Asia-Pacific Journal of Ophthalmology最新文献

英文中文

Low-concentration atropine for controlling myopia onset and progression in East Asia 低浓度阿托品在东亚地区控制近视的发生和发展。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-11-01 DOI: 10.1016/j.apjo.2024.100122

Ebenezer Zaabaar , Yuzhou Zhang , Ka Wai Kam , Xiu Juan Zhang , Clement C. Tham , Li Jia Chen , Chi Pui Pang , Jason C. Yam

Purpose

Over the past few years, there has been a rapid accumulation of data on the use of low-concentration atropine for myopia control, especially in East Asian children, with its effectiveness varying in different studies. This review aims to evaluate the current evidence surrounding the efficacy and safety of low-concentration atropine in the management of myopia onset and progression in East Asia.

Methods

Clinical trials involving atropine for myopia control in East Asia were reviewed.

Results

Atropine has been shown to reduce myopia progression in East Asian children, compared with placebo. Its efficacy is concentration-dependent, with 1 % atropine yielding the greatest effect in slowing myopia progression by over 70 %, but it is associated with significant rebound and side effects. Lower concentrations also confer significant myopia-control effects while maintaining a more acceptable safety profile, with relative reductions of 67 % and 43 % reported for 0.05 % and 0.025 % atropine, respectively. While 0.01 % atropine showed the least effect compared to 0.05 % and 0.025 %, it still yielded a significant efficacy in slowing myopic refraction. Over two years, 0.05 % atropine reduced the incidence of myopia by nearly 50 %, demonstrating greater effectiveness than 0.01 % atropine. This effect was particularly notable in children with low hyperopic reserves (< +0.75 D), but not in those with higher reserves.

Conclusions

The current evidence shows that low-concentration atropine plays a crucial role in managing myopia in East Asian children and demonstrates satisfactory safety profiles. Timely administration of the most effective and safest concentration can potentially prevent sight-threatening complications and subsequent vision loss.

目的：在过去的几年中，关于使用低浓度阿托品控制近视的数据迅速积累，特别是在东亚儿童中，不同研究的效果不同。本综述旨在评价目前东亚地区低浓度阿托品治疗近视发生和发展的有效性和安全性的证据。方法：回顾了东亚地区使用阿托品控制近视的临床试验。结果：与安慰剂相比，阿托品已被证明可以减少东亚儿童的近视进展。它的疗效是浓度依赖性的，1%的阿托品在减缓近视进展方面的效果最大，超过70%，尽管它与显著的反弹和副作用有关。较低浓度的阿托品也具有显著的近视控制效果，同时保持了可接受的安全性，0.05%和0.025%阿托品的相对降低率分别为67%和43%。与0.05%和0.025%相比，0.01%的阿托品效果最差，但仍有显著的疗效。两年后，0.05%的阿托品使近视发生率降低了近50%，比0.01%的阿托品更有效。这种效果在低远视储备（< +0.75 D）的儿童中尤为显著，但在远视储备较高的儿童中则不明显。结论：目前的证据表明，低浓度阿托品在治疗东亚儿童近视中起着至关重要的作用，并且具有令人满意的安全性。及时给予最有效和最安全的浓度可以潜在地预防威胁视力的并发症和随后的视力丧失。

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引用次数: 0

Clinical and anatomical features of myopia 近视的临床与解剖学特征。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-11-01 DOI: 10.1016/j.apjo.2024.100114

