American Journal of Ophthalmology最新文献

Background: To study and analyze the demographics, clinical features and surgical indications in Congenital X-linked Retinoschisis (CXLRS) in Indian population.

Design: Retrospective case series.

Methods: It was a retrospective case series in 70 eyes which included all the patients diagnosed with CXLRS. A data set including demographic characteristics, phenotype, frequency of follow-up/surgery, surgical techniques and details, pre- and post-operative visual acuity and complications of CXLRS patients followed-up were obtained and analyzed.

Results: 70 eyes of 35 patients were included. Mean age at presentation was 6.9±3.8 years. Mean follow-up time was 65.2±30.4 months. Most common phenotype was type 3(77.1%) which is foveal schisis on clinical examination and OCT, as well as lamellar schisis on OCT, plus peripheral schisis on ophthalmoscopy. 5 eyes underwent vitreo-retinal surgery (VR), 2 eyes underwent laser therapy. Mean central foveal thickness (microns) was 532±223.1 µm. Median best-corrected visual acuity (BCVA) of patients undergoing VR surgery (LogMAR) was 1.8(1.1-2). Rhegmatogenous retinal detachment (RRD) was the most common cause of surgery in patients with CXLR. Median best-corrected final VA (LogMAR) was 0.6(0.2-2.0). Most frequent VR procedure was pars plana vitrectomy and most common tamponade used was silicone oil (100%).

Conclusion: Family history and screening is important. RRD is a vision threatening complication of XLRS, surgical intervention in the form of vitrectomy or scleral buckle can be performed. Multi-modal imaging like optical coherence tomography (OCT) can be an assistive tool.

Purpose: The association between GLP-1 receptor agonists (GLP-1RA) and non-arteritic anterior ischemic optic neuropathy (NAION) remains unclear. Given the debilitating sequelae of NAION and rapid increase of GLP-1RA use, further research is essential to investigate this potential relationship. This study seeks to determine the risk of NAION and ischemic optic neuropathy (ION) in patients prescribed GLP-1RAs.

Design: Retrospective matched cohort study SETTING: TriNetX United States collaborative network PARTICIPANTS: Patients ≥12 years old with type 2 diabetes (T2DM) and considered overweight or obese (high BMI), with at least one ophthalmology or neurology visit. Among T2DM patients, approximately 120,000 patients with a semaglutide prescription and 220,000 prescribed any GLP-1RA were compared to matched T2DM controls. Among high BMI patients, approximately 58,000 on semaglutide and 66,000 on any GLP-1RA were compared to matched controls.

Methods: Patients prescribed semaglutide or any GLP-1RA were compared with those on non-GLP-1RA medications. Populations were propensity matched (1:1) on various demographic and risk factors to balance baseline cohorts.

Main outcomes and measures: Cumulative incidence and risk of NAION and ION. Risk ratios (RR) with 95% confidence intervals (CI) were reported, with significance defined as CI <0.9 or > 1.1.

Results: In T2DM patients prescribed semaglutide, the risk of NAION (RR = 0.7, 95% CI: 0.523-0.937) and ION (RR = 0.788, 95% CI: 0.609-1.102) after 5 years was not significantly increased compared to matched T2DM controls. Similarly, T2DM patients on any GLP-1RA demonstrated no significant difference in the risk of NAION (RR = 0.887, 95% CI: 0.735-1.071) or ION (RR = 0.969, 95% CI: 0.813-1.154) compared to controls. Furthermore, no increased risk of either outcome was found in the high BMI groups prescribed semaglutide or any GLP-1RA. The cumulative 5-year risk of NAION and ION in T2DM patients on semaglutide was 0.065% and 0.08%, respectively. In those with high BMI prescribed semaglutide, the risk of NAION and ION after two years was 0.038% and 0.404%, respectively.

Conclusions: There was no significant increase in risk of NAION or ION in patients taking semaglutide or GLP-1RAs compared to T2DM or high BMI controls.

