BMC Ophthalmology最新文献

Purpose: This study aims to evaluate the effectiveness and safety of phacoemulsification cataract extraction with intraocular lens implantation (PEI) combined with Goniosynechialysis (GSL), Goni-otomy (GT), and PEI combined with Trabeculectomy (TRAB), in managing mid to late-stage Primary Angle-Closure Glaucoma (PACG) combined with cataract.

Methods: A retrospective analysis was conducted on 42 patients (54 eyes) with mid to late-stage PACG combined with cataracts, who were previously treated at Dongyang People's Hospital from December 3, 2020, to November 30, 2023. Among them, 16 (24 eyes) underwent PEI-GSL-GT, and 26 (30 eyes) underwent PEI-TRAB. After minimum of 6 months of postoperative follow-up, observations were made on intraocular pressure (IOP), best-corrected visual acuity (BCVA), use of antiglaucoma medications, and complications for both surgical procedures.

Results: Postoperative BCVA improved significantly in both groups. In the PEI-GSL-GT group, IOP decreased by 26% (from 17.75 to 13.13 mmHg); in the PEI-TRAB group, it decreased by 14.5% (from 17.87 to 15.27 mmHg). At the 6-month follow-up, IOP was significantly lower in the PEI-GSL-GT group compared to the PEI-TRAB group. The number of patients using antiglaucoma medications decreased significantly in both groups. By the 6-month follow-up, no patients in the PEI-GSL-GT group were using antiglaucoma medications.

Conclusions: PEI-GSL-GT is more effective than PEI-TRAB in lowering IOP in patients with mid to late-stage PACG, potentially reducing or discontinuing postoperative antiglaucoma medications, decreasing postoperative complications, and improving visual acuity.

Background: The XEN45 Gel Stent (XGS) is an innovative, minimally invasive glaucoma surgery device, which is typically inserted via an ab-interno method, avoiding conjunctival dissection. With increasing experience, some surgeons have advocated for a transconjunctival ab-externo approach, with or without conjunctival dissection, for the delivery of XGS.

Case presentation: A 33-year-old male patient with a history of primary open-angle glaucoma diagnosed three years ago presented to the clinic with the complaint of visual field loss. This case report presents the initial implantation of XGS in both glaucoma eyes, using the transconjunctival ab-externo technique without conjunctival dissection. However, subsequent follow-up revealed that in the left eye, the XGS had been fractured as a result of external force. Meanwhile, in the right eye, the displacement of the XGS was attributed to the surgical needlework. To facilitate re-implantation, the transconjunctival ab-externo approach with conjunctival dissection was employed to enhance the securement of the XGS.

Conclusions: The case highlights that external force and needling can cause XGS fracture and displacement. To reduce this risk, employing a transconjunctival ab-externo approach with conjunctival dissection and securing the XGS with sutures was found to decrease complications, indicating a more effective surgical strategy for XGS implantation.

Purpose: To investigate the correlation of contrast sensitivity function (CSF) with myopic shift in Chinese children.

Methods: This prospective case-series study included 62 eyes (31 children) who visited the Eye and ENT Hospital of Fudan University in January 2022 and were followed up for 6 months. Routine ophthalmic examinations and quantitative CSF (qCSF) tests without refractive correction were performed. Differences in CSF parameters, including the area under the log CSF (AULCSF), CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cpd, were compared between two groups stratified according to the myopic shift based on mydriatic spherical equivalent (<-0.50 D or ≥-0.50 D) during follow-up.

Results: The myopia progressed by 0.13 ± 0.24 and 1.18 ± 0.75 D in the stabilized (28 eyes) and advanced (34 eyes) groups, respectively. Compared with the advanced group, the stabilized group showed significantly lower baseline qCSF test results for CSF acuity and CS at 1.0 and 1.5 cpd. The qCSF readings for CSF acuity and CS at 1.0, 1.5, and 3.0 cpd increased significantly during the 6-month follow-up in the stabilized group, while these values showed non-significant decreases in the advanced group. CS at 3.0 cpd was significantly correlated with myopic shift. Compared with the advanced group, participants in the stabilized group with higher myopia showed relatively significantly lower CS (baseline CSF acuity and CS at 1.0, 1.5, and 3.0 cpd).

