American Journal of Ophthalmology最新文献_第4页

The Safety of Office-Based Pterygium Surgery

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-11 DOI: 10.1016/j.ajo.2025.02.005

Sandra Lora Cremers , Adam G. Hidad , Jenny Ha , Matthew Joy , Kishan Avaiya , Emma Antall , Elise Bolin , Jesus Alberto Martinez

PURPOSE

Hospital and ambulatory eye surgical procedures continue to transition to the office setting. Pterygium surgery is the most commonly performed ocular surface surgical procedure in the world. No studies to date have evaluated its safety in the office-based surgical setting. Our study evaluates the safety, complication rate, cost-savings, and cosmetic satisfaction of office-based pterygiectomy.

DESIGN

Retrospective case series.

METHODS

A retrospective review was performed. Procedures were performed in an office-based suite with a Zeiss surgical microscope by two board-certified ophthalmologists under topical anesthesia and oral sedation. Over a 3 year period (2013-2016), 1071 office-based pterygiectomies were performed. Follow-up was performed via in-person office visits. Data collected included: date of service; location of pterygium (nasal, temporal, or both); primary or recurrent; use of mitomycin C, fibrin glue, and amniotic membrane; preoperative and postoperative refraction; intraocular pressure (IOP); endothelial cell density (ECD); patient-reported pain (as measured by an eleven-point visual analog scale, 0-10); cosmetic satisfaction; intraoperative surgical time; speculum width; incidence of ptosis (defined as a decrease in MRD1 by 2 mm) postoperatively at 12 weeks and 1 year and postoperative complications. Postoperative measures were checked at 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 1 year. The average operational and procedural costs were compared between in-office and comparable surgical centers and academic hospital cases in our area.

RESULTS

A total of 1015 pterygia from 992 eyes were examined postoperatively. One case of central retinal artery occlusion due to peribulbar anesthetic injection with epinephrine at postoperative week 2 was noted, leading to the removal of epinephrine from the anesthetic regimen. At the 1-year follow-up, 393 pterygium cases in 343 eyes were assessed. One-year complication rates included overall recurrence (N = 8/393; 2.04%), dellen (N = 12/393; 3.05%), and granuloma (N = 15/393; 3.82%), ptosis 2.6% (N = 9/343). There were no cases of infection. Patient-reported pain scores remained less than 1.0 peri‑ and postoperatively, and cosmetic satisfaction was greater than 88% at 1 year. The average cost of office-based pterygium surgery was $1795 ($1700-$1890, depending on supplies used). In comparison, the costs at local surgical centers and hospitals were $3812.50 ($2625-$5000) and $5562 ($5095-$6029), respectively.

CONCLUSION

Office-based pterygiectomy is safe, cost-effective, and offers low recurrence rates and high patient satisfaction.

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引用次数: 0

Common Forms of Adult Esotropia Require Augmented Surgical Dosing

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-11 DOI: 10.1016/j.ajo.2025.02.007

Veronika Yehezkeli , Joseph L. Demer

Introduction

Age-related distance esotropia (ARDE) in older adults is commonly caused by sagging eye syndrome. Decompensated esophoria (DE) is a progressive esotropia in younger adults. We evaluated claims that dosing of medial rectus (MR) recession must appreciably exceed customary recommendations to avert surgical undercorrections in treatment of DE and ARDE.

Study Design

Comparative interventional case series.

Methods

We compared with Parks’ tables the actual dosing of strabismus surgery that included bilateral MR recession in consecutive patients with DE and ARDE from 2015 to 2024.