Purpose: To describe the clinical characteristics of ocular toxoplasmosis (OT) in Colombia and identify factors associated with ocular complications and poor visual outcomes.

Design: Multicenter cross-sectional study.

Methods: Demographic and clinical characteristics-including disease course, uveitis location (according to the Standardization of Uveitis Nomenclature), type of inflammation (presumed granulomatous vs. non-granulomatous), ocular complications (cataract, glaucoma, macular edema, retinal detachment, vitreous hemorrhage, epiretinal membrane, band keratopathy), and visual outcomes-were collected from patients with OT across seven ophthalmological centers in Colombia. A subgroup analysis included patients with documented lesion characteristics. Logistic regression, adjusted for age and sex, assessed factors associated with ocular complications (any of the complications above), moderate-to-severe vision impairment (BCVA <20/60 to >20/400 in the better-seeing eye), and blindness (BCVA ≤20/400 in the better-seeing eye).

Results: 853 OT patients (431 females, 422 males) were included, with a mean age of 38 ± 17.9 years. OT predominantly manifested as acute (57%), unilateral (79%), and non-granulomatous uveitis (78%). Sixty percent (512) had a final BCVA >20/60. Factors associated with ocular complications included age >50 (OR=4.75; p<0.001), retinochoroiditis with vitritis/AC inflammation (OR=2.85; p<0.001), presumed granulomatous uveitis (OR=2.04; p<0.001), persistent disease or early recurrences (sooner than 3 months) (OR=3.24; p<0.001), and recurrences first occurring after 3 months (OR=1.79; p=0.009). Blindness was linked to age <16 (OR=1.94; p=0.025), >50 (OR=1.74; p=0.001), bilateral involvement (OR=1.53; p=0.017), and zone 1 lesions (OR=8.25; p=0.015).

Conclusion: OT in Colombia shows worse outcomes compared to other regions. Extreme ages, bilateral involvement, retinochoroiditis with vitritis/AC inflammation, and zone 1 lesions are major risk factors for complications and poor visual outcomes.

Purpose: To evaluate the predictive accuracy of 18 intraocular lens (IOL) power calculation formulas across diverse biometric parameters using a modified formula performance index (FPI) and prediction error variability metrics.

Design: Prospective, comparative, accuracy and reliability analysis of IOL power calculations.

Methods: This study included 213 cataract patients who underwent phacoemulsification with SN60WF IOL implantation. Preoperative biometry was obtained using the IOLMaster 700. Eighteen IOL power calculation formulas, including Barrett TK, Barrett Universal II, Castrop, Cooke K6, EVO 2.0, Haigis, Hoffer Q, Hoffer QST, Holladay 1, Holladay 2, Kane, Karmona, Ladas Super Formula, Nallasamy, PEARL-DGS, RBF 3.0, SRK/T, and T2, were evaluated. Predictive accuracy was assessed using FPI and standard deviation (SD) for overall performance, while root mean square error (RMSE) and subgroup-specific FPI (FPI_sub) were used for biometric subgroup analysis. Additional metrics included mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D.

Results: Cooke K6 achieved the highest FPI (0.724) and lowest SD (0.394), followed by PEARL-DGS (FPI=0.714, SD=0.399) and Barrett TK (FPI=0.710, SD=0.411). Barrett TK had the highest percentage of eyes within ±0.25 D (54.5%). Subgroup analysis revealed that PEARL-DGS exhibited the highest accuracy in short eyes (AL≤22 mm, FPI_sub=0.838, RMSE=0.271), while Haigis performed best in long eyes (AL≥26 mm, FPI_sub=0.826, RMSE=0.336) and steep corneas (K>46 D, FPI_sub=0.765, RMSE=0.350). Barrett TK ranked highest in medium-long eyes (24.5-26 mm, FPI_sub=0.700, RMSE=0.400) and flatter corneas (K<42 D, FPI_sub=0.639, RMSE=0.382). Cooke K6 was most accurate in shallow anterior chambers (ACD≤3.0 mm, FPI_sub=0.737, RMSE=0.383). Traditional formulas, including Hoffer Q, Holladay 1, and SRK/T, exhibited lower accuracy and higher prediction error variability.

