American Journal of Ophthalmology最新文献_第7页

An Artificial Intelligence-Based Prognostic Model for Prediction of Functional Glaucoma Progression From Clinical and Structural Data 从临床和结构数据预测功能性青光眼进展的基于ai的预后模型

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2026-01-01 DOI: 10.1016/j.ajo.2025.12.026

Vahid Mohammadzadeh , Sean Wu , Sajad Besharati , Mahshad Rafiee , Yasamin Banaei , Arthur Martinyan , Jane Zou , Evelyn Kung , Kiumars Edalati , Esteban Morales , Fabien Scalzo , Joseph Caprioli , Kouros Nouri-Mahdavi

Purpose

Integration of various sources of information for prediction of disease progression is an unmet need in glaucoma diagnostics. We designed a deep learning-based prognostic model incorporating clinical and structural data for forecasting functional glaucoma progression and compared its performance to clinicians.

Design

Retrospective, comparative cohort study of prognostic accuracy.

Subjects

We included 1599 eyes (908 patients) with definite or suspected glaucoma with ≥5 24-2 visual fields (VF) and 3 or more years of follow-up.

Methods

VF mean deviation (MD) rates of change were estimated with linear regression. Sequential MD rates of change were estimated with each series spanning only 5 years of follow-up. VF progression was declared when four sequential statistically significant negative MD slopes were observed, and slope for the entire follow-up was significant. A convolutional neural network pretrained on ImageNet was designed to predict VF progression using baseline clinical and demographic data, disc photographs, and optical coherence tomography-derived global and sectoral retinal nerve fiber layer and macular thickness measurements. In addition, average intraocular pressure and treatment information during follow-up were put into the model. The same data for a subset of patients was provided to two clinicians to independently predict future progression. The model was validated on a separate cohort of eyes in which optical coherence tomography imaging was done with a different device (291 eyes).

Main Outcome Measures

Model’s area under receiver operating characteristic curves (AUC), accuracy, and area under the precision and recall curves.

Results

Average (SD) baseline MD and number of VF exams were −3.5 (4.9) dB and 10.1 (4.7). 399 eyes (25%) deteriorated. The best-performing model incorporated baseline disc photographs, and retinal nerve fiber layer and macular thickness: AUC, 0.839 (0.771-0.906), accuracy, 76.0% (62.0%-85.0%), and area under the precision and recall curves, 0.558 (0.385-0.733). Deep learning model significantly outperformed clinical graders (AUC : 0.629 [0.531-0738], P < .001 and 0.680 [0.584-0.776], P = .001, for grader one and two, respectively). Model performance was similar on the validation cohort (AUC: 0.754 [0.671-0.837], and accuracy: 77% [71%-82%], respectively, P = .122). The model performed well when predicting fast-progression, defined as MD rate <−1.0 dB/y (AUC: 0.869 [0.792-0.947]).

Conclusions

Our newly designed deep learning model can combine baseline demographic and clinical data with widely available structural measurements and provide clinically relevant information for the prediction of glaucoma progression.

目的在青光眼诊断中，整合各种信息来源预测疾病进展是一个尚未满足的需求。我们设计了一个基于深度学习的预后模型，结合临床和结构数据来预测功能性青光眼的进展，并将其与临床医生的表现进行比较。设计预后准确性的回顾性、比较队列研究。我们纳入1599只眼睛（908名患者），明确或疑似青光眼，≥5个24-2视野（VF），随访3年或更长时间。方法采用线性回归估计svf平均偏差（MD）变化率。每个系列的MD变化率仅在5年随访期间进行估计。当观察到四个连续的统计学上显著的负MD斜率时，宣布VF进展，整个随访的斜率是显著的。在ImageNet上预训练卷积神经网络，利用基线临床和人口统计数据、椎间盘照片、光学相干断层扫描衍生的全局和局部视网膜神经纤维层和黄斑厚度测量来预测VF进展。并将随访期间的平均眼压和治疗信息输入模型。将一部分患者的相同数据提供给两位临床医生，以独立预测未来的进展。该模型在另一组眼睛上进行了验证，其中光学相干断层扫描成像使用不同的设备（291只眼睛）。主要结果测量模型在接收者工作特征曲线（AUC）下的面积，准确度，精度和召回率曲线下的面积。结果平均（SD）基线MD和VF检查次数分别为- 3.5 (4.9)dB和10.1 (4.7)dB。399只眼（25%）恶化。最佳模型包含了基线椎间盘照片、视网膜神经纤维层和黄斑厚度：AUC为0.839(0.771-0.906)，准确率为76.0%(62.0%-85.0%)，精度曲线和召回曲线下面积为0.558（0.385-0.733）。深度学习模型显著优于临床分级（AUC: 0.629 [0.531-0738], P <； 0.001和0.680 [0.584-0.776],P = .001，分别为1级和2级）。模型在验证队列上的表现相似（AUC: 0.754[0.671-0.837]，准确率：77% [71%-82%]，P = 0.122）。该模型在预测快速进展时表现良好，定义为MD率<；−1.0 dB/y （AUC: 0.869[0.792-0.947]）。结论我们新设计的深度学习模型可以将基线人口统计学和临床数据与广泛可用的结构测量相结合，为青光眼的进展预测提供临床相关信息。