Results

Strabismus surgery was performed in 54 DE patients of mean age 31 ± 12 years (standard deviation) and 61 ARDE patients of age 70 ± 8 years. Preoperative esotropia was significantly greater in DE at 21 ± 10Δ than 14 ± 9Δ in ARDE (P = .0003). Although surgery initially produced orthotropia in most patients in both groups, esotropia gradually recurred in 10 DE patients (22%) after a mean of 3 ± 1.3 years, due to greater decline in surgical effect than in ARDE (P = .0022). There was no correlation between the use of adjustable sutures and reoperation (P = .73). Regression analysis indicated that the initial 4.6 mm MR recession in DE and 3.5 mm in ARDE had no effect on final alignment, but each additional mm total MR recession corrected 3Δ in DE and 2.4Δ in ARDE. These surgical effects are less than predicted by Parks tables.

Conclusions

Current recommendations for augmented MR recession in ARDE are appropriate, but dosing must be further augmented to achieve satisfactory alignment in DE to avoid undercorrections caused by early recurrences of esotropia.

{"title":"Common Forms of Adult Esotropia Require Augmented Surgical Dosing","authors":"Veronika Yehezkeli , Joseph L. Demer","doi":"10.1016/j.ajo.2025.02.007","DOIUrl":"10.1016/j.ajo.2025.02.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Age-related distance esotropia (ARDE) in older adults is commonly caused by sagging eye syndrome. Decompensated esophoria (DE) is a progressive esotropia in younger adults. We evaluated claims that dosing of medial rectus (MR) recession must appreciably exceed customary recommendations to avert surgical undercorrections in treatment of DE and ARDE.</div></div><div><h3>Study Design</h3><div>Comparative interventional case series.</div></div><div><h3>Methods</h3><div>We compared with Parks’ tables the actual dosing of strabismus surgery that included bilateral MR recession in consecutive patients with DE and ARDE from 2015 to 2024.</div></div><div><h3>Results</h3><div>Strabismus surgery was performed in 54 DE patients of mean age 31 ± 12 years (standard deviation) and 61 ARDE patients of age 70 ± 8 years. Preoperative esotropia was significantly greater in DE at 21 ± 10Δ than 14 ± 9Δ in ARDE (<em>P</em> = .0003). Although surgery initially produced orthotropia in most patients in both groups, esotropia gradually recurred in 10 DE patients (22%) after a mean of 3 ± 1.3 years, due to greater decline in surgical effect than in ARDE (<em>P</em> = .0022). There was no correlation between the use of adjustable sutures and reoperation (<em>P</em> = .73). Regression analysis indicated that the initial 4.6 mm MR recession in DE and 3.5 mm in ARDE had no effect on final alignment, but each additional mm total MR recession corrected 3Δ in DE and 2.4Δ in ARDE. These surgical effects are less than predicted by Parks tables.</div></div><div><h3>Conclusions</h3><div>Current recommendations for augmented MR recession in ARDE are appropriate, but dosing must be further augmented to achieve satisfactory alignment in DE to avoid undercorrections caused by early recurrences of esotropia.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 74-81"},"PeriodicalIF":4.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative Cost Analysis of Secondary Intraocular Lens Surgeries Using Time-Driven Activity-Based Costing.

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-08 DOI: 10.1016/j.ajo.2025.02.008

Warren W Pan, Crystal Young, David Portney, Amanda Fowler, Shahzad I Mian, Emily Eton, Thomas J Wubben

Objective: To assess the economics of secondary IOL surgeries, with a focus on variations in day-of-surgery costs based on surgical approach and number of surgeons involved.

Design: Retrospective, time-driven, activity-based costing study analyzing costs and reimbursement rates.

Setting: University of Michigan Kellogg Eye Center, analyzing procedures performed between January 1, 2014 and December 31, 2023.

Participants: Patients undergoing secondary IOL surgeries, including both single- and multi-surgeon cases and procedures without vitrectomy, with anterior vitrectomy, and with pars plana vitrectomy (PPV).

Methods: Data were obtained from the institution's Electronic Health Record and Revenue Department secondary IOL surgeries (CPT codes 66985 and 66986) performed over ten years at a single academic institution. Time-driven activity-based costing was applied to calculate the costs associated with each procedure. Primary outcomes were the total cost, reimbursement, and net margins for secondary IOL surgeries. Secondary outcomes were surgical times, time-related costs, and materials costs.