Conclusions: Modern formulas, particularly Cooke K6, PEARL-DGS, and Barrett TK, demonstrated superior accuracy with lower prediction error variability than traditional formulas. Subgroup analysis highlighted the importance of biometric-driven formula selection to optimize refractive outcomes, providing a clinically reference for personalized IOL power selection.

Objective: Faricimab-associated intraocular inflammation (IOI) is an emerging concern. We aimed to investigate clinical features, management, and outcomes of severe IOI following faricimab therapy, with particular attention to cases displaying features consistent with herpes simplex virus (HSV) involvement.

Design: Single-center retrospective interventional case series.

Subjects: Five patients (five eyes) who developed severe IOI following intravitreal faricimab injection for neovascular age-related macular degeneration (nAMD, n=4) or diabetic macular edema (DME, n=1) between June 2023 and October 2024. The nAMD patients had received a mean of 17.75 ± 9.18 prior anti-VEGF injections (range 6-26 injections). The DME patient had previously received seven aflibercept injections and two dexamethasone implants. Prior to faricimab, three patients were being treated with aflibercept and two with ranibizumab biosimilar.

Methods: Medical records were reviewed for clinical features, treatment approaches, and outcomes. Cases were identified through systematic review of follow-up appointments and urgent care presentations. When clinically indicated, additional investigations including optical coherence tomography and fluorescein angiography were performed.

Main outcome measures: Best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber (AC) inflammation, presence of keratic precipitates (KPs), vitreous cells, signs of viral reactivation, and treatment response.

Results: The median number of faricimab injections before inflammation was 5 (range 3-13). Mean interval between injection and symptom onset was 16.8 days (range 1-35). All patients presented with AC inflammation and elevated IOP (mean 32.8 ± 4.15 mmHg, range 28-38 mmHg). All patients demonstrated features consistent with HSV keratouveitis, including dendritic ulcers, reduced corneal sensation, and granulomatous KPs. Treatment included topical or systemic steroids in all cases, with four patients (80%) receiving concurrent antiviral therapy. Median time to inflammation resolution was 15.5 days. Four patients (80%) did not recover baseline vision.

Conclusions: This case series identifies a previously unreported association between faricimab-associated IOI and features of viral reactivation. The temporal relationship including onset patterns suggestive of delayed hypersensitivity, alongside consistent HSV features and favourable antiviral response, suggests a possible mechanism linked to VEGF-A and Ang-2 mediated alterations in ocular immune surveillance. While further investigation is needed to establish causality, clinicians should consider viral mechanisms when evaluating and treating these cases.

Background and objective: Retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR), and telomere biology disorders (TBD) are classified as distinct diseases. However, emerging genetic research and evidence on multimodal imaging suggest a spectrum along which ROP may overlap with FEVR or TBD.

Design: Retrospective case series.

Methods: This was an institutional review board-approved, retrospective study. A literature review was performed, and medical records of all patients with phenotypic ROP evaluated by the pediatric retina service at Bascom Palmer Eye Institute from March 1, 2019 to July 30, 2023 were analyzed.

Results: Eighteen patients with phenotypic and genetically confirmed FEVR or TBD were identified. Of these, the initial diagnosis was ROP with preterm gestational age (n=11, 57.9%) or ROP at moderate to late preterm gestational age (n=8, 42.1%). Final diagnosis for 15 patients (78.9%) was FEVR, and final diagnosis for 4 patients (21.1%) was TBD. The most common genetic variants in the FEVR group were identified in the genes LRP5 (n=5, 33.3%) and FZD4 (n=3, 20%), and in the TBD group, CTC1 (n=3; 75%). The mean age at diagnosis was 5.7 years old (range 0.3 - 36.7 years).

