American Journal of Ophthalmology最新文献

Purpose: To describe a new feature in pathologic myopia: perivascular patchy chorioretinal atrophy (PVCA) DESIGN: Cross-sectional study METHODS: 604 eyes of 312 highly myopic patients followed at Strasbourg University Hospitals were reviewed for the presence of PVCA lesions. Demographic, clinical, and paraclinical data (ultra-widefield retinography, optical coherence tomography (OCT), fluorescein and indocyanine green angiography images) were analyzed. Controls were matched for age, sex, and axial length (AL).

Results: 47 eyes (7.8%) of 32 patients presented with 88 PVCA lesions in total. Mean age was 65.9 ± 10.2 years, mean best corrected visual acuity (BVCA) was 0.86 LogMAR ± 0.76. All patients had posterior staphyloma, with PVCA localized within the staphyloma (58%), on its margins (39%), or outside it (3%). Atrophic lesions were mainly located in the temporal retina (71%) and on the first or second order branches of the central retinal vessels (95%). OCT scans revealed an anterior scleral protrusion in 74% of cases, with an average height of 319 µm ± 152. PVCA patients had longer AL (32.94mm ± 1.87 vs. 29.96mm ± 2.79; p<0.01) than non-PVCA patients. When compared to matched control PVCA patients had lower BCVA (0.86LogMAR ± 0.76 vs. 0.59LogMAR ± 0.71; p=0.01) and reduced macular choroidal thickness (38µm ± 31 vs. 54µm ± 38; p=0.02).

Conclusion: PVCA is a newly described feature of pathological myopia associated with reduced visual acuity. Its association with anterior scleral protrusion suggests that scleral curvature change may represent a specific cause leading to chorioretinal atrophy.

Purpose: To assess the risk of renal adverse events, particularly acute kidney injury (AKI), between intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents.

Design: Meta-analysis.

Methods: A systematic literature search was conducted on Ovid Medline, Embase and the Cochrane Library for randomized controlled trials (RCTs) published from January 2005 to February 2024 involving adult patients receiving anti-VEGF intravitreal injections for agerelated macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion. The primary outcome was the comparative risk of AKI between anti-VEGF agents and sham injections. Secondary outcomes involved other renal adverse events. Subgroup analyses were conducted by specific disease indications. A random-effects model was used for meta-analysis to estimate risk ratios (RR) and their 95% confidence intervals (CI), with a p-value of less that 0.05 representing statistical significance. Risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB2) tool, and the certainty of evidence was evaluated through the GRADE framework.

Results: A total of 10,031 eyes from eleven RCTs were included. No significant differences were found in the risk of acute or chronic renal conditions, obstructive uropathies, neoplasia, or infectious processes between anti-VEGF agents as well as sham therapy. AKI was reported in 5.4% (n=10/185) of patients treated with bevacizumab, 1.3% (n=6/456) with sham, 1.0% (n=48/4,724) with aflibercept, 0.8% (n=15/1,929) with faricimab, 0.5% (n=5/1,098) with brolucizumab, and 0.3% (n=5/1,639) with ranibizumab. No significant differences in AKI risk were observed between any of the anti-VEGF agents and sham (p>0.05 for all comparisons). However, there was an increased risk of patient-reported symptoms with 1.25mg bevacizumab compared to 2mg aflibercept (RR=3.26, 95% CI=1.07-9.93, p=0.04), primarily driven by reports of hematuria: 4.3% (bevacizumab), 0.7% (sham), 0.2% (aflibercept), 0.1% (faricimab), and 0.1% (ranibizumab).

Conclusions: FDA-approved intravitreal anti-VEGF agents do not significantly increase the risk of AKI compared to sham injections. Nevertheless, variations in patient-reported renal symptoms were observed across different anti-VE F drugs. These variations were primarily influenced by differences in hematuria events, which may be a result of differential systemic absorption by these agents. These results underscore the importance of continuous monitoring and pharmacovigilance.

Purpose: The integration of generative artificial intelligence (GAI) into scientific research and academic writing has generated considerable controversy. Currently, standards for using GAI in academic medicine remain undefined. This study aims to conduct a comprehensive analysis of the guidance provided for authors regarding the use of GAI in ophthalmology scientific journals.

Design: Cross-sectional bibliometric analysis.

Participants: A total of 140 ophthalmology journals listed in the Scimago Journal & Country Rankings, regardless of language or origin.

Methods: We systematically searched and screened the 140 ophthalmology journals' websites on October 19 to 20, 2024, and conducted updates on November 19 to 20, 2024.

Main outcome measures: The content of GAI guidelines from the websites of the 140 ophthalmology journals.

Results: Of the 140 journals, 96 (69%) provide explicit guidelines for authors regarding the use of GAI. Among these, nearly all journals agree on three key points: 1) 94 journals (98%) have established specific guidelines prohibiting GAI from being listed as an author. 2) 94 journals (98%) emphasize that human authors are responsible for the outputs generated by GAI tools. 3) All 96 journals require authors to disclose any use of GAI. Additionally, 20 journals (21%) specify that their guidelines pertain solely to the writing process with GAI. Furthermore, 92 journals (66%) have developed guidelines concerning GAI-generated images, with 63 journals (68%) permitting their use and 29 (32%) prohibiting them. Among those that prohibit GAI images, 27 journals (93%) allow their use under specific conditions.