Results: 391 cases were included in this analysis over a ten-year period, including 145 without vitrectomy, 56 with anterior vitrectomy, and 190 with PPV. There was no difference in primary or secondary outcome measures between IOL insertion (CPT 66985) and IOL exchange (CPT 66986). The total day-of-surgery costs were $4248.40-$4447.15 for secondary IOL without vitrectomy, $4245.05-$4600.36 for secondary IOL with anterior vitrectomy, $5518.52-$5272.21 for single-surgeon secondary IOL with PPV, and $7769.22-$8609.39 for multiple-surgeon secondary IOL with PPV. The calculated Medicare reimbursements were $2771.67-$2901.81 for secondary IOL without vitrectomy, $3005.66-$3155.75 for secondary IOL with anterior vitrectomy, and $4813.26-$4861.62 for secondary IOL with PPV. Therefore, the net margins were -($1675.48-$1347.59) for secondary IOL without vitrectomy, -($1444.60-$1239.39) for secondary IOL with anterior vitrectomy, -($704.26-$410.59) for single-surgeon secondary IOL with PPV, and -($3796.13-$2907.60) and for multiple-surgeon secondary IOL with PPV.

Conclusions: All secondary IOL surgeries result in net negative margins with single-surgeon PPV cases having the most favorable reimbursement that covers 87-92% of day-of-surgery costs and multiple-surgeon PPV surgeries having the least favorable with only 56-63% of costs reimbursed. Identifying these cost-intensive procedures offers insights for potential cost-reduction strategies, supporting both economic viability and patient access to necessary eye care.

目的：评估二次人工晶体植入手术的经济性：评估二次人工晶体植入手术的经济效益，重点关注手术方法和参与手术的外科医生数量导致的手术日成本差异：设计：回顾性、时间驱动、基于活动的成本计算研究，分析成本和报销率：密歇根大学凯洛格眼科中心，分析 2014 年 1 月 1 日至 2023 年 12 月 31 日期间进行的手术：接受二次人工晶体植入手术的患者，包括单个和多个手术医生的病例，以及不进行玻璃体切除术、进行前部玻璃体切除术和进行玻璃体旁切除术（PPV）的手术：数据来源于一家学术机构的电子健康记录和收入部门十年来进行的二次人工晶体手术（CPT代码66985和66986）。采用时间驱动活动成本法计算每项手术的相关成本。主要结果是二次人工晶体植入手术的总成本、报销额度和净利润。次要结果是手术时间、时间相关成本和材料成本：本次分析共纳入了 391 个病例，时间跨度长达 10 年，其中 145 例未进行玻璃体切除术，56 例进行了前部玻璃体切除术，190 例进行了 PPV 手术。人工晶体植入术（CPT 66985）和人工晶体置换术（CPT 66986）的主要或次要结果指标没有差异。不进行玻璃体切除术的二次人工晶体植入术的手术日总费用为 4248.40 美元-4447.15 美元，进行前部玻璃体切除术的二次人工晶体植入术的手术日总费用为 4245.05 美元-4600.36 美元，单个手术医生进行 PPV 的二次人工晶体植入术的手术日总费用为 5518.52 美元-5272.21 美元，多个手术医生进行 PPV 的二次人工晶体植入术的手术日总费用为 7769.22 美元-8609.39 美元。计算得出的医疗保险报销金额为：不进行玻璃体切割的二次人工晶体为 2771.67 美元-2901.81 美元，进行前部玻璃体切割的二次人工晶体为 3005.66 美元-3155.75 美元，进行 PPV 的二次人工晶体为 4813.26 美元-4861.62 美元。因此，不进行玻璃体切割的二次人工晶体植入术的净差额为-（1675.48-1347.59美元），进行前部玻璃体切割的二次人工晶体植入术的净差额为-（1444.60-1239.39美元），单个手术医生进行带PPV的二次人工晶体植入术的净差额为-（704.26-410.59美元），多个手术医生进行带PPV的二次人工晶体植入术的净差额为-（3796.13-2907.60美元）：结论：所有二次人工晶体植入手术都会导致净负差，单个手术医生 PPV 病例的报销比例最高，可报销 87-92% 的手术日费用，而多个手术医生 PPV 手术的报销比例最低，只能报销 56-63% 的费用。识别这些成本密集型手术为潜在的成本削减策略提供了启示，有助于提高经济可行性和患者获得必要的眼科护理。