Jost B. Jonas , Songhomitra Panda-Jonas , Li Dong , Rahul A. Jonas

The purpose of the review is to summarize clinical and anatomically-related aspects of myopia. Recent studies have revealed macular atrophy as myopic maculopathy (MMP) stage-4 was accompanied by a central Bruch´s membrane (BM) defect associated with a subretinal proliferation (as sign of previous macular neovascularization). Patchy atrophies (MMP-stage 3) could be differentiated into those without versus with BM defects/subretinal proliferations. BM defects and subretinal proliferations were associated with each other (OR: 78.3; P < 0.001). Fundus tessellation as MMP-stage-1 correlated with visual acuity reduction, suggesting pathological changes already at MMP stage 1, in addition to a leptochoroid as risk factor. Myopic parapapillary beta zone (potentially caused by an axial elongation-related enlargement of the retinal pigment epithelium [RPE] layer opening; characterized by small or no alpha zone, few or no RPE drusen at its border, normal BM thickness) can be differentiated from glaucomatous parapapillary beta zone (characterized by alpha zone, RPE drusen, and thickened BM). The overlying retinal layers extended into the parapapillary zones, deeper than the superficial layers. Prevalence of non-glaucomatous optic neuropathy increased non-linearly with longer axial length in highly myopic eyes and was a major cause for vision loss in high myopia. In patients aged 85 + years, prevalence of MMP stage 3 or 4 in highly myopic eyes (axial length ≥ 26.5 mm) was about 75 %. Myopia was associated with a lower prevalence of diabetic retinopathy, age-related macular degeneration and angle-closure glaucoma, while high myopia, more than moderate myopia, was associated with higher prevalence and incidence of open-angle glaucoma.

综述的目的是总结近视的临床和解剖学相关方面。最近的研究表明，黄斑萎缩为近视黄斑病变（MMP） 4期伴有中央布鲁氏膜（BM）缺损，并伴有视网膜下增生（作为先前黄斑新生血管的标志）。斑片状萎缩（mmp - 3期）可以区分为无基底膜缺损或视网膜下增生。基底膜缺损与视网膜下增生相互关联(OR: 78.3；P < 0.001)。MMP- 1期时眼底再裂与视力下降相关，提示MMP- 1期已发生病理改变，此外细脉络膜是危险因素。近视的乳头旁β区(可能是由于视网膜色素上皮[RPE]层开口轴向伸长引起的扩大；青光眼乳头旁β带（以α带、RPE结节、BM厚度正常为特征）与α带、RPE结节、BM增厚为特征。覆盖的视网膜层延伸到乳头旁区，比浅层更深。非青光眼性视神经病变在高度近视眼中的患病率随着眼轴长度的增加呈非线性增加，是高度近视视力丧失的主要原因。在85岁以上的患者中，高度近视眼（眼轴长度≥26.5mm）的3期或4期MMP患病率约为75%。近视与糖尿病视网膜病变、年龄相关性黄斑变性和闭角型青光眼的患病率较低相关，而高度近视比中度近视与开角型青光眼的患病率和发病率较高相关。

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引用次数: 0

Diabetic Blindness Remains a Big Challenge Despite All Recent Advancements in Diagnostics and Treatments 尽管诊断和治疗技术不断进步，糖尿病性失明仍然是一个巨大的挑战。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100105

Jingfa Zhang, Min Wang, Ling Chen, Nishant Radke

引用次数: 0

UBM helps differentiate sulcus or in-the-bag IOL placement UBM 帮助区分人工晶体植入是囊内植入还是囊外植入。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100088

Peng ZhiZhao , Leung Hiu Ying , Nishant Vijay Radke

引用次数: 0

Long-term Outcomes of Combined Phacotrabeculectomy Surgery in a Singapore Tertiary Hospital 新加坡一家三级医院的咽喉切除联合手术的长期疗效。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100102

Annabel CY Chew , Hla Myint Htoon , Shamira A. Perera , Tin Aung , Ho Ching Lin , Rahat Husain , Boey Pui Yi , Daniel Hsien Wen Su , Jocelyn Chua , Tina T. Wong

Purpose

To describe the long-term outcomes of phacotrabeculectomy from a tertiary glaucoma service in Singapore.

Design

Retrospective case series.

Methods

Seven hundred ninety-six eyes of 698 patients who underwent phacotrabeculectomy surgery at the Singapore National Eye Centre between 2005 and 2007 with a minimum follow-up of three years were included. The primary outcome measure was intraocular pressure (IOP). Secondary outcomes included best-corrected visual acuity (BCVA), number of glaucoma medications, and surgical complications.