Conclusions: Children with relatively slower myopic shift showed lower contrast sensitivity at low spatial frequencies, which might be an effective factor in myopia control.

Purpose: To assess the diurnal changes in corneal biomechanics in healthy young adults.

Methods: At Wenzhou Medical University Eye Hospital in China, a prospective case series. Each healthy subject had six Corvis ST examinations, from 10:00 on a first day to 6:00 on the following day, at 4-hour intervals. The data collected included the biomechanically corrected IOP (bIOP), the central corneal thickness (CCT) and six dynamic corneal response (DCR) parameters, namely deformation amplitude (DA), the ratio between DA values at the apex and 2 mm from the apex (DAR2), integrated inverse radius (IIR), the stiffness parameter at first applanation (SP-A1), Corvis biomechanical index (CBI) and the updated stress-strain index (SSIv2). A multilevel model was used to assess the changes in DCR parameters of patients over time during the examination period.

Results: Sixty-one subjects were included and intra-operator reproducibility was good for most DCR parameters at the 6 time points. DA, DAR2, IIR and CBI showed small fluctuations during the 24-hour cycle with mean values of 0.1, 0.16, 0.34, and 0.04 units, respectively, while SP-A1 showed higher variations averaging 20.57 units and SSIv2 had the least fluctuation within 0.10 units during 24-hour cycle. After correcting for the effects of CCT and bIOP, the diurnal fluctuations in IIR, CBI and SSIv2 were not statistically significant, unlike the fluctuations in DA, DAR2 and SP-A1, which remained significant.

Conclusions: Compared with the DA, DAR2, IIR and CBI, SP-A1 was more affected while SSIv2 was the less affected by the diurnal variations and associated corneal edema.

Background: This systematic review assesses the efficacy of single-step transepithelial photorefractive keratectomy (tPRK) in terms of postoperative pain, epithelial healing, postoperative haze and visual acuity. It also compares single tPRK to two-step tPRK where data is available.

Methods: This systematic review adhered to the PRISMA reporting guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). An electronic literature search was conducted on PUBMED, Scopus, and Google Scholar. The quality of the studies included in this systematic review was evaluated using the Newcastle Ottawa Scale (NOS). The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.

Results: A total of 11 studies published between 2013 and 2023 were included in this systematic review. Studies revealed a significant improvement in visual acuity with both single-step tPRK and two-step tPRK. Two studies showed that single-step tPRK not only offers a better UDVA but also a significant improvement in the manifest sphere, cylinder, and spherical equivalent at various follow-up periods compared to two-step tPRK. One study demonstrated the broad effectiveness of single-step tPRK for myopia correction across low-, moderate-, and high-severity groups. Rapid epithelial healing was a consistent finding. Complete epithelial healing within 72 h was noted in 100% of eyes treated with single-step tPRK in one of the studies. The incidence of corneal haze following tPRK was generally low across the studies. Post-tPRK pain scores were initially lower in the single-step tPRK group. One study reported that the maximum pain level within the first four days after surgery was significantly lower in the single-step tPRK group than in the two-step tPRK group.

Conclusion: Both two-step and single-step tPRK are safe refractive procedures. Single-step tPRK, because of less haze formation, lower pain scores, faster healing, and greater effectiveness in improving visual acuity, is superior to the two-step technique.

Trial registration: The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.

Background: Myopia is a prevalent disease influenced by both genetic and environmental factors. This study aims to explore myopia risk factors, including the association between night-time reading habits under low illumination in children.

Methods: A cross-sectional survey was conducted in Argentina as part of the "Myopia Awareness Campaign" in June 2024. A total of 1,298 children aged 7-15 years were included. Data on self-reported myopia, reading habits, illumination levels, type of housing, outdoor time, and parental high myopia were collected through a 23-question Google Forms survey disseminated by ophthalmologists. Multiple logistic regression was used to assess the association between these factors and self-reported myopia.