Conclusions: The authors reinforce the classification of ROPER (ROP and FEVR) and introduce the term, ROPMERE (ROP and TBD), to classify these patients in a way that reflects their clinical presentation and underlying genetic diagnosis. Identification of this subset of patients will allow for sustained surveillance of infants with these diseases.

Purpose: To compare the clinical accuracy of five modern toric intraocular lens (IOL) calculation formulas-Barrett, EVO, Naeser/Savini combined with Hoffer QST, Kane, and Abulafia-Koch combined with Hill RBF-in predicting postoperative refractive outcomes in cataract patients with astigmatism.

Design: Retrospective, comparative analysis of IOL formula accuracy.

Subjects: One hundred forty-six eyes from 146 cataract patients with toric IOL implantation.

Methods: Biometric measurements were obtained using the Lenstar LS900, with personalized surgically induced astigmatism values applied for each surgeon. Postoperative outcomes, including mean absolute prediction error (MAE), centroid error, and the proportion of eyes within a prediction error of ±0.50 D and ±0.75 D, were evaluated. Subgroup analyses were performed for with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. Statistical significance was assessed using non-parametric and multivariate tests.

Setting: Eunpyeong St.Mary's Hospital, Seoul, Republic of Korea RESULTS: No significant differences in MAE were observed among the formulas in the overall cohort (p > 0.05). The proportion of eyes with a prediction error ≤ ±0.50 D was highest for EVO (71.92%), followed by Kane and Abulafia-Koch with Hill RBF (70.55%), Naeser/Savini with Hoffer QST (69.18%), and Barrett (67.12%). Among ATR cases, EVO, Abulafia-Koch with Hill RBF, and Naeser/Savini with Hoffer QST demonstrated statistically lower MAEs compared to Barrett (p < 0.05).

Conclusion: All five toric IOL calculation formulas demonstrated excellent overall accuracy, with slight variations observed in specific subgroups. The EVO formula showed superior precision in ATR astigmatism. These findings provide real-world insights to enhance refractive outcomes and optimize formula selection in toric IOL surgery.

Purpose: To estimate the prevalence of uncorrectable visual impairment and to identify sociodemographic factors associated with such impairment among US adolescents.

Design: Cross-sectional study.

Methods: Setting: 1999-2008 National Health and Nutrition Examination Survey (NHANES) STUDY POPULATION: Adolescents (age 12-19 years) OBSERVATION: Best-corrected visual acuity OUTCOME MEASURES: Prevalence of unilateral uncorrectable visual impairment, defined as best-corrected visual acuity of 20/40 or better in one eye with greater than 2 lines of visual acuity asymmetry, and of bilateral uncorrectable visual impairment, defined as best-corrected visual acuity worse than 20/40 in both eyes. Multivariable logistic regression was used to identify sociodemographic factors (race and ethnicity, caregiver education, household income, food security, citizenship status, health insurance type, and healthcare access) associated with uncorrectable visual impairment, adjusting for age and sex.

Results: The survey identified 9949 participants (mean [SD] age, 15.86 [2.27] years; 4914 female participants [49%]).The prevalence estimate of uncorrectable visual impairment was 4.0% (491 participants, 95% CI 3.4-4.7%). After adjusting for age and sex, there were increased odds of uncorrectable visual impairment among those with family income below poverty level (OR, 1.59; 95% CI, 1.14-2.22) compared to poverty level and above, those with Mexican-American ethnicity (OR, 1.64; 95% CI, 1.18-2.29) or Non-Hispanic Black race (OR, 1.43; 95% CI, 1.03-1.99) compared to non-Hispanic White race, those with food insecurity (OR, 1.67; 95% CI, 1.21-2.32), those with caregiver education below high school (OR, 1.68; 95% CI, 1.24-2.28), those with public insurance (OR, 1.67; 95% CI, 1.21-2.30), and those with no insurance (OR, 1.71; 95% CI, 1.12-2.59) compared to those with private insurance.