Results

The mean age was 69.5 years, 51 % were male, and 86 % were Chinese. Most eyes had primary glaucoma (90.6 %). The mean follow-up duration was 9.4 years. The overall success rate at three years was 97 % if surgical success was defined as IOP ≤ 21 mm Hg, 92 % if IOP ≤ 18 mm Hg, 66 % if IOP ≤ 15 mm Hg. By Kaplan–Meier survival analysis over 13 years, the cumulative success rate fell from 98.1 % to 89.1 % if IOP ≤ 21 mm Hg, 98.1–76.9 % if IOP ≤ 18 mm Hg, 98–50.3 % if IOP ≤ 15 mm Hg. The postoperative IOP improved significantly at all time points (P < 0.05) and 72 % had at least 20 % IOP reduction. There was a slight improvement in postoperative BCVA (P < 0.05). The mean number of glaucoma medications was reduced postoperatively (P < 0.001). There were no significant risk factors for surgical failure.

Conclusions

Phacotrabeculectomy was found to be safe, resulting in clinically significant IOP lowering for 13 years with reduced dependency on glaucoma medications and improved BCVA.

目的：描述新加坡一家三级青光眼服务机构的虹膜睫状体切除术的长期疗效：设计：回顾性病例系列：方法：纳入 2005 年至 2007 年期间在新加坡国立眼科中心接受青光眼超声乳化手术的 698 名患者中的 796 只眼睛，随访至少三年。主要结果是眼压（IOP）。次要结果包括最佳矫正视力（BCVA）、青光眼用药次数和手术并发症：平均年龄为 69.5 岁，51% 为男性，86% 为中国人。大多数眼睛患有原发性青光眼（90.6%）。平均随访时间为 9.4 年。如果将手术成功定义为眼压≤21毫米汞柱，三年后的总成功率为97%；如果眼压≤18毫米汞柱，总成功率为92%；如果眼压≤15毫米汞柱，总成功率为66%。通过13年的卡普兰-米尔生存分析，如果眼压≤21毫米汞柱，累计成功率从98.1%降至89.1%；如果眼压≤18毫米汞柱，累计成功率从98.1%降至76.9%；如果眼压≤15毫米汞柱，累计成功率从98%降至50.3%。术后眼压在所有时间点均有明显改善（P < 0.05），72%的患者眼压至少降低了 20%。术后 BCVA 略有改善（P < 0.05）。术后青光眼药物的平均数量有所减少（P < 0.001）。手术失败没有明显的风险因素：法氏囊切除术是一种安全的手术，可在13年内显著降低眼压，减少对青光眼药物的依赖，改善BCVA。

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引用次数: 0

Bilateral Retinal Detachment Associated with Ascaris suum Infection 与蛔虫感染有关的双侧视网膜脱离

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100100

Tomoyuki Ishibashi, Kazuyuki Emi

引用次数: 0

Advances in understanding and management of IgG4-related ophthalmic disease 对 IgG4 相关眼科疾病的认识和管理进展。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100101

Kenneth Ka Hei Lai , Terence Wee Xiang Ang , Wah Cheuk , Angie Kwok , Ming Lin , Yael Lustig , Dinesh Selva , Guy Ben Simon , Yue Xing , Zhi Hui Xu , Hua Sheng Yang , Kelvin Kam Lung Chong , Hunter Kwok Lai Yuen

Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is an emerging, immune-mediated fibroinflammatory orbital disease, characterized by tumefactive lesions with noticeable IgG4+ plasma cell infiltration and distinctive pathohistological features. This disease is often associated with elevated serum IgG4 concentrations. IgG4-ROD may affect any ophthalmic tissues, particularly the lacrimal gland, extraocular muscles, and trigeminal nerves. Although the exact pathogenic role of IgG4 antibodies remains unclear, B-cell depleting agents have been reported to be an effective treatment. The diverse clinical manifestations of IgG4-ROD complicate diagnosis, and without prompt treatment, visual-threatening complications such as optic neuropathy may arise. Recent advances in understanding and managing IgG4-ROD have revolutionized the diagnosis and treatment of this emerging disease. This review article aims to provide a comprehensive overview of the latest advancements in the field of IgG4-ROD.