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引用次数: 0

Clinical Assessment of a Highly Multiplexed Panel Assay for the Diagnosis of Infectious Uveitis 诊断感染性葡萄膜炎的高度多重面板试验的临床评价。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-31 DOI: 10.1016/j.ajo.2025.12.024

Paulo J.M. Bispo , Nicole L. Belanger , Renee Liu , Eduardo Ferracioli-Oda , Tatiana Tanaka , Joyce Hisae Yamamoto , Lucia Sobrin

Purpose

Current diagnostic workup for infectious uveitis relies on the use of various immunoassays and polymerase chain reaction (PCR) tests on ocular fluids that are time consuming and not comprehensive, requiring large sample volumes to probe for all causes. To streamline the diagnostic process, improve turnaround time, and target inclusivity, we developed a highly multiplexed pan-ocular-pathogen panel (OcuPan) that can be used for broad-range pathogen detection in only 1 assay, with PCR-level sensitivity and in a timely fashion (12 hours). Here, we assessed the clinical usefulness and performance of this innovative assay as a novel tool for rapid and accurate laboratory diagnosis of infectious uveitis.

Design

Laboratory evaluation of a novel diagnostic test and technology

Participants and Controls

A total of 109 patients from 2 centers were included, including 78 infectious uveitis cases and 31 controls.

Methods

Intraocular samples (n = 108 from patients and 43 from controls) were processed by PCR and the OcuPan diagnostic assay that detects 46 ocular pathogens plus 2 resistance/virulence markers.

Main Outcome Measures

Clinical sensitivity and specificity, quantification capabilities, and agreement between PCR and the OcuPan assay.

Results

The clinical sensitivity and specificity of the OcuPan assay were 50.9% (95% CI, 41.3-60.5) and 100% (95% CI 89.7%-100%), respectively. Sensitivity varied according to the sample matrix tested, with undiluted vitreous having the highest positivity rates (72.4%, 95% CI 55.1-89.7), followed by dilute vitreous (53.3%, 95% CI 34.4-72.3) and aqueous (36.7%, 95% CI 22.7-50.7). There was excellent overall agreement (93.5%) between the OcuPan assay and PCR (kappa of 0.870 ± 0.047; P < .001) with positive (PPA) and negative (NPA) percentage agreements >92% for all targets. PPA was 100% for herpesviruses and Treponema pallidum, whereas the NPA values ranged from 96.6% to 100% for these pathogens. For Toxoplasma gondii, the PPA was 75% and NPA 100%. We also found significant correlation (Spearman ρ = –0.7506, P < .0001) between the quantitative metric for the OcuPan assay and the real-time PCR cycle threshold values.

Conclusions

The OcuPan assay offers an all-in-one highly multiplexed detection system for rapid, comprehensive, quantitative, and accurate diagnosis of infectious uveitis.

目的：目前感染性葡萄膜炎的诊断工作依赖于使用各种免疫测定和PCR检测眼液，耗时且不全面，需要大量样本量来探测所有原因。为了简化诊断过程，改善周转时间和目标包容性，我们开发了一种高度多用途的泛眼病原体面板（OcuPan），只需一次检测就可以用于广泛的病原体检测，具有pcr水平的灵敏度，并且及时（12小时）。在这里，我们评估了这种创新的检测方法作为一种快速准确的实验室诊断感染性葡萄膜炎的新工具的临床实用性和性能。设计：一种新型诊断测试和技术的实验室评估参与者和对照组：来自两个中心的109例患者，包括78例感染性葡萄膜炎患者和31例对照组。方法：采用PCR和OcuPan诊断法检测46种眼部病原菌和2种耐药/毒力标记物，对患者108例和对照组43例眼内样本进行处理。主要结果测量：临床敏感性和特异性，定量能力，以及PCR和OcuPan测定之间的一致性。结果：OcuPan检测的临床敏感性和特异性分别为50.9%（95%可信区间[CI]）、41.3 ~ 60.5)和100% （95% CI, 89.7% ~ 100%）。灵敏度根据检测的样品基质而变化，未稀释的玻璃体具有最高的阳性率（72.4%,95% CI， 55.1至89.7），其次是稀释玻璃体（53.3%,95% CI， 34.4至72.3）和水溶液（36.7%,95% CI， 22.7至50.7）。OcuPan试验与PCR之间的总体一致性很好（93.5%）（kappa为0.870，±0.047；所有靶标的P为92%）。疱疹病毒和苍白t的PPA值为100%，而这些病原体的NPA值为96.6% ~ 100%。弓形虫的PPA为75%，NPA为100%。结论：OcuPan检测为感染性葡萄膜炎的快速、全面、定量、准确诊断提供了一种一体化、高度多元的检测系统。

