American Journal of Ophthalmology最新文献

Purpose: To investigate the effect of tamsulosin on iris morphology, ciliary muscle thickness (CMT), pupil diameter (PD), and pupil responses to light using anterior segment optical coherence tomography and corneal topography.

Design: Prospective clinical before-and-after study METHODS: The right eyes of 43 patients with newly diagnosed benign prostatic hyperplasia were included in this study. Iris dilator muscle region (DMR) thickness, sphincter muscle region (SMR) thickness, DMR/SMR ratio, PD (scotopic, mesopic and photopic light conditions), CMT1 (1 mm posterior to the scleral spur), CMT2 (2 mm posterior to the scleral spur), CMT3 (3 mm posterior to the scleral spur) and anterior chamber depth (ACD) were measured before and after dilation. Measurements were performed twice firstly before starting tamsulosin treatment and secondly at the 3rd month of tamsulosin treatment.

Results: Pre-dilation DMR thickness (P < .001), post-dilation DMR thickness (P < .001) pre-dilation DMR/SMR ratio (P = .001), and post-dilation DMR/SMR ratio (P = .001) were reduced significantly after tamsulosin treatment. Pre-dilation PD decreased after treatment in scotopic, mesopic and photopic conditions, but only photopic conditions showed a significant difference (P = .733, P = .142, and P = .04, respectively). Post-dilation PD was significantly reduced after tamsulosin treatment (P < .001). No significant differences were found in pre- and post-dilation iris SMR thickness (P = .08 and P = .784, respectively), pre-dilation CMT1, CMT2, and CMT3 (P = .841, 0.794, 0.880, respectively), post-dilation CMT1, CMT2, and CMT3 (P = .367, 0.114, 0.256, respectively), pupil dilation speed (P = .463), pre-dilation ACD (P = .583), and post-dilation ACD(P = .305) after treatment.

Conclusion: Tamsulosin treatment does not change the iris SMR thickness, CMT1, CMT2, CMT3, and ACD but statistically significantly reduces the iris DMR thickness, DMR/SMR ratio, pre-dilation photopic PD, and post-dilation PD.

Purpose: Primarily, to evaluate the repeatability and reproducibility of the new noncontact esthesiometer (NCE) in healthy subjects. Secondarily, the corneal sensitivity threshold measurements of the NCE were compared with those of the Cochet-Bonnet esthesiometer (CBE).

Design: Assessment reliability study.

Methods: Two examiners measured bilateral corneal sensitivity thresholds by NCE and CBE. Triple NCE measurements were performed per eye at all 5 levels, whereas single CBE measurements were performed per eye. When appropriate, NCE (mBar) and CBE (mm) measurements were converted to millinewtons (mN) for direct comparison between devices. The NCE measurement variations were calculated with the intra-class correlation coefficients (ICC) for the primary objective. For the secondary objective, Bland-Altman plots with 95% limits of agreement (95%-LoA) and Spearman's rank correlation coefficients were used to evaluate the level of agreement and linear relationship between the corneal sensitivity thresholds obtained with both devices. Generalized estimating equation models were used to account for the inter-eye correlation of the same study participant.

Results: Fifty subjects (100 eyes) aged 29 years (median) were included. There were no statistically significant differences in the pressure measured by both observers at each NCE level (all P > .05). There was a high intra-observer and inter-observer repeatability of the NCE measurements (ICC > 0.90) and a strong linear correlation (rho > 0.7) at each NCE level. The difference between the mean corneal sensitivity thresholds (mN) measured with the NCE (0.052 ± 0.021 mN) and CBE (0.046 ± 0.005 mN) was statistically significant (P = .001). Bland-Altman analysis revealed a differential bias of +0.00578 mN (95%-LoA -0.03677 - +0.04833 mN) between threshold measurements.

Conclusions: The NCE provides reliable user-independent corneal sensitivity measurements. The NCE and CBE do not yield similar values. Thus, both devices cannot be used interchangeably.