免疫球蛋白 G4 相关眼科疾病（IgG4-ROD）是一种新出现的免疫介导的眼眶纤维炎性疾病，其特征是具有明显 IgG4+ 浆细胞浸润的肿瘤活性病变和独特的病理组织学特征。这种疾病通常与血清 IgG4 浓度升高有关。IgG4-ROD 可影响任何眼科组织，尤其是泪腺、眼外肌和三叉神经。尽管 IgG4 抗体的确切致病作用尚不清楚，但有报道称 B 细胞去势药物是一种有效的治疗方法。IgG4-ROD 的临床表现多种多样，使诊断变得复杂，如果不及时治疗，可能会出现视神经病变等威胁视力的并发症。近年来，对 IgG4-ROD 的认识和管理取得了进展，为这一新兴疾病的诊断和治疗带来了革命性的变化。这篇综述文章旨在全面概述 IgG4-ROD 领域的最新进展。

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引用次数: 0

Acute Macular Neuroretinopathy Associated with COVID-19 Pandemic: A Real-world Observation Study 与 COVID-19 大流行相关的急性黄斑神经视网膜病变：真实世界观察研究

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100103

Xiaojia Song , Yajie Yu , Haiying Zhou , Yongpeng Zhang , Yu Mao , Hong Wang , Xusheng Cao , Xiaoqing Zhu , Zhihua Li , Lin Li , Jinghua Liu , Xiaoyan Peng , Qian Li

Purpose

To evaluate the clinical and retinal imaging features of Chinese patients with acute macular neuroretinopathy (AMN) associated with COVID-19.

Design

A prospective observational study.

Methods

Retinal imaging, including color fundus photography, near-infrared imaging (NIR), swept-source optical coherence tomography (SS-OCT), optical coherence tomography angiography (OCTA), and Humphrey perimetry, were conducted for each case.

Results

All cases were included within the first three months following the pandemic outbreak. A total of 12 male patients (36.36 %) and 21 female patients (63.64 %) were prospectively recruited, and 29 cases (87.88 %) were bilaterally affected. The median interval between the onset of fever and the appearance of ocular symptoms was two days (range, 0.5–5.0 days). Apart from the outer retinal changes typical of AMN, changes in the inner retinal layers were observed, including intraretinal hemorrhage (8.06 %), cotton wool spots (9.68 %), and paracentral acute middle maculopathy (PAMM) (8.06 %). Smaller retinal inner nuclear layer hyperreflective speckles (RIHS) (41.94 %) were identified as a distinguishing feature from typical PAMM. Voids of vessel signals were found in the superficial (11.54 %), intermediate (82.69 %), and deep capillary plexus (98.08 %), and in the choriocapillaris (19.23 %) on OCTA. Humphrey perimetry illustrated central, paracentral, and peripheral scotomas. The occult lesions associated with AMN, PAMM, and some of the RIHS illustrated by OCT were visualized topographically and further confirmed by OCTA as perfusion defects.

Conclusion

An increase in AMN cases correlated with the SARS-CoV-2 outbreak. Additional features, including widespread inner retinal perfusion deficits, were observed and may serve as potential biomarkers for systemic microcirculation dysregulation in COVID-19.

目的：评估与COVID-19相关的中国急性黄斑神经视网膜病变（AMN）患者的临床和视网膜成像特征：前瞻性观察研究：方法：对每个病例进行视网膜成像，包括彩色眼底照相、近红外成像（NIR）、扫源光学相干断层扫描（SS-OCT）、光学相干断层血管成像（OCTA）和汉弗莱视网膜测量：结果：所有病例都是在大流行爆发后的头三个月内发现的。前瞻性招募了 12 名男性患者（36.36%）和 21 名女性患者（63.64%），29 例患者（87.88%）为双侧受累。从发烧到出现眼部症状的中位间隔为两天（0.5-5.0 天不等）。除了AMN典型的视网膜外层变化外，还观察到视网膜内层的变化，包括视网膜内出血（8.06%）、棉絮斑（9.68%）和旁中心急性中间黄斑病变（PAMM）（8.06%）。较小的视网膜核内层高反射斑点（RIHS）（41.94%）被确定为区别于典型 PAMM 的特征。在 OCTA 上，表层（11.54%）、中间层（82.69%）和深层毛细血管丛（98.08%）以及绒毛膜（19.23%）都发现了血管信号空洞。汉弗莱视网膜测图显示了中心、旁中心和周边视网膜灶。OCT显示的与AMN、PAMM和部分RIHS相关的隐匿性病变可通过地形图观察到，并通过OCTA进一步证实为灌注缺损：结论：AMN病例的增加与SARS-CoV-2爆发有关。结论：AMN病例的增加与SARS-CoV-2疫情有关，同时还观察到其他特征，包括广泛的视网膜内部灌注缺陷，这些特征可能成为COVID-19中全身微循环失调的潜在生物标志物。