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引用次数: 0

Reply to Comment on Glucagon-Like Peptide-1 Receptor Agonist Use and Risk of Cataract Development. 胰高血糖素样肽-1受体激动剂的使用与白内障发展风险的评论回复。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-30 DOI: 10.1016/j.ajo.2025.12.021

Abhimanyu S Ahuja, Alfredo A Paredes Iii, Sejal A Ahuja, Benjamin K Young

引用次数: 0

Comment on: Glucagon-Like Peptide-1 Receptor Agonist Use and Risk of Cataract Development. 评论：胰高血糖素样肽-1受体激动剂的使用和白内障发展的风险。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-29 DOI: 10.1016/j.ajo.2025.11.050

Ha-Neul Yu, Isdin Oke, Julius T Oatts

引用次数: 0

Association of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists With Risk of Cataract 钠-葡萄糖共转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂与白内障风险的关系

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-26 DOI: 10.1016/j.ajo.2025.12.025

Bing-Hua Lin , Shu-Han Chuang , Lien-Chen Wu , Yu-Pin Chen , Yi-Jie Kuo , Cheng-Hsien Chang

Purpose

To evaluate the risk of age-related cataract (ARC) among patients with type 2 diabetes mellitus (T2DM) using sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA) as second-line antihyperglycemic agents.

Design

Population-based retrospective cohort study.

Participants

Adults aged over 40 years with a diagnosis of T2DM between January 2015 and June 2025 were identified from the TriNetX Global Network. The patients were categorized into three cohorts: (1) SGLT2i plus metformin, (2) GLP-1 RA plus metformin, and (3) metformin monotherapy. Patients with aphakia or pseudophakia, orbital injuries, secondary cataracts, or congenital ocular malformations were excluded.

Methods

Pairwise comparisons were performed with a 3-year follow-up. Baseline characteristics were balanced using 1:1 propensity score matching for demographics, comorbidities, T2DM severity, and cataract risk factors. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Main Outcome Measures

The primary outcome was the incidence of ARC events, defined as a diagnosis of ARC or cataract surgery, with stratified analyses conducted by demographics, glycemic control, and comorbidities.

Results

After matching, three pairwise comparisons included 34,259 (SGLT2i vs metformin; mean age, 62.8 years; 35.1% female), 50,877 (GLP-1 RA vs metformin; mean age, 58.3 years; 54.8% female), and 23,022 (SGLT2i vs GLP-1 RA; mean age, 61.0 years; 40.8% female) patients. Adjunctive SGLT2i or GLP-1 RA was associated with a reduced risk of ARC events (SGLT2i, HR: 0.82, 95% CI: 0.76-0.89; GLP-1 RA, HR: 0.93, 95% CI: 0.87-0.99). The protective effect of SGLT2i was greater than that of GLP-1 RA (HR: 0.84, 95% CI: 0.76-0.92). However, in patients with advanced age, obesity, or diabetic retinopathy, the association attenuated. When analyzed as separate outcomes, adjunctive use of SGLT2i and GLP-1 RA remained associated with a reduced risk of ARC diagnosis, while the risk of cataract surgery did not differ significantly (SGLT2i, HR: 1.14, 95% CI: 0.95-1.34; GLP-1 RA, HR: 1.01, 95% CI: 0.79-1.26).

Conclusions

Adjunctive use of SGLT2i or GLP-1 RA was associated with a lower risk of ARC, with a stronger effect for SGLT2i; however, neither agent reduced the risk of cataract surgery. Further studies are needed to clarify the underlying biological pathways and validate our findings.