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引用次数: 0

Epidemiology of Cataract-related Blindness in Brazil: 30 Years of Public Policy Evolution: Review Article.

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-08 DOI: 10.1016/j.ajo.2025.01.023

Newton Kara-Junior, Silvana Rossi

Purpose: This review evaluated the impact of various public policies on the number of cataract surgeries performed annually by the Public Health System (SUS) in Brazil and its regions. The goal was to provide insights for managers and the medical community to assess the effectiveness of strategies to prevent cataract-related blindness.

Design: Trend studies based on literature review.

Methods: This study was developed through a literature review, with a bibliographic survey conducted in databases such as PubMed, MEDLINE, Web of Science, Embase, LILACS, and SciELO.

Results: Until the early 2000s, approximately 130,000 cataract surgeries were performed annually in Brazil. In 2001, the National Cataract Campaign (CNC) was introduced, which significantly increased surgical volume by providing unrestricted federal funding. By 2003, the SUS had performed 430,000 surgeries, underscoring the critical role of funding in combating cataract blindness. However, the Ministry of Health discontinued the CNC in 2006, leading to a decline in surgeries in subsequent years. The annual surgical volume recovered to 430,000 only in 2011, following the adoption of new policies that involved directly contracting private companies through government tenders. In 2013, the SUS achieved the minimum number of surgeries required to prevent an accumulation of cataract blindness cases, conducting 530,000 procedures. By the early 2020s, parliamentary amendments directed to specific municipalities through Health Social Organizations became a primary funding source for cataract procedures. This approach proved effective, with approximately 860,000 surgeries performed in 2022 to prevent new accumulations and reduce overall cataract blindness. The COVID-19 pandemic disrupted progress, causing a 23% decline in surgeries in 2020. However, surgical rates surged with the relaxation of restrictions in 2021, exceeding prepandemic levels by 21%. By 2022, the number of cataract surgeries increased by 63% compared to the prepandemic average, fully addressing the backlog created during the health crisis.

Conclusion: The increase in surgeries was driven by unlimited federal funding, private contracts, and targeted parliamentary amendments. Despite these efforts, regional disparities persist, requiring equitable policies based on local epidemiological data. Ensuring access to cataract surgery demands sustained public investment. The resilience of Brazil's SUS in the post-pandemic era underscores the need for consistent investments to effectively address healthcare challenges.

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引用次数: 0

Which Test Is Best: Evaluation of Traditional and Contemporary Statistical Tests for Analysis of Spherical Equivalent Prediction Error

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.01.022

Nathan T. Cannon , Giacomo Savini , Seth M. Pantanelli , Kenneth Hoffer , Petros Aristodemou , Kamran Riaz , David Murphy , David Griffin , Christian Berry , Guillaume Debellemanière , Mathieu Gauvin , Avi Wallerstein , Woong-Joo Whang , Kyungmin Koh , Kazuno Negishi , Ken Hayashi , Diogo Hipólito-Fernandes , David L. Cooke

Purpose

To characterize the performance of traditional and contemporary statistics tests for analysis of spherical equivalent prediction error (SEQ-PE) after cataract surgery, with regard to test significance and self-consistency.

Design

Comparison of the utility of statistical tests.