Topic: evaluation of clinical outcomes of patients with retinoblastoma treated with intravitreal chemotherapy (IvitC).

Design: Systematic review and single-arm meta-analysis CLINICAL RELEVANCE: Clinical outcomes with IVitC vary across reports according to patient characteristics and concomitant treatment modalities, mainly intravenous chemotherapy (IVC) and intra-arterial chemotherapy (IAC). There are currently no large clinical trials or meta-analyses focusing on the topic.

Methods: A systematic search was conducted in MEDLINE, EMBASE and Cochrane. All articles reporting use of IVitC for RB and safety or efficacy outcomes were included regardless of publication date. Studies with fewer than 10 eyes were excluded. Enucleation rates (ER) were calculated using proportions and 95% confidence intervals (CIs). The analysis was performed using the Random Effects model in R Studio.

Results: 25 studies comprising 1082 eyes met inclusion criteria. Melphalan was exclusively used in 687 eyes (63.49%), 104 eyes received topotecan exclusively (9.61%), and the remaining 291 (26.90%) used a combination. General ER was 24.70% (95% CI 19.20-31.18%). Subgroup analysis showed an ER of 27.76% (95% CI 19.05-38.55%) for melphalan, 14.23% (95% CI 5.61-21.66%) for topotecan, and 23.82% (95% CI 11.95-41.87%) for combination therapy (p<0.05). It also revealed an ER of 21.54% (95% CI 15.57-29.01%) for studies that implemented IAC+IVitC versus 35.50% (95% CI 20.73-53.66%) for those who used IVC+IVitC (p<0.05). Pigmentary retinopathy rate was 36.56% (95% CI 24.61-50.44%) in subjects treated with melphalan and 2.42% (95% CI 0.70-8.01%) for those receiving topotecan (p<0.05). Other adverse events were cataract (17.76%) followed by vitreous hemorrhage (12.10%) and retinal detachment (5.62%). All studies, except one, were determined to have a serious risk of bias.

Conclusion: IVitC represents an effective strategy for retinoblastoma, especially when administered after IAC; however, melphalan retinal toxicity still poses a challenge. Results with topotecan are promising but scarce. Comparing both drugs is needed to define the best treatment strategy. This study is limited by the lack of large, randomized studies on this subject.

Purpose: Adalimumab, a TNF-alpha inhibitor, is the only FDA-approved biologic for non-infectious uveitis (NIU). However, treatment responses vary, potentially due to interindividual pharmacokinetic differences influenced by body mass index (BMI). This study aimed to evaluate the impact of BMI on adalimumab serum trough levels and therapeutic efficacy in patients with NIU.

Design: cross-sectional, clinical study.

Method: Setting: Single-center study. - Study Population: 80 patients with NIU treated with Adalimumab - Observation Procedure: Adalimumab serum trough levels and anti-Adalimumab antibody (AAA) levels were measured. BMI was calculated at treatment initiation, and patients were categorized into normal weight, overweight, obese, and morbidly obese groups. - Main Outcome Measures: The correlation between BMI, adalimumab levels, and clinical response was analyzed using Pearson correlation, chi-square tests, and logistic regression.

Results: Higher BMI was associated with lower adalimumab serum levels and a reduced likelihood of clinical response. A significant negative correlation was found between BMI and adalimumab levels (r = -0.408, P = .007). Logistic regression identified BMI as a significant predictor of treatment response (P = .017). A BMI threshold of 26.4 was identified, above which the probability of a positive response significantly decreased. Additionally, 51.2% of patients were non-responders, all of whom demonstrated detectable AAA.

Conclusions: Higher BMI is associated with lower adalimumab trough levels and reduced treatment efficacy in NIU patients. A BMI threshold of 26.4 may serve as a clinical marker for tailoring adalimumab therapy, highlighting the need for personalized dosing strategies in patients with elevated BMI.