目的评价钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）或胰高血糖素样肽-1受体激动剂（GLP-1 RA）作为二线降糖药物对2型糖尿病（T2DM）患者发生年龄相关性白内障（ARC）的风险。设计基于人群的回顾性队列研究。2015年1月至2025年6月期间诊断为2型糖尿病的40岁以上成年人从TriNetX全球网络中确定。患者被分为三个队列：(1)SGLT2i +二甲双胍，(2)GLP-1 RA +二甲双胍，(3)二甲双胍单药治疗。排除无晶状体或假性晶状体、眼窝损伤、继发性白内障或先天性眼畸形的患者。方法采用3年随访进行两组比较。基线特征采用1:1倾向评分匹配人口统计学、合并症、T2DM严重程度和白内障危险因素进行平衡。采用Cox比例风险模型估计风险比（hr）和95%置信区间（ci）。主要结局指标主要结局指标是ARC事件的发生率，定义为ARC或白内障手术的诊断，并根据人口统计学、血糖控制和合并症进行分层分析。结果匹配后，三组两两比较包括34,259例（SGLT2i vs二甲双胍，平均年龄62.8岁，女性占35.1%）、50,877例（GLP-1 RA vs二甲双胍，平均年龄58.3岁，女性占54.8%）和23,022例（SGLT2i vs GLP-1 RA，平均年龄61.0岁，女性占40.8%）患者。辅助SGLT2i或GLP-1 RA与降低ARC事件的风险相关（SGLT2i, HR: 0.82, 95% CI: 0.76-0.89; GLP-1 RA, HR: 0.93, 95% CI: 0.87-0.99）。SGLT2i的保护作用大于GLP-1 RA （HR: 0.84, 95% CI: 0.76 ~ 0.92）。然而，在老年、肥胖或糖尿病视网膜病变患者中，相关性减弱。当作为单独的结果进行分析时，辅助使用SGLT2i和GLP-1 RA仍然与ARC诊断风险降低相关，而白内障手术的风险没有显着差异（SGLT2i, HR: 1.14, 95% CI: 0.95-1.34; GLP-1 RA, HR: 1.01, 95% CI: 0.79-1.26）。结论联合使用SGLT2i或GLP-1 RA与较低的ARC风险相关，且对SGLT2i的作用更强；然而，这两种药物都不能降低白内障手术的风险。需要进一步的研究来阐明潜在的生物学途径并验证我们的发现。

{"title":"Association of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists With Risk of Cataract","authors":"Bing-Hua Lin , Shu-Han Chuang , Lien-Chen Wu , Yu-Pin Chen , Yi-Jie Kuo , Cheng-Hsien Chang","doi":"10.1016/j.ajo.2025.12.025","DOIUrl":"10.1016/j.ajo.2025.12.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of age-related cataract (ARC) among patients with type 2 diabetes mellitus (T2DM) using sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA) as second-line antihyperglycemic agents.</div></div><div><h3>Design</h3><div>Population-based retrospective cohort study.</div></div><div><h3>Participants</h3><div>Adults aged over 40 years with a diagnosis of T2DM between January 2015 and June 2025 were identified from the TriNetX Global Network. The patients were categorized into three cohorts: (1) SGLT2i plus metformin, (2) GLP-1 RA plus metformin, and (3) metformin monotherapy. Patients with aphakia or pseudophakia, orbital injuries, secondary cataracts, or congenital ocular malformations were excluded.</div></div><div><h3>Methods</h3><div>Pairwise comparisons were performed with a 3-year follow-up. Baseline characteristics were balanced using 1:1 propensity score matching for demographics, comorbidities, T2DM severity, and cataract risk factors. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the incidence of ARC events, defined as a diagnosis of ARC or cataract surgery, with stratified analyses conducted by demographics, glycemic control, and comorbidities.</div></div><div><h3>Results</h3><div>After matching, three pairwise comparisons included 34,259 (SGLT2i vs metformin; mean age, 62.8 years; 35.1% female), 50,877 (GLP-1 RA vs metformin; mean age, 58.3 years; 54.8% female), and 23,022 (SGLT2i vs GLP-1 RA; mean age, 61.0 years; 40.8% female) patients. Adjunctive SGLT2i or GLP-1 RA was associated with a reduced risk of ARC events (SGLT2i, HR: 0.82, 95% CI: 0.76-0.89; GLP-1 RA, HR: 0.93, 95% CI: 0.87-0.99). The protective effect of SGLT2i was greater than that of GLP-1 RA (HR: 0.84, 95% CI: 0.76-0.92). However, in patients with advanced age, obesity, or diabetic retinopathy, the association attenuated. When analyzed as separate outcomes, adjunctive use of SGLT2i and GLP-1 RA remained associated with a reduced risk of ARC diagnosis, while the risk of cataract surgery did not differ significantly (SGLT2i, HR: 1.14, 95% CI: 0.95-1.34; GLP-1 RA, HR: 1.01, 95% CI: 0.79-1.26).</div></div><div><h3>Conclusions</h3><div>Adjunctive use of SGLT2i or GLP-1 RA was associated with a lower risk of ARC, with a stronger effect for SGLT2i; however, neither agent reduced the risk of cataract surgery. Further studies are needed to clarify the underlying biological pathways and validate our findings.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 66-77"},"PeriodicalIF":4.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844794","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

The AJO and Academic Freedom: Then and Now AJO和学术自由：过去和现在

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-26 DOI: 10.1016/j.ajo.2025.12.023

Richard K. Parrish

引用次数: 0

Elevated Retinal Neovascularization on Widefield Optical Coherence Tomography Angiography Predicts Complications in High-Risk Proliferative Diabetic Retinopathy 宽视场OCTA RNV升高预测高危PDR并发症