Methods

Subjects: Eyes from 5 academic centers and 2 private practices that had cataract surgery and postoperative manifest refraction between March 2011 and December 2022. SEQ-PE data were randomly divided into subsets with sample sizes of 100, 300, 500, 700, and 2600 eyes. Mean absolute error (MAE), median absolute error (MedAE), SD, root mean squared absolute error (RMSAE), and the proportion of eyes within 0.50 diopters (D) of predicted were calculated for 6 power prediction formulas and analyzed using Friedman post hoc Dunn, Cochran Q post hoc McNemar, Eyetemis, and Wilcox-Holladay-Wang-Koch (WHWK) statistical tests. All tests were corrected for multiple comparisons using the Holm correction. Main outcome measures: The percentage of significant relationships (Percent Significance), proportion of inconsistencies (Inconsistency Ratio), and proportion of self-consistent significant relationships (Significance Index) for each statistical test.

Results

Analysis was performed on 7839 eyes of 7839 patients. WHWK.MAE (42%), WHWK.SD (41%), Eyetemis.MAE (40%), WHWK.RMSAE (39%), and Dunn.MAE (34%) were more robust, respectively, than the remaining 3 tests by Percent Significance (all P < .001). Dunn.MAE had the best Inconsistency Ratio (0.11) in the 100-eye subsets. The same top 5 tests were most robust by Significance Index (0.39, 0.35, 0.35, 0.34, and 0.31, respectively; all P < .02). WHWK.SD and WHWK.RMSAE had the best Significance Indices (both 0.77) in the 2600-eye subsets. McNemar had the poorest Significance Index overall (0.09).

Conclusions

The 5 high-performing tests produced significant results more often and were also self-consistent. WHWK.MAE and McNemar were highest and lowest performing overall, respectively. Dunn.MAE may be useful in sample sizes <150 eyes.

{"title":"Which Test Is Best: Evaluation of Traditional and Contemporary Statistical Tests for Analysis of Spherical Equivalent Prediction Error","authors":"Nathan T. Cannon , Giacomo Savini , Seth M. Pantanelli , Kenneth Hoffer , Petros Aristodemou , Kamran Riaz , David Murphy , David Griffin , Christian Berry , Guillaume Debellemanière , Mathieu Gauvin , Avi Wallerstein , Woong-Joo Whang , Kyungmin Koh , Kazuno Negishi , Ken Hayashi , Diogo Hipólito-Fernandes , David L. Cooke","doi":"10.1016/j.ajo.2025.01.022","DOIUrl":"10.1016/j.ajo.2025.01.022","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize the performance of traditional and contemporary statistics tests for analysis of spherical equivalent prediction error (SEQ-PE) after cataract surgery, with regard to test significance and self-consistency.</div></div><div><h3>Design</h3><div>Comparison of the utility of statistical tests.</div></div><div><h3>Methods</h3><div>Subjects: Eyes from 5 academic centers and 2 private practices that had cataract surgery and postoperative manifest refraction between March 2011 and December 2022. SEQ-PE data were randomly divided into subsets with sample sizes of 100, 300, 500, 700, and 2600 eyes. Mean absolute error (MAE), median absolute error (MedAE), SD, root mean squared absolute error (RMSAE), and the proportion of eyes within 0.50 diopters (D) of predicted were calculated for 6 power prediction formulas and analyzed using Friedman post hoc Dunn, Cochran <em>Q</em> post hoc McNemar, Eyetemis, and Wilcox-Holladay-Wang-Koch (WHWK) statistical tests. All tests were corrected for multiple comparisons using the Holm correction. Main outcome measures: The percentage of significant relationships (Percent Significance), proportion of inconsistencies (Inconsistency Ratio), and proportion of self-consistent significant relationships (Significance Index) for each statistical test.</div></div><div><h3>Results</h3><div>Analysis was performed on 7839 eyes of 7839 patients. WHWK.MAE (42%), WHWK.SD (41%), Eyetemis.MAE (40%), WHWK.RMSAE (39%), and Dunn.MAE (34%) were more robust, respectively, than the remaining 3 tests by Percent Significance (all <em>P</em> < .001). Dunn.MAE had the best Inconsistency Ratio (0.11) in the 100-eye subsets. The same top 5 tests were most robust by Significance Index (0.39, 0.35, 0.35, 0.34, and 0.31, respectively; all <em>P</em> < .02). WHWK.SD and WHWK.RMSAE had the best Significance Indices (both 0.77) in the 2600-eye subsets. McNemar had the poorest Significance Index overall (0.09).</div></div><div><h3>Conclusions</h3><div>The 5 high-performing tests produced significant results more often and were also self-consistent. WHWK.MAE and McNemar were highest and lowest performing overall, respectively. Dunn.MAE may be useful in sample sizes <150 eyes.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 33-42"},"PeriodicalIF":4.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Five to Twelve Year Outcomes of Autologous Simple Limbal Epithelial Transplantation.