Purpose: Visual impairment (VI) in working-age individuals significantly impacts public health and the economy. However, the avoidable causes, defined as cataract and refraction disorders, have not been extensively investigated. This study aims to quantify global trends, inequalities, and projections for avoidable VI among this demographic.

Design: Retrospective, observational, population-based trend study.

Methods: We derived data on avoidable VI prevalence and population size data in working age from the Global Burden of Disease (GBD) 2021 study. We employed the joinpoint regression analysis to assess trends from 1990 to 2021 by age, sex, sociodemographic index (SDI), type, and severity at the global, regional, and national levels. Cross-country inequalities were evaluated using the slope index of inequality and the health inequality concentration index. Subsequently, we performed Bayesian age-period-cohort modeling to estimate the avoidable BVL burden in working age by 2040.

Results: The prevalence of avoidable VI in working age decreased overall from 1990 to 2021, driven primarily by reductions in refraction disorders, with an average annual percentage change (AAPC) of -0.15 (95% confidence interval [CI], -0.18 to -0.12; P<0.001). We observed significant declines in severe vision loss and blindness, while moderate vision loss remained stable. Females exhibited a heavier burden of avoidable VI, but showed slower improvement compared to males. Socioeconomic disparities persisted, with lower SDI regions bearing a disproportionate burden, whereas the high SDI region showed an unfavorable increasing trend. From 1990 to 2021, the inequality slope index increased from 574.45 (95% CI, 914.95 to 233.95) to 652.27 (95% CI, 932.95 to 371.58), while the health inequality concentration index improved from -0.21 (95% CI, -0.26 to -0.17) to -0.17 (95% CI, -0.2 to -0.14). We project a continued decline in the global prevalence of avoidable working-age VI, but a 23.4% increase in avoidable VI cases by 2040, reaching approximately 146 million.

Conclusions: Despite overall declines in avoidable VI among working-age individuals, significant improvement opportunities and disparities persist. The anticipated increase in avoidable VI cases necessitates integrated eye health strategies, substantial investment in eye care services to enhance accessibility and affordability, and fair employment policies for the visually impaired.

Purpose: To report the long-term disease course of pentosan polysulfate (PPS) maculopathy following drug cessation.

Design: Single-institution, prospective case series.

Methods: 23 eyes of 12 participants seen at the Emory Eye Center with a diagnosis of PPS maculopathy were included in our study. Participants were enrolled between December 1, 2018, and December 1, 2019, and data were collected annually for four years.

Main outcomes and measures: Changes in visual function and retinal structure were the primary outcomes measured. Visual function was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), ETDRS low-luminance visual acuity (LLVA), Minnesota low-vision reading (MNREAD) performance, contrast sensitivity, mesopic and scotopic microperimetry, and dark adaptometry. Patient reported outcomes were assessed with the National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) and Low Luminance Questionnaire (LLQ). Structural outcomes included the presence of complete retinal pigment epithelium and outer retinal atrophy (cRORA), atrophic lesion size (in mm²), macular central subfield thickness (CST), and subfoveal choroidal thickness (SFCT).

Results: Of the 12 participants, 11 (91.7%) were female, with a median age at enrollment of 58 years. The median ETDRS BCVA letter score at baseline was 83, with a median change of -5 letters over 4 years (P = 0.005). The median 4-year change in mesopic microperimetry average threshold and percent reduced threshold was -5.4 dB (P = 0.003) and 48.6% (P = 0.004), respectively. MNREAD performance (assessed at 2 and 4 years) declined across all measures, with a median maximum reading speed change of -21 words per minute (P = 0.007). NEI-VFQ-39 and LLQ composite scores significantly decreased over 4 years. At baseline, 9 eyes (39%) had macular cRORA. By the study's end, 5 of the remaining eyes (35.7%) developed new-onset cRORA. The median linearized growth rate of atrophic lesions was 0.23 mm/year. The median 4-year change of CST and SFCT was -7.0 µm (P = 0.055) and -22.0 µm (P = 0.610), respectively.

