all GATT variants resulted in significant IOP and AGM reductions (p < 0.001), with no statistically significant differences in IOP, BCVA, success rates, or complications among the four groups (p > 0.05). EVFW extent and safety profiles were similar across groups.

Conclusion: Partial GATT (superior 180°, inferior 180°, or 270°) provides similar surgical outcomes and safety as complete 360° GATT. Hemi-GATT may serve as a time-efficient and effective alternative to circumferential GATT in appropriate patients.

Purpose: Pregnancy induces significant changes in the body, including increased peripheral and choroidal blood perfusion and an increased systemic corticosteroid level. Here, we systematically reviewed the evidence on pregnancy as a risk factor for developing central serous chorioretinopathy (CSC) and conducted a meta-analysis to obtain a summary estimate.

Methods: We searched 12 literature databases on 16 February 2025 for epidemiological studies, which evaluated the potential association between pregnancy and CSC. All eligible studies were included for a qualitative review and a meta-analysis. The meta-analysis was made using the random-effects model on the odds ratio (OR) of the association between pregnancy and CSC.

Results: Four studies were eligible for our review. Of the 2766 individuals (1345 patients with CSC, 1391 controls) in these studies, females constituted 26%-64% of study populations in individual studies. The calculated summary estimate of pregnancy as a risk factor for CSC was OR 5.51 (95% CI: 2.12-14.30, p = 0.00046). Heterogeneity statistics suggested minimal to no heterogeneity (Cochran's Q = 0.72; I² = 0%), the funnel plot was symmetrical and the sensitivity analysis suggested robustness of the estimates.

Conclusion: Pregnancy appears to be a significant risk factor for CSC.

Purpose: To assess the prevalence and associations of external limiting membrane (ELM) defects on optical coherence tomographic (OCT) images in a general population, affected by age-related macular degeneration (AMD) or free of any retinal disease.

Methods: Using OCT images, we assessed the ELM defect presence in participants of the population-based Beijing Eye Study.

Results: The study population consisted of 712 (44.2%) eyes with early AMD, 295 (18.3%) eyes with intermediate AMD, 12 (0.7%) eyes with geographic atrophy and 592 (36.7%) eyes without signs of AMD. ELM defect prevalence increased from 6/592 (1.0%; 95% CI: 0.0, 2.0) in the normal group to 57/712 (8.0%; 95% CI: 6.0, 10.0), 117/295 (39.7%; 95% CI: 34.2, 45.2) and 11/12 (91.7%; 95% CI: 73.7, 100) in the group with early AMD stage, intermediate AMD and late AMD stage, respectively. Higher ELM defect prevalence was spatially associated with higher prevalence of ellipsoid zone (EZ) defects (OR: 929; 95% CI: 291-2964; p < 0.001). In multivariable analysis, higher ELM defect prevalence correlated with higher AMD stage (OR: 2.22; 95% CI: 1.33, 3.71; p = 0.002), higher prevalence of intraretinal hyperreflective foci (iHRFs) superior to the EZ/ELM (OR: 29.7; 95% CI: 8.69-102; p < 0.001), lower prevalence of iHRFs beneath the EZ/ELM (OR: 0.11; 95% CI: 0.04, 0.35; p < 0.001) and higher prevalence of localized interdigitation zone thinnings (IZTs) (OR: 5.66; 95% CI: 3.14, 10.2; p < 0.001).

Conclusions: The spatial correlation between ELM defects and EZ defects, the associations of both defect types with a higher occurrence of iHRFs superior to the ELM, the association between an absence of ELM defects and a higher prevalence of iHRFs located inferior to the ELM, and the association between a higher ELM defect prevalence and higher IZT prevalence may suggest the ELM/EZ may act as a barrier for RPE cells migrating into the retina.

Purpose: To characterise the baseline clinical features and genotypes of adults with pre-mRNA processing factor 31 (PRPF31)-associated retinal dystrophy (RD) enrolled in a prospective, multicentre 4-year natural history study, and to explore correlations between selected baseline parameters.