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-24 DOI: 10.1016/j.ajo.2025.12.017

AN-LUN WU , JINYI HAO , LIQIN GAO , YUKUN GUO , TRISTAN T. HORMEL , CHRISTINA J. FLAXEL , MERINA THOMAS , BENJAMIN K. YOUNG , STEVEN T. BAILEY , DONG-WOUK PARK , YALI JIA , THOMAS S. HWANG

Purpose

To determine whether retinal neovascularization (RNV) metrics derived from single-shot widefield swept-source OCT angiography (SS-OCTA) predict subsequent vision-threatening complications in eyes with high-risk proliferative diabetic retinopathy (PDR).

Design

Prospective case series.

Participants

Eyes clinically graded as high-risk PDR at a tertiary care center, followed up for at least 6 months.

Methods

Eligible eyes underwent single-shot 26 × 21-mm SS-OCTA imaging (DREAM OCT, Intalight Inc.). A validated deep learning-based algorithm segmented the vitreous cavity slab to generate en face OCTA images for automated detection and quantification of RNV membrane and the vascular areas. Lesions were classified as elevated when they were separated from the internal limiting membrane (ILM) and attached when there was no space between the lesion and the ILM. We analyzed baseline OCTA-derived metrics for their predicting eyes that developed new or recurrent vitreous hemorrhage (VH) or tractional retinal detachment (TRD) during follow-up.

Main outcome measures

Incidence of new or recurrent vitreous hemorrhage and traction retinal detachment.

Results

Over a median follow-up period of 291 days (range, 180-466), 8 of 18 eyes (44.4%) developed complications, with 7 (38.9%) developing VH and 1 (5.6%) developing TRD. Among the 115 identified RNV lesions, 87 (75.7%) were located outside the arcades. Compared to eyes without complications, eyes with complications had a larger median total RNV membrane area (25.72 mm² vs 1.33 mm²; P = .006) and a larger median total RNV vascular area (9.72 mm² vs 0.76 mm²; P = .010). Eyes with complications had a larger elevated RNV membrane area (5.13 mm^² vs 0.10 mm²; P = .009) and vascular area (2.69 mm^² vs 0.05 mm²; P = .007), whereas attached RNV metrics were not significantly different between groups. Total RNV membrane area demonstrated the highest predictive performance for identifying eyes at risk of complications (AUC = 0.888), with a sensitivity of 87.5% and a specificity of 80.0% at a cutoff value of 3.40 mm².

Conclusions

Widefield SS-OCTA is useful for evaluating RNV burden and its axial relationship to the ILM in high-risk PDR. Elevated baseline RNV, incorporating spatial and anatomic features, predicts subsequent tractional complications such as VH and TRD. These imaging biomarkers may complement current clinical staging of PDR.

目的探讨单次广角扫描源OCT血管造影（SS-OCTA）视网膜新生血管（RNV）指标是否能预测高风险增殖性糖尿病视网膜病变（PDR）患者随后出现的视力威胁并发症。DesignProspective案例系列。参与者在三级医疗中心被临床分级为高风险PDR，随访至少6个月。方法对符合条件的眼睛进行26 × 21 mm SS-OCTA单次成像（DREAM OCT, Intalight Inc.）。经过验证的基于深度学习的算法对玻璃体腔板进行分割，生成正面OCTA图像，用于RNV膜和血管区域的自动检测和定量。当病变与内限制膜（ILM）分离时，病变被归类为升高，当病变与内限制膜之间没有空间时，病变被归类为附着。我们分析了基线octa衍生指标，用于预测随访期间发生新的或复发性玻璃体出血（VH）或牵引性视网膜脱离（TRD）的眼睛。主要观察指标：新发或复发玻璃体出血及牵引性视网膜脱离的发生率。结果18只眼中有8只（44.4%）发生并发症，其中7只（38.9%）发生VH， 1只（5.6%）发生TRD。在115例确诊的RNV病变中，87例（75.7%）位于拱廊外。与无并发症的眼睛相比，有并发症的眼睛中位总RNV膜面积更大（25.72 mm²vs 1.33 mm²；P = ）。006)和更大的中位总RNV血管面积（9.72 mm²vs 0.76 mm²；P = .010）。并发症眼RNV膜面积升高较大（5.13 mm²vs 0.10 mm²；P = ）。009)和血管面积(2.69 mm²vs 0.05 mm²；P = 。007)，而附加的RNV指标在组间无显著差异。总RNV膜面积在识别并发症风险方面表现出最高的预测性能（AUC = 0.888），在截止值为3.40 mm²时，敏感性为87.5%，特异性为80.0%。结论swdefield SS-OCTA可用于评价高危PDR患者RNV负荷及其与ILM的轴向关系。基线RNV升高，结合空间和解剖特征，预测随后的牵拉并发症，如VH和TRD。这些成像生物标志物可以补充当前PDR的临床分期。