Conclusion: This prospective study demonstrates continued progression of broad-ranging functional and structural deficits in PPS maculopathy long after drug cessation. These findings should inform PPS prescribing patterns, patient counseling, and disease monitoring strategies.

Objective: Not all strabismus surgeons use prophylactic topical antibiotics postoperatively because they may be poorly tolerated, costly, and may increase antimicrobial resistance. The purpose of the study is to assess the effect of postoperative topical antibiotics on the rate of surgical site infections following strabismus surgery.

Design: Retrospective clinical cohort study.

Participants: Patients who underwent strabismus surgery in the past 20 years. Patients who were or were not prescribed postoperative topical antibiotics comprised the study and control groups, respectively.

Methods: This study was conducted using data from TriNetX, an international electronic health-record registry containing data for over 130 million patients. Strabismus surgery patients were identified using CPT codes. The prescription of eye topical antibiotics and the frequency of surgical site infections were identified by RxNorm and ICD-10 codes, respectively. Analysis was conducted using the measures of association feature of TriNetX. Patient demographics such as age, sex, and race were recorded based on their presence in the electronic records system.

Main outcome measure: Development of endophthalmitis, orbital and preseptal cellulitis.

Results: There were 84,052 patients who underwent strabismus surgery. 38,484 (46%) patients received 1 or more postoperative topical antibiotics. About 70% of the patients were White and 10% Black. There was a slight female preponderance (51%). Endophthalmitis developed in 16 patients (0.019%), orbital cellulitis in 24 patients (0.029%) and preseptal cellulitis in 55 patients (0.065%). There was no difference in the rates of endophthalmitis, orbital, and preseptal cellulitis between the groups (p values 0.855, 0.684, 0.925 respectively).

Conclusions: The prescription of prophylactic topical antibiotics did not decrease rates of surgical site infections following strabismus surgery. Administering postoperative topical antibiotics can be distressing to children, costly, and may contribute to antimicrobial resistance. Given no clear advantage and potential disadvantages, the use of postoperative topical antibiotics following strabismus surgery may not be beneficial.

Objective: This review article discusses investigational subretinal gene therapies for retinal vascular diseases, including AVA-101, an adeno-associated viral (AAV) 2 vector expressing soluble vascular endothelial growth factor (VEGF) receptor 1, ABBV-RGX-314, an AAV8 vector expressing an anti-VEGF-A antibody fragment, and EXG102-031, an AAV8 vector expressing a recombinant protein that blocks VEGF family members and angiopoietin 2.

Design: Review article CONCLUSION: Subretinal injection is a commonly used delivery route for investigational gene therapy agents which is theorized to provide relative immune privilege, thereby reducing the risk of inflammation, while providing high transgene expression in photoreceptors and retinal pigment epithelium. Subretinal injection of AVA-101 demonstrated safety and tolerability in Phase I and IIa trials, but failed to maintain visual acuity and control exudation. In contrast, subretinal injection of some doses of ABBV-RGX-314 have shown evidence of controlling exudation and the maintaining vision, as well as safety and tolerability, leading to two ongoing pivotal trials comparing subretinal delivery of two different doses of ABBV-RGX-314 versus intravitreal injections of 0.5mg ranibizumab or 2mg aflibercept. These preliminary results are an encouraging and welcome development in the search for efficacious, long-duration treatments for retinal vascular diseases.

Purpose: To describe clinical features, management, and outcomes of anterior segment dominated persistent fetal vasculature (aPFV) .

Design: A secondary analysis of aPFV data from a longitudinal cohort study.