Conclusions: Although there is considerable ethical consensus among ophthalmology journals regarding the use of GAI, notable variations exist in terms of permissible use and disclosure practices. Establishing standardized guidelines is essential to safeguard the originality and integrity of scientific research. Researchers must uphold high standards of academic ethics and integrity when utilizing GAI.

Purpose: To analyze the effect of individual parameters on the postoperative refractive outcomes of small incision lenticule extraction in myopic eyes using machine learning methods.

Design: Retrospective Clinical Cohort Study METHODS: We included 477 patients (922 eyes) of small incision lenticule extraction at Tianjin Ophthalmology Hospital and divided the patients into two groups to analyzed the factors affecting postoperative refractive outcomes based on the label of postoperative spherical equivalent (SE) ≤ -0.50D. A total of 72 parameters, including 34 biomechanical parameters, 31 morphological parameters, 4 surgical related parameters, and 3 preoperative refractive parameters obtained clinically, were included as features in the XGBoost model. The XGBoost model randomly selected 42 patients (the number of patients in the group with poor refractive outcomes) from the group with good refractive outcomes and conducted 100 influential factor analysis. Normality tests were performed on the data using the Kolmogorov-Smirnov test, group differences were compared using independent sample t-test or Mann-Whitney U-test; the correlation between various factors and postoperative SE was analyzed using Spearman correlation analysis.

Results: The average preoperative SE and postoperative SE of 922 eyes were -5.01 ± 1.48 D and -0.06 ± 0.18 D. The 10 most important factors affecting postoperative refractive outcomes included corneal biomechanical parameters (highest concavity [HC] time, the time of maximum deflection amplitude [Deflection Amp Max (ms)], and stress-strain index [SSI]), surgery-related parameters (percentage thickness ablation [PTA], maximum lenticule thickness [LT_max], and residual stroma thickness[RST]), corneal morphological parameters (radius and steep radius of the anterior corneal surface), and preoperative refractive parameters (SE and spherical diopter [SD]). When PTA ≥ 25.09%, LT_max ≥ 139 μm, SE ≤ -7.00 D, or SD ≤ -6.75 D, the postoperative SE significantly increased (all P<0.05), with averages of -0.183 D, -0.171 D, -0.188 D, and -0.184 D. After controlling for age, intraocular pressure, and corneal thickness, the postoperative SE significantly increased when HC time was ≥ 17.422 and Deflection Amp Max (ms) ≥ 16.616, reaching -0.209 D and -0.202 D.

Conclusions: Excessive tissue cutting, greater HC time, Deflection Amp Max (ms), lower SSI, and high preoperative refractive power worsened postoperative refractive outcomes. Appropriate nomogram adjustments could improve results.

Purpose: To investigate the ability to quantify fundus curvature and detect posterior staphyloma using widefield optical coherence tomography (OCT).

Design: Cross-sectional diagnostic evaluation.

Subjects and participants: 205 highly myopic eyes of 205 participants.

Methods: The Gaussian curvature map of the fundus was automatically calculated from two million scan points over an area of 24mm × 20mm, visualizing localized deformations in the posterior region. Two fovea-centered areas were designated as follows: the 6mm × 6mm was the macular region, and the 8mm × 16mm area was the posterior region. Macular mean curvature (MMC) and curvature deviation (MCD), posterior mean curvature (PMC) and curvature deviation (PCD), and maximum posterior curvature (MPC) were calculated. The relationship between curvature indices, ocular parameters, and myopic complications was investigated. The diagnostic ability of curvature indices for posterior staphyloma was evaluated.7 RESULTS: The mean (SD) age of 205 participants was 34.06 (12.74) years, with 107 being female (52.2%). Posterior staphyloma was found in 33 of 205 (16.1%) eyes. The curvature value map and curvature deviation map revealed detailed morphologic patterns of posterior staphyloma. Eyes with staphyloma had a steeper and more irregular fundus than eyes without staphyloma, with a larger MPC (20.420 × 10-3 mm-2 vs. 10.925 × 10-3 mm-2, P<0.001), PMC (6.754 × 10-3 mm-2 vs. 5.352 × 10-3 mm-2, P=0.002), MCD (1.889 × 10-3 mm-2 vs. 1.078 × 10-3 mm-2, P<0.001), and PCD (3.894 × 10-3 mm-2 vs. 1.683 × 10-3 mm-2, P<0.001). However, no difference in MMC was found between eyes with and without posterior staphyloma. Larger MPC, MCD, and PCD were associated with greater degrees of myopia, more severe myopic maculopathy, and worse best-corrected visual acuity (all P<0.05). PCD demonstrated the ability to discriminate the presence of posterior staphyloma (area under the curve: 0.909 [95% CI, 0.854-0.963; P<0.001]). The optimal cutoff value of PCD was 3.060 × 10-3 mm-2 (Youden's index = 0.725), with a specificity of 90.7% and a sensitivity of 81.8%.

Conclusions: Widefield OCT-based analysis of fundus curvature enhances detection and quantitative assessment of posterior staphyloma in high myopia.