{"title":"Elevated Retinal Neovascularization on Widefield Optical Coherence Tomography Angiography Predicts Complications in High-Risk Proliferative Diabetic Retinopathy","authors":"AN-LUN WU , JINYI HAO , LIQIN GAO , YUKUN GUO , TRISTAN T. HORMEL , CHRISTINA J. FLAXEL , MERINA THOMAS , BENJAMIN K. YOUNG , STEVEN T. BAILEY , DONG-WOUK PARK , YALI JIA , THOMAS S. HWANG","doi":"10.1016/j.ajo.2025.12.017","DOIUrl":"10.1016/j.ajo.2025.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether retinal neovascularization (RNV) metrics derived from single-shot widefield swept-source OCT angiography (SS-OCTA) predict subsequent vision-threatening complications in eyes with high-risk proliferative diabetic retinopathy (PDR).</div></div><div><h3>Design</h3><div>Prospective case series.</div></div><div><h3>Participants</h3><div>Eyes clinically graded as high-risk PDR at a tertiary care center, followed up for at least 6 months.</div></div><div><h3>Methods</h3><div>Eligible eyes underwent single-shot 26 × 21-mm SS-OCTA imaging (DREAM OCT, Intalight Inc.). A validated deep learning-based algorithm segmented the vitreous cavity slab to generate <em>en face</em> OCTA images for automated detection and quantification of RNV membrane and the vascular areas. Lesions were classified as elevated when they were separated from the internal limiting membrane (ILM) and attached when there was no space between the lesion and the ILM. We analyzed baseline OCTA-derived metrics for their predicting eyes that developed new or recurrent vitreous hemorrhage (VH) or tractional retinal detachment (TRD) during follow-up.</div></div><div><h3>Main outcome measures</h3><div>Incidence of new or recurrent vitreous hemorrhage and traction retinal detachment.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 291 days (range, 180-466), 8 of 18 eyes (44.4%) developed complications, with 7 (38.9%) developing VH and 1 (5.6%) developing TRD. Among the 115 identified RNV lesions, 87 (75.7%) were located outside the arcades. Compared to eyes without complications, eyes with complications had a larger median total RNV membrane area (25.72 mm² vs 1.33 mm²; <em>P</em> = .006) and a larger median total RNV vascular area (9.72 mm² vs 0.76 mm²; <em>P</em> = .010). Eyes with complications had a larger elevated RNV membrane area (5.13 mm<sup>²</sup> vs 0.10 mm²; <em>P</em> = .009) and vascular area (2.69 mm<sup>²</sup> vs 0.05 mm²; <em>P</em> = .007), whereas attached RNV metrics were not significantly different between groups. Total RNV membrane area demonstrated the highest predictive performance for identifying eyes at risk of complications (AUC = 0.888), with a sensitivity of 87.5% and a specificity of 80.0% at a cutoff value of 3.40 mm².</div></div><div><h3>Conclusions</h3><div>Widefield SS-OCTA is useful for evaluating RNV burden and its axial relationship to the ILM in high-risk PDR. Elevated baseline RNV, incorporating spatial and anatomic features, predicts subsequent tractional complications such as VH and TRD. These imaging biomarkers may complement current clinical staging of PDR.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 268-278"},"PeriodicalIF":4.2,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822818","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

Geographic and Phenotypic Variability in RHO-Associated Retinopathy: Evidence From a Chinese Cohort and Global Literature rho相关视网膜病变的地理和表型变异：来自中国队列和全球文献的证据

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-23 DOI: 10.1016/j.ajo.2025.12.020

CHENYUE HANG , TIANYUAN ZHAO , ZHIXUAN CHEN , HONG WANG , LIN CHEN , TING ZHANG , YUTIAN JIAO , TONG LI , JUNRAN SUN , SUQIN YU , YUANYUAN GONG , HAO ZHOU , XUJUN JIANG , XINXIN LIU , HUIXUN JIA , KAIRONG ZHENG , XIAOLING WAN , JIEQIONG CHEN , XIAODONG SUN

Purpose

To investigate the genotype-phenotype correlation in RHO-associated retinopathy, with a focus on delineating an ethnic-specific variant spectrum and comparing clinical severity across biological classes and common variants.

Design

Retrospective cohort study and literature review.

Methods

We systematically reviewed all published cases of RHO-associated retinal diseases (2196 patients, 1278 probands) and analyzed clinical, genetic, and imaging data from our institutional cohort (80 probands). Variants were categorized by type and by biological class (Class 1-7), and phenotypes were compared across different biological classes and three common variants.