Methods: The age and gender of each participant upon initial presentation, along with biological parameters, best-corrected visual acuity (BCVA), and biomicroscopic assessments were collected. The aPFV eyes were categorized into 3 groups (type I:pupillary-iris-anterior lens plane, type II:retrolental-anterior hyaloid membrane plane and type III:combined) according to the location of the vascular abnormalities and further classified into mild (a) and severe (b) according to the degree of severity. The surgical techniques used in this investigation were reported. Visual outcomes, ocular hypertension, postoperative adverse events, and additional surgical interventions were recorded at each follow-up visit.

Results: A total of 470 individuals (619 eyes) were enrolled (ages 36.7±45.4 months, range 1 to 394 months), divided into 129 eyes (20.8%) Type 1, 420 eyes (67.9%) Type 2, and 70 eyes (11.3%) Type 3. Cataracts were identified in 505 eyes (81.6 %): for type I, the common forms were nuclear and membranous opacity (both 12/50 eyes, 24%); type II: subcapsular opacity (214/399 eyes, 53.6%) and type III: complete cortex (17/56 eyes, 30.4%). Posterior capsular tear was mostly present in type II a. Type III had the shallowest anterior chamber depth and the largest corneal astigmatism. Six hundred patients (96.7%) had surgery. After surgery, 119 eyes experienced adverse events: intravitreal hemorrhages occurred in 0.2% of eyes, visual axis obscuration occurred in 9.4% of eyes, and ocular hypertension which required eye drop medication occurred in 19.2% of eyes. In 47 patients (7.6%), a second surgery procedure was done. In 456 eyes (73.7%), visual acuity had improved at the last follow-up. The worst BCVA was associated with types IIb and IIIb.

Conclusions: The magnitude of aPFV can be usefully characterized by a classification protocol focusing on the location and disease severity. Here, we propose a surgical and medical management algorithm for aPFV to achieve favorable outcomes with limited intraoperative and postoperative complications.

Purpose: To determine if paracentral acute middle maculopathy (PAMM) and peripapillary intraretinal and subretinal fluid (IRF/SRF) could help distinguish between arteritic anterior ischemic optic neuropathy (A-AION) and nonarteritic AION (NA-AION) at an early stage.

Design: Nested prospective cross-sectional diagnostic accuracy study.

Methods: This study used single-center optical coherence tomography (OCT) data from 8 patients with A-AION and 24 patients with NA-AION from two prospective cross-sectional studies with consecutive sampling (ClinicalTrials.gov: NCT05248906 and NCT05305079). The diagnosis of A-AION was based on expert interpretation of biochemical markers of inflammation, temporal artery biopsy and positron emission tomography/computed tomography. The diagnosis of NA-AION was made in cases without suspicion or clinical evidence of A-AION and with confirmed neuroophthalmological expert diagnosis. For this substudy patients were also required to have an OCT scan in relation to the diagnosis of AION. Macular OCT scans were graded by two independent, masked graders for the presence of PAMM and for IRF/SRF. The extension of IRF/SRF was assessed using an Early Treatment Diabetic Retinopathy Study (ETDRS) grid.

Results: PAMM was found in 50% of patients with A-AION and in 0% of patients with NA-AION (P = .0019). In the setting of AION, the sensitivity of PAMM for the diagnosis of A-AION was 50% (95% CI: 16%-84%) while the specificity was 100% (95% CI: 86%-100%). Conversely, peripapillary IRF/SRF with extension into the ETDRS grid was observed in 83% of patients with NA-AION but in 0% of patients with A-AION (P = .000047). The sensitivity of central macula-involving IRF/SRF for the diagnosis of NA-AION was 83% (95% CI: 63%-95%), while the specificity was 100% (95% CI: 63%-100%). Combining the two biomarkers, 75% of patients with AION could be classified based on OCT alone.

Conclusion: PAMM appears to be a biomarker of A-AION while extensive peripapillary fluid appears to be a biomarker of NA-AION. Combining OCT biomarkers might allow for early classification of AION and warrants further prospective studies.