Methods: Thirty-one patients with PRPF31-RD underwent comprehensive multimodal assessment, including slit-lamp ophthalmoscopy, best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), mesopic and scotopic microperimetry (MP), full-field stimulus threshold (FST) testing, spectral-domain optical coherence tomography (SD-OCT) to assess retinal structure and measure ellipsoid zone (EZ) width, and ultra-widefield fundus autofluorescence (UWF-FAF) to define hyperautofluorescent ring (HAR) area. Correlations between structural and functional measures were analysed using Spearman's rank correlation.

Results: Patients from 21 families carrying 17 distinct disease-causing variants in the PRPF31 gene were identified. The median age was 38 years (range 19-84). Thirty patients exhibited a classic retinitis pigmentosa (RP) phenotype, and one had a pericentral pattern of dystrophy. Frequent findings included cystoid macular oedema (52%), epiretinal membrane (55%) and current or prior cataract (71%). Most patients could complete FST (84%-90%) and mesopic MP testing (77%), while measures of scotopic MP (57%), HAR area (52%) and EZ (68%) excluded the more advanced-staged patients. The HAR area correlated strongly with the functional measures mesopic MP and FST white. The HAR area, EZ width and scotopic MP were also strongly correlated.

Conclusion: This study confirms phenotypic variability in PRPF31-RD and expands the spectrum with pericentral RD. The feasibility of structural and functional assessments depended on disease stage, with scotopic cyan MP limited to eyes with preserved HAR and EZ.

Purpose: This study evaluates whether mesopic microperimetry (MMP) provides a more robust measure of retinal function compared to visual acuity (VA) in age-related macular degeneration (AMD) clinical trials, with a focus on optimal analysis strategies.

Method: Fellow-eyes of unilateral neovascular AMD were prospectively studied. Presenting VA was measured. The Macular Integrity Assessment Microperimeter (MAIA) was used with a 4 to 2 staircase strategy with a 10° diameter grid containing 37 loci. Three analysis strategies were calculated: the mean of 37 sensitivity thresholds (MS), the per cent reduced threshold (PRT), and the log-transformed candela mean (MS cd log). Sample size requirements were calculated for 12- and 24-month follow-ups using a paired one-sided T-test (α = 0.05, power = 0.80).

Results: N = 123 were analysed (82 (65.5%) females; mean age 74.2 (7.8) years). Ranked high to low, the required sample size at 12 months was: MS (n = 51), MS cd log (n = 52), PRT (n = 139), and VA (n = 203). Similar trends were seen at 24 months, with MS requiring the smallest sample size (n = 85) and VA the largest (n = 1673).

Conclusion: All MMP analysis strategies outperformed VA, and MS required the least number of patients to show significant changes. This trend was consistent for both 12 and 24 months. These findings provide strong statistical arguments for the use of MMP in longitudinal within-subjects clinical trials and suggest that averaging decibels is optimal.

Purpose: To define the curriculum content for two interactive learning courses on age-related macular degeneration (AMD): (1) an advanced course tailored for general ophthalmologists and (2) a basic course for non-ophthalmologist healthcare staff. This initiative aims to establish a national consensus on the educational framework for AMD management among general ophthalmologists in Denmark.

Methods: We conducted a three-round Delphi study. The Delphi panel consisted of 33 ophthalmologists (28 retinal specialists from Denmark and five internationally recognized retinal specialists), eight non-ophthalmologist healthcare staff (six optometrists, one ophthalmic nurse and one clinic assistant) with experience in managing patients with AMD. To ensure national representation, we recruited panel participants from all five Danish regions.

Results: Response rates were 85%, 73% and 71% for Delphi rounds 1, 2 and 3, respectively. In the first round, participants suggested a total of 390 potential curriculum components and learning goals: 211 components for the advanced course and 179 for the basic course. After the third round, the panel reached consensus on an AMD curriculum, which included 46 topics for the advanced course (e.g., OCT interpretation: signs of disease activity versus atrophic changes) and 15 topics for the basic course (e.g., visual requirements for driving).

Conclusion: This study reached consensus on the curricula for courses on AMD for general ophthalmologists and non-ophthalmologist healthcare staff. This forms the basis for developing instructional, virtual, interactive courses that can support the development and maintenance of competencies related to AMD, both in Denmark and abroad.

Purpose: Myopia is a growing concern in children worldwide, leading to significant visual impairments. This study investigates the efficacy of plano spectacle lenses with lenslets in preventing the onset of myopia in pre-myopic children. This study aims to contribute to the development of evidence-based strategies for myopia prevention by assessing compliance, efficacy and safety of plano spectacle lenses with lenslets.