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.02.003

Swapna S Shanbhag, Anahita Kate, Shayeri Ganguly, Saumya Jakati, Rashmi Deshmukh, Sayan Basu

Purpose: To objectively assess the long-term corneal epithelial recovery after autologous simple limbal epithelial transplantation (SLET) for ocular chemical burn (OCB)-induced unilateral limbal stem cell deficiency (LSCD).

Design: Prospective, fellow-eye controlled, cross-sectional imaging and diagnostic study.

Subjects: The study included 47 patients, who were 5 to 12 years post-autologous SLET done for OCB-induced unilateral LSCD.

Methods: The donor and recipient eyes of all patients were assessed at a single follow-up visit with slit-lamp biomicroscopy (SLB), in vivo confocal microscopy (IVCM), impression cytology (IC), anterior segment optical coherence tomography (ASOCT), and Scheimpflug imaging (SI). The objective parameters that were assessed were corneal epithelial phenotype (CEP), thickness (CET), reflectivity (CER), and densitometry (CED). Median values with inter-quartile ranges were assessed for all parameters and analyzed using non-parametric tests.

Main outcome measures: The primary outcome measure was successful restoration of normal CEP on SLB, IVCM, and IC. Secondary outcome measures were comparison of CET and CER on ASOCT, and CED on SI between the eyes with successful and failed CEP restoration, and donor eyes.

Results: The study analyzed 94 eyes of 47 patients, with a median follow-up of 5.75 years post-SLET. Successful restoration of CEP on SLB, IVCM, and IC was observed in 32 (68%) recipient eyes, while failure was seen in 15 (32%) eyes. The CEP was normal in all 47 (100%) donor eyes. The median CET was similar in healthy donor eyes, eyes with successful CEP restoration (55.9 microns, 50.3-59.2 vs. 57.8, 49.9-63.1; p=0.47) and eyes with failure (57.7 microns, 50.9-66.2; p≥0.59). Although, the median CER (100.72, 89.9-111.2 vs. 121.6, 109.7-139.8; p=0.001) and CED (14.7, 13.4-17.1 vs. 26.5, 20.1-30.2; p=0.02) values were significantly lower in eyes with successful CEP restoration as compared to eyes with failure, they were still significantly greater than corresponding values in the healthy donor eyes for CER (90.33, 84.9-96.9; p=0.02), and CED (13.5, 11.4-15.1; p=0.03), respectively.

Conclusions: Long-term five-to-twelve-year successful restoration of the corneal epithelial phenotype was seen in two-thirds of eyes post-autologous SLET. While corneal epithelial reflectivity, and densitometry were relatively better in eyes with successful outcomes, corneal epithelial thickness was similar in all eyes.