Results: The prevalence of self-reported myopia in children was 23.7%. Significant risk factors for myopia included older age (odds ratio, OR: 1.15; 95% Confidence Intervals, CI:1.08-1.23), high-intensity reading (OR: 1.69; 95% CI:1.12-2.55), parental high myopia (OR: 2.88; 95% CI:2.07-4.00), less outdoor time (OR: 0.98; 95% CI: 0.97-0.999), and living in a house without a garden (OR:1.49; 95% CI:1.12-2.00). While initial unadjusted analysis suggested that reading at night in the dark was associated with myopia, the association lost significance after adjusting for age.

Conclusions: This study highlights the importance of environmental factors and lifestyle choices in myopia development. Although reading at night in the dark appeared as a potential risk factor, further research is needed to clarify its role in myopia development and progression. The existence of accessible outdoor areas may increase the time children spent outdoors helping to mitigate myopia incidence.

Background: Congenital cataracts (CC) are one of the leading causes of impaired vision or blindness in children, with approximately 8.3-25% being inherited. The aim of this study is to investigate the mutation spectrum and frequency of 9 cataract-associated genes in 19 Chinese families with congenital cataracts.

Purpose: To identify the gene variants associated with congenital cataracts.

Methods: This study included a total of 58 patients from 19 pedigrees with congenital cataracts. All probands were initially screened by whole-exome sequencing(WES), and then validated by co-segregation analysis using Sanger sequencing.

Results: Likely pathogenic variants were detected in 8 families, with a positivity rate of 42.1%. Variants in various genes were identified, including GJA3, CRYGD, CRYBA4, BFSP2, IARS2, CRYAA, CRYBA1, ARL2 and CRYBB3. Importantly, this study identified compound heterozygous variants of IARS2 in one family.

Conclusions: Our research findings have revealed multiple gene variants associated with cataracts, providing clinical guidance for improved molecular diagnosis of congenital cataracts in the era of precision medicine.

Purpose: The objective of this study was to analyze hyperreflective foci at the vitreous-retinal interface in cases of idiopathic epiretinal membrane (iERM) using enface-OCT.

Methods: This study included 47 patients (52 eyes) diagnosed with iERM between January 2020 and July 2023. We observed changes in hyperreflective foci in the macular area at each stage of iERM using OCTA on a 6 mm slab of the VRI. Evaluations included the density and percentage of hyperreflective foci of the epiretinal membrane at each stage, as well as the relationship between hyperreflective foci density and other OCT parameters, such as macular thickness and changes in macular superficial vascular density.

Results: Statistically significant differences in hyperreflective foci density and percentage were observed across the four stages of patients (p < 0.05). Additionally, statistically significant differences in superficial vascular density were noted among the four stages (p < 0.05). Hyperreflective foci area percentage and density correlated significantly with hyperreflective foci, FAZ area, and FAZ perimeter (p < 0.005). However, no correlation was found between hyperreflective foci density and area percentage with superficial vascular density and superficial perfusion density (p > 0.05).

Conclusion: Hyperreflective foci were identified in all stages of iERM, with their number and density increasing as the disease progressed.

Background: We examined the relationship between contrast sensitivity (CS) and visual field stage/severity in patients with open-angle glaucoma (OAG), and correlated CS with Quality of Vision (QOV) scores.

Methods: CS was measured under photopic (100 cd) and mesopic (10 cd) conditions in 218 eyes of 109 patients with OAG aged < 60 years. The glaucoma stages were divided into four groups according to the mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24 - 2 or 10 - 2 Swedish Interactive Thresholding Algorithm (SITA) standard, and their relationship with CS was examined.

Results: The results of the Japanese version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in 79 patients were converted into Rasch scores and correlated with CS. Both HFA24-2 and 10 - 2 showed statistically significant improvements in all items except 10