Conclusions: Socioeconomic disparities in the prevalence of uncorrectable visual impairment are evident by adolescence. Interventions to treat amblyopia, the most common cause of uncorrectable vision loss, have limited efficacy in late childhood. Efforts are needed to identify and treat amblyopia in socioeconomically disadvantaged populations at an earlier age to prevent permanent vision loss.

Purpose: In eyes with intermediate age-related macular degeneration (iAMD), we separately quantified the hyperreflective foci (HRF) along the retinal pigment epithelium (rpeHRF) and the intraretinal HRF (iHRF) to determine if the location of the HRF predicted the progression from iAMD to the onset of large persistent choroidal hypertransmission defects (hyperTDs).

Design: Post hoc subgroup cohort analysis of a prospective study.

Methods: A retrospective analysis was performed on a prospective natural history database of eyes with AMD imaged using swept-source optical coherence tomography (SS-OCT). En face images derived from choroidal slabs positioned 64 µm to 400 µm beneath Bruch's membrane were used with a semi-automated algorithm to identify and quantify hypotransmission defects (hypoTDs) attributable to either iHRF or rpeHRF within a 5 mm fovea-centered circle. iHRF were identified on corresponding B-scans as hyperreflective lesions within the neurosensory retina, and rpeHRF were identified as areas of RPE thickening. Multivariable survival analysis was performed to determine if the area measurements of either iHRF or rpeHRF were more likely to predict the onset of the first large persistent hyperTD.

Results: Of the 171 eyes with iAMD included in this study, 82 (48%) developed at least one large hyperTD during a median follow-up of 59.1 months. Univariable Cox regression analyses showed that rpeHRF area (P<0.001), iHRF area (P=0.003), and drusen volume (P<0.001) were all significantly associated with the onset of the first large persistent hyperTD. However, a multivariable Cox regression model showed that only the rpeHRF area remained a significant predictor of disease progression (P<0.001).

Conclusions: In iAMD eyes, the area of rpeHRF was more predictive of disease progression than either the drusen volume or iHRF, which suggests that these rpeHRF serve as harbingers of focal atrophy formation and may predict where hyperTDs form.

Purpose: To utilize a convolutional neural network (CNN) to predict the response of treatment-naïve diabetic macular edema (DME) to a single injection of anti-vascular endothelial growth factor (anti-VEGF) with data from optical coherence tomography (OCT).

Design: Retrospective study performed via chart review.

Methods: Setting: This was a single-center study performed at the Storm Eye Institute, Medical University of South Carolina.

Patient population: Patients with a new diagnosis of DME who underwent intravitreal (IVT) anti-VEGF injections were eligible for inclusion, provided they had a baseline OCT scan at the time of diagnosis and a 1-month follow-up OCT scan after the first anti-VEGF injection. Exclusion criteria included prior treatment with anti-VEGF, lack of required OCT scans, coexistent macular degeneration, and macular edema due to other retinal diseases. Seventy-three (73) eyes from 53 patients were included.

Intervention: The OCT scan from the baseline visit was compared to the follow-up OCT scan approximately 1 month after the first anti-VEGF injection to determine change in central subfield thickness (delta CST). The delta CST was fed into the CNN as a label to train the system to predict treatment response from only the baseline OCT scan.

Main outcome measure: CNN prediction of treatment response to anti-VEGF. Treatment response was defined as a CST reduction of10 µm or more.

Results: Based on delta CST from two OCT scans, 57 eyes were responders and 16 eyes were non-responders to the initial anti-VEGF injection. Analyzing only the baseline OCT scan for each eye, the trained CNN demonstrated an area under the curve (AUC) of 0.81. At the reported operating point, the CNN correctly identified 45 of the 57 responder eyes (i.e., recall of 78.9%) and 11 of the 16 non-responder eyes (i.e., specificity of 68.8%).

Conclusions: The results of this study demonstrate the potential of a CNN to predict the response of treatment-naïve DME to a single injection of anti-VEGF therapy.