目的：客观评估自体单纯角膜缘上皮移植（SLET）治疗眼化学烧伤（OCB）引起的单侧角膜缘干细胞缺乏症（LSCD）后角膜上皮的长期恢复情况：前瞻性、同眼对照、横断面成像和诊断研究：方法：所有患者的供体眼和受体眼均为自体SLET：所有患者的供体眼和受体眼均在一次随访中接受了裂隙灯生物显微镜（SLB）、活体共聚焦显微镜（IVCM）、印模细胞学（IC）、前节光学相干断层扫描（ASOCT）和Scheimpflug成像（SI）的评估。评估的客观参数包括角膜上皮表型（CEP）、厚度（CET）、反射率（CER）和密度计（CED）。采用非参数检验对所有参数的中位值和四分位间范围进行评估和分析：主要结果指标：SLB、IVCM 和 IC 成功恢复正常 CEP。次要结果指标是比较成功和失败的 CEP 恢复眼与供体眼在 ASOCT 上的 CET 和 CER 以及在 SI 上的 CED：研究分析了 47 名患者的 94 只眼睛，中位随访时间为 SLET 术后 5.75 年。32只（68%）受体眼成功恢复了SLB、IVCM和IC上的CEP，15只（32%）受体眼恢复失败。所有 47 只（100%）供体眼的 CEP 均正常。健康供体眼、成功恢复 CEP 眼（55.9 微米，50.3-59.2 vs. 57.8，49.9-63.1；p=0.47）和失败眼（57.7 微米，50.9-66.2；p≥0.59）的中位 CET 相似。虽然中位 CER（100.72，89.9-111.2 vs. 121.6，109.7-139.8；p=0.001）和 CED（14.7，13.4-17.1 vs. 26.5，20.1-30.2；p=0.02）的值明显低于CEP修复成功的眼，但仍明显高于健康供体眼的CER（90.33，84.9-96.9；p=0.02）和CED（13.5，11.4-15.1；p=0.03）的相应值：自体SLET术后三分之二的眼睛在5至12年的长期治疗中成功恢复了角膜上皮表型。虽然成功恢复的眼睛的角膜上皮反射率和密度计相对较好，但所有眼睛的角膜上皮厚度相似。

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引用次数: 0

Relationship Between Chemokine in Aqueous Humor and Primary Glaucoma: A Meta-Analysis

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.02.002

XIN SUN , JING ZHOU , XIANDONG ZENG , YANHUA JIANG

Objective

Glaucoma is a group of diseases characterized by optic nerve damage and corresponding visual field loss as clinical changes. A close relationship has been identified between chemokine in aqueous humor and primary glaucoma; however, this association remains controversial.

Design

Systematic review and meta-analysis.

Methods

The Web of Science, Wiley Online Library, PubMed, and Embase databases were searched. The title or abstract search term “glaucoma” was used together with “chemokine”. Meta-analysis results were presented as the standardized mean difference (SMD) with a corresponding 95% confidence interval (Cl).

Results

Twenty studies were included in this meta-analysis, which showed that patients with primary glaucoma had significantly elevated CCL2 (SMD: 0.48, 95% CI [0.11, 0.86]), CCL4 (SMD: 0.74, 95% CI [0.30, 1.17]), CCL5 (SMD: 0.97, 95% CI [0.07, 1.85]), CCL7 (SMD: 2.28, 95% CI [0.86, 3.71]), CXCL8 (SMD: 1.75, 95% CI [1.04, 2.46]), and CXCL10 (SMD: 1.45, 95% CI [0.46, 2.43]) levels in aqueous humor compared to the control group (P < .05).

Conclusions

This systematic review is the first to systematically and comprehensively evaluate chemokine levels in aqueous humor of patients with primary glaucoma. Clarifying the role of chemokines will be helpful for the treatment of glaucoma.

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引用次数: 0

Geographical Distribution of Ophthalmologists in the United States by Gender

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.02.006

Maya T. Harrington , Sophie J. Bakri

PURPOSE

Female representation is growing each year in ophthalmology, but women are still underrepresented overall. Because of the potential impact of physician gender on the physician–patient relationship, this imbalance could affect patient outcomes and satisfaction. This study describes the geographic variation of gender disparities in ophthalmology throughout the United States.