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引用次数: 0

Patient Perceptions Regarding the Use of Eyeglasses Among Ophthalmologists 患者对眼科医生使用眼镜的看法。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100099

Andrew Oh, Brian Chou

引用次数: 0

Real-World Large Sample Assessment of Drug-related Dry Eye Risk: Based on the FDA Adverse Event Reporting System Database 药物相关干眼症风险的真实世界大样本评估：基于 FDA 不良事件报告系统数据库。

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1016/j.apjo.2024.100104

Shi-Nan Wu , Caihong Huang , Yu-Qian Wang , Xiao-Dong Chen , Xiang Li , Si-Qi Zhang , Dan-Yi Qin , Linfangzi Zhu , Chang-Sheng Xu , Qing-He Zhang , Jiaoyue Hu , Zuguo Liu

Purpose and design

This study aimed to evaluate the risk of drug-related dry eye using real-world data, underscoring the significance of tracing pharmacological etiology for distinct clinical types of dry eye.

Methods

Analyzing adverse event reports in the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to September 2023, we employed disproportionality analysis and the Bayesian confidence propagation neural network algorithm. The analysis involved categorizing drugs causing dry eye, assessing risk levels, and conducting segmental assessments based on the time of onset of drug-related dry eye adverse reactions.

Results

In the FAERS database, adverse reactions related to dry eye were linked to 1160 drugs. Disproportionality analysis identified 33 drugs with significant risk, notably in ophthalmic (brimonidine, bimatoprost), oncology (tisotumab vedotin, erdafitinib), and other medications (isotretinoin, oxymetazoline). The top three drugs with the highest risk of drug-related dry eye are isotretinoin (Bayesian confidence propagation neural network (BCPNN) = 6.88), tisotumab vedotin (BCPNN = 6.88), and brimonidine (BCPNN = 6.77). Among different categories of drugs, respiratory medications have the shortest mean onset time for drug-related dry eye, averaging 50.99 days. The prevalence skewed towards females (69.9 %), particularly in menopausal and elderly individuals (45–70 years old, mean age 54.7 ± 18.2). Reports of drug-related dry eye adverse reactions showed an annual increase.

Conclusion

Informed clinical decision-making is crucial for preventing drug-related dry eye. Assessing the risk of dry eyes associated with both local and systemic medications helps optimize treatment and provide necessary cautionary information.

目的和设计：本研究旨在利用真实世界的数据评估药物相关干眼症的风险，强调对不同临床类型的干眼症进行药理病因追踪的重要性：分析食品药品管理局不良事件报告系统（FAERS）2004 年 1 月至 2023 年 9 月期间的不良事件报告，我们采用了比例失调分析和贝叶斯置信度传播神经网络算法。分析包括对导致干眼症的药物进行分类、评估风险等级，以及根据药物相关干眼症不良反应的发生时间进行分段评估：在 FAERS 数据库中，与干眼症相关的不良反应与 1160 种药物有关。比例失调分析确定了 33 种具有重大风险的药物，尤其是眼科药物（溴莫尼定、比马前列素）、肿瘤药物（替索单抗维多汀、埃达非替尼）和其他药物（异维A酸、奥美沙唑啉）。药物相关干眼症风险最高的前三种药物是异维A酸（贝叶斯置信传播神经网络（BCPNN）=6.88）、替索单抗维多汀（BCPNN=6.88）和溴莫尼丁（BCPNN=6.77）。在各类药物中，呼吸系统药物导致药物性干眼症的平均发病时间最短，平均为 50.99 天。发病率偏向女性（69.9%），尤其是更年期和老年人（45-70 岁，平均年龄为 54.7 ± 18.2）。与药物相关的干眼症不良反应报告呈逐年上升趋势：结论：知情的临床决策对于预防药物相关干眼症至关重要。评估与局部和全身用药相关的干眼症风险有助于优化治疗并提供必要的警示信息。

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