Results

A marked geographic divergence was observed: P23H was common in North America but rare in other populations, whereas P347L and R135W were major common variants in European and Asian populations. Genotype-phenotype analysis revealed that Class 2 variants were associated with later onset and slower visual decline, whereas Class 1 and Class 3 variants correlated with earlier onset (P < .0001) and more aggressive phenotypes. Notably, R135W (Class 3) emerged as an under-recognized but highly aggressive variant, with earlier onset (P < .01) and potentially earlier macular involvement.

Conclusions

Our study represents the largest study integrating ethnic, genotypic, and clinical data in RHO-associated retinopathy. The findings highlight substantial inter-ethnic differences in common variants and underscore the clinical relevance of biological classification in predicting disease course. In particular, R135W and P347L warrants closer clinical attention due to their aggressive trajectory, which may inform prioritization in gene therapy trials and individualized patient management.

目的研究rho相关视网膜病变的基因型-表型相关性，重点描述种族特异性变异谱，并比较不同生物类别和常见变异的临床严重程度。设计回顾性队列研究及文献回顾。方法：我们系统地回顾了所有已发表的rro相关视网膜疾病病例（2196例患者，1278个先证者），并分析了我们的机构队列（80个先证者）的临床、遗传和影像学资料。变异按类型和生物类别（1-7类）分类，并比较了不同生物类别和三种常见变异的表型。结果P23H基因在北美人群中较为常见，在其他人群中较为少见，而P347L和R135W基因在欧洲和亚洲人群中较为常见。基因型-表型分析显示，2类变异与发病较晚和较慢的视力下降有关，而1类和3类变异与发病较早（P < .0001）和更具侵袭性的表型相关。值得注意的是，R135W（3类）是一种未被充分认识但具有高度侵袭性的变异，发病时间更早（P < 0.01），可能更早累及黄斑。sour研究是整合rho相关视网膜病变种族、基因型和临床数据的最大研究。研究结果强调了常见变异的实质性种族间差异，并强调了生物学分类在预测疾病进程中的临床相关性。特别是，R135W和P347L由于其侵袭性轨迹，值得更密切的临床关注，这可能为基因治疗试验和个体化患者管理的优先级提供信息。

{"title":"Geographic and Phenotypic Variability in RHO-Associated Retinopathy: Evidence From a Chinese Cohort and Global Literature","authors":"CHENYUE HANG , TIANYUAN ZHAO , ZHIXUAN CHEN , HONG WANG , LIN CHEN , TING ZHANG , YUTIAN JIAO , TONG LI , JUNRAN SUN , SUQIN YU , YUANYUAN GONG , HAO ZHOU , XUJUN JIANG , XINXIN LIU , HUIXUN JIA , KAIRONG ZHENG , XIAOLING WAN , JIEQIONG CHEN , XIAODONG SUN","doi":"10.1016/j.ajo.2025.12.020","DOIUrl":"10.1016/j.ajo.2025.12.020","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the genotype-phenotype correlation in <em>RHO</em>-associated retinopathy, with a focus on delineating an ethnic-specific variant spectrum and comparing clinical severity across biological classes and common variants.</div></div><div><h3>Design</h3><div>Retrospective cohort study and literature review.</div></div><div><h3>Methods</h3><div>We systematically reviewed all published cases of <em>RHO</em>-associated retinal diseases (2196 patients, 1278 probands) and analyzed clinical, genetic, and imaging data from our institutional cohort (80 probands). Variants were categorized by type and by biological class (Class 1-7), and phenotypes were compared across different biological classes and three common variants.</div></div><div><h3>Results</h3><div>A marked geographic divergence was observed: P23H was common in North America but rare in other populations, whereas P347L and R135W were major common variants in European and Asian populations. Genotype-phenotype analysis revealed that Class 2 variants were associated with later onset and slower visual decline, whereas Class 1 and Class 3 variants correlated with earlier onset (<em>P</em> < .0001) and more aggressive phenotypes. Notably, R135W (Class 3) emerged as an under-recognized but highly aggressive variant, with earlier onset (<em>P</em> < .01) and potentially earlier macular involvement.</div></div><div><h3>Conclusions</h3><div>Our study represents the largest study integrating ethnic, genotypic, and clinical data in <em>RHO</em>-associated retinopathy. The findings highlight substantial inter-ethnic differences in common variants and underscore the clinical relevance of biological classification in predicting disease course. In particular, R135W and P347L warrants closer clinical attention due to their aggressive trajectory, which may inform prioritization in gene therapy trials and individualized patient management.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 1-11"},"PeriodicalIF":4.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823647","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

Natural History of CNGA1-Associated Retinitis Pigmentosa in a Large Chinese Cohort Revealing an Optimal Intervention Window cnga1相关视网膜色素变性的自然历史揭示了一个最佳的干预窗口

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-23 DOI: 10.1016/j.ajo.2025.12.018

YUE LIU , DINGDING ZHANG , YUNYU ZHOU , YAMEI LI , XIAOXU HAN , ZIXI SUN , XING WEI , HUI LI , XUAN ZOU , RUIFANG SUI

Purpose

To detail the natural history, clinical manifestations, and molecular characteristics of a large Chinese cohort of patients with CNGA1-associated retinitis pigmentosa (CNGA1-RP).