DESIGN

Retrospective cross-sectional study.

METHODS

Physician characteristics were obtained from the 2023 Medicare Physician Compare National Database for physicians listing “ophthalmology” as their primary specialty. Duplicate physician entries were excluded. The remaining 17,503 physicians were grouped into states, allowing for analysis of gender distribution geographically.

RESULTS

Of the 17,503 ophthalmologists registered on the Medicare Physician Compare, 4,965 were female (28.37%). Gender distributions of ophthalmologists varied among states and regions, with the highest female representation in Massachusetts (41.25%) and the District of Columbia (38.37%). The lowest representation was in Wyoming (9.09%) and Utah (15.73%).

CONCLUSIONS

Geographical gender imbalances may be due to several factors including personal preference, state policies, and family choices. By identifying factors that contribute to where women geographically choose to practice, we can better guide approaches to increase female engagement in areas with the lowest representation to close potential healthcare disparities.

目的：眼科领域的女性比例逐年增加，但总体而言女性比例仍然偏低。由于医生性别对医患关系的潜在影响，这种不平衡可能会影响患者的治疗效果和满意度。本研究描述了美国眼科性别差异的地域差异：设计：回顾性横断面研究：从 2023 年医疗保险医生比较国家数据库中获取了将 "眼科 "列为主要专业的医生的特征。排除了重复输入的医生。将剩余的 17,503 名医生按州分组，以便对性别分布进行地域分析：结果：在医疗保险医生比较系统中注册的 17,503 名眼科医生中，有 4,965 名女性（占 28.37%）。眼科医生的性别分布因州和地区而异，女性比例最高的是马萨诸塞州（41.25%）和哥伦比亚特区（38.37%）。怀俄明州（9.09%）和犹他州（15.73%）的女性比例最低：地理上的性别失衡可能是由多种因素造成的，包括个人偏好、州政策和家庭选择。通过确定导致女性选择执业地区的因素，我们可以更好地指导在女性比例最低的地区提高女性参与度的方法，以缩小潜在的医疗差距。

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引用次数: 0

Autograft Donor Site Repair In Pterygium Surgery.

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.01.025

Minas T Coroneo, Ximena Masgoret, Vijay Reena Durai

引用次数: 0

Titaminates, a Biocompatible Titanium–Organic Hybrid Film, Support the Growth and Function of Conjunctival Epithelial Cells

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-02-07 DOI: 10.1016/j.ajo.2025.02.004

Changrim Lee , Veronica Anne-Line Kathrine Killi , Ola Nilsen , Darlene A. Dartt

PURPOSE

To find an ideal biosurface to regenerate conjunctival epithelium.

DESIGN

Experimental study.

METHODS

Pieces of human cadaveric conjunctival epithelium removed of connective tissues were randomly placed on 8 different biosurfaces to grow primary conjunctival epithelial cells for 9 to 14 days until the fastest growing cultures covered 80% to 90% of the film surface. Main outcome measures were growth, proliferation capacity, startification, mucin 5AC (MUC5AC) secretion, and compositional balance in cell types.

RESULTS

All titanium-based films (titaminates) supported the growth, stratification, proliferation, and MUC5AC secretion function of human primary conjunctival epithelial cells (HCjECs), but none of the zinc-based films grew cells at all. Although HCjECs’ ability to proliferate, stratify, and secrete MUC5AC per unit cell area was similar across all titaminates, titanium dioxide (TiO₂) and glycine titaminates (TiG) outperformed TiD and TiGD in terms of outgrowth, recapitulation of native conjunctival epithelium, and compositional balance in cell types. When goblet cells (a subtype of HCjECs) were predominantly grown on these films by using a different culture medium, the results were similar in all aspects.

CONCLUSIONS

Given the body-friendly nature and clinically proven safety and efficacy of titanium, titaminates TiO₂ and TiG have potential as an alternative bioactive substrate for conjunctival epithelium regeneration.

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引用次数: 0