Methods: This randomized controlled trial involves 388 pre-myopic children aged 6-9 years. Participants are randomly assigned to either the intervention group, using plano spectacle lenses with lenslets for at least 8 h daily with smart frames recording wearing time, or the control group, which receives no intervention. The primary outcome is the 1-year cumulative incidence of myopia. Secondary outcomes include changes in spherical equivalent under cycloplegia, axial length, choroidal thickness, visual acuity and accommodation function over the study period. Statistical analyses, including chi-squared tests and t-tests, will evaluate these outcomes.

Discussion: This study will offer valuable insights into the use of plano spectacle lenses with lenslets in slowing down the progression to myopia in children at risk. Findings are expected to inform clinical practices and shape guidelines for myopia prevention strategies among the paediatric population.

Trial registration: NCT06860737.

Objective: To assess the prevalence and associations of the detectability of the three-layer sign (TLS) in a general population, including individuals with age-related macular degeneration (AMD) or without any retinal disease.

Methods: Using OCT images running horizontally through the foveola of participants of the population-based Beijing Eye Study, we assessed the TLS detectability. We defined the TLS as the visibility of the ellipsoid zone (EZ), interdigitation zone and retinal pigment epithelium (RPE)/Bruch's membrane line as separate units in the foveola on optical coherence tomographic (OCT) images.

Results: The study included 1566 eyes (age: 65.3 ± 9.8 years; axial length: 23.01 ± 0.93 mm; range: 19.90 mm-28.93 mm), randomly selected within each group of normal eyes (n = 592; 37.8%), eyes with early AMD (n = 700; 44.7%), intermediate AMD (n = 267; 17.0%), and late AMD (n = 7; 0.4%). In the normal group, TLS prevalence decreased with older age (OR: 0.93; p < 0.001), declining from 217/265 (81.9%) in the 50-59 years age group to 57/126 (45.2%) in individuals aged 70+ years. In the whole study cohort, TLS prevalence decreased (p < 0.001) from 389/592 (65.7%) in the normal group to 334/700 (47.7%), 66/267 (24.7%) and 0/7 (0%) in early AMD, intermediate AMD and late AMD, respectively. In multivariable analysis, higher TLS prevalence was associated with younger age (OR: 0.92; p < 0.001), female sex (OR: 1.65; p < 0.001), lower AMD stage (OR: 0.51; p < 0.001), better best-corrected visual acuity (OR: 0.42; p = 0.03), and lower prevalence of a flat retinal pigment epithelium elevation (OR: 0.68; p = 0.04).

Conclusions: The foveal TLS may be taken as a qualitative sign of the intactness of the deep layers of the fovea, with its prevalence decreasing with older age, higher AMD stage and worse best-corrected visual acuity.

Purpose: To investigate the association between best-corrected visual acuity (BCVA) and quantitative macular fluid volumes, compared to central subfield thickness (CST) in treatment-naïve and previously treated patients with active neovascular age-related macular degeneration (nAMD).

Methods and analysis: Baseline data were collected from 290 eyes of 290 participants consecutively enrolled in a prospective, randomized phase III clinical trial. Intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) volumes were quantified and localized using an MDR-certified AI algorithm (Fluid Monitor, RetInSight). Fluid volumes and CST were included in linear regression models for comparison.

Results: Significantly greater IRF volumes within each macular region were observed in treatment-naïve patients, whereas larger PED volumes contributed to higher CST values in pretreated patients. In both subgroups, the largest proportion of BCVA variance could be explained by measuring IRF and SRF volumes within the entire 6-mm area (adjusted R² = 0.140 and 0.225, respectively). In pre-treated eyes, CST explained only half as much BCVA variance as the 6-mm fluid model, and the model's fit was even poorer when compared to the CST model in the treatment-naïve subgroup (adjusted R² = 0.078 vs. 0.198).

Conclusion: The examination of IRF and SRF volumes significantly impacts BCVA in nAMD. The weaker association of CST highlights its limitations as a parameter of disease activity. These findings emphasize the necessity of distinct fluid volume quantification as a relevant surrogate for visual function loss or benefit in nAMD, with particular emphasis on treatment duration and fluid in regions beyond the central 1-mm.