Design

Single-center, retrospective case series.

Participants

A total of 58 Chinese patients with CNGA1-RP from 52 families were enrolled between 2011 and 2025.

Methods

Longitudinal data were available for 20 individuals, with the longest follow-up of 11 years. All participants underwent comprehensive clinical evaluations and genetic analysis. The impact of age on best-corrected visual acuity (BCVA) and visual field (VF) was evaluated using restricted cubic spline (RCS) analysis. Retinal multimodal imaging was acquired, including optical coherence tomography (OCT), ultra-widefield (UWF) scanning laser ophthalmoscope (SLO) and UWF fundus autofluorescence (FAF). Moreover, electroretinogram (ERG) was performed.

Main Outcome Measures

Clinical symptoms, age-related changes in BCVA and VF, retinal multimodal imaging features, molecular characteristics.

Results

Night blindness was the universal initial symptom, with most patients (88%) experiencing onset during childhood. BCVA remained stable (0.09 logMAR) until age of 30.7 years, followed by a progressive decline at 0.029 logMAR per year; by age of 72 years, 32% of patients had developed blindness (BCVA > 1.30 logMAR). VF impairment began in childhood and progressed to tunnel vision (VF ≤ 10°) at a median age of 39.4 years. A high degree of interocular symmetry was observed for both BCVA and VF. FAF imaging revealed a macular hyper-autofluorescent (hyperAF) ring in 73% of patients. Genetic analysis identified 14 novel pathogenic variants in CNGA1, and c.265delC was confirmed as a hotspot variant with an allele frequency of 72% in the Chinese population. Furthermore, homozygous carriers of this hotspot variant exhibited more severe phenotypes.

Conclusions

Our study characterized the natural history of CNGA1-RP and identified c.265delC as a hotspot variant in the Chinese population. Based on the quantitative data, VA loss in CNGA1-RP is late-onset and slow-progressing, whereas VF loss occurs earlier and more severely. The optimal window of intervention for CNGA1-RP in the Chinese population appears to be between the 3rd and 4th decade of life.

目的探讨中国cnga1相关性视网膜色素变性（CNGA1-RP）患者的自然病史、临床表现和分子特征。设计单中心回顾性病例系列。2011年至2025年间，共有58名来自52个家庭的CNGA1-RP患者入组。方法收集20例患者的纵向资料，最长随访时间为11年。所有参与者都进行了全面的临床评估和基因分析。采用限制性三次样条（RCS）分析评价年龄对最佳矫正视力（BCVA）和视野（VF）的影响。获得视网膜多模态成像，包括光学相干断层扫描（OCT）、超宽视场（UWF）扫描激光检眼镜（SLO）和超宽视场眼底自体荧光（FAF）。并行视网膜电图（ERG）检查。临床症状、BCVA和VF的年龄相关变化、视网膜多模态成像特征、分子特征。结果夜盲症是常见的首发症状，大多数患者（88%）在儿童期发病。BCVA在30.7岁前保持稳定（0.09 logMAR），随后以每年0.029 logMAR的速度逐渐下降；到72岁时，32%的患者发生失明（BCVA > 1.30 logMAR）。VF损害始于儿童时期，在中位年龄39.4岁时发展为隧道性视力（VF≤10°）。BCVA和VF均有高度眼间对称性。FAF成像显示73%的患者有黄斑超自体荧光环。遗传分析发现CNGA1有14个新的致病变异，其中c.265delC在中国人群中被确认为热点变异，等位基因频率为72%。此外，该热点变异的纯合携带者表现出更严重的表型。结论我们研究了CNGA1-RP的自然历史，确定了c.265delC是中国人群中的热点变异。定量数据显示，CNGA1-RP的VA损失是晚发性的、进展缓慢的，而VF损失发生的更早、更严重。在中国人群中，CNGA1-RP的最佳干预窗口似乎是在生命的第三和第四个十年之间。

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引用次数: 0

Gonioscopy Assisted Transluminal Trabeculotomy (GATT) as a viable intervention for Neovascular Glaucoma 经腔镜辅助小梁切开术（GATT）作为新生血管性青光眼可行的干预手段

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology

Pub Date : 2025-12-23 DOI: 10.1016/j.ajo.2025.12.016

Avilasha Mohapatra, Vyshak Suresh, Sushmita Kaushik

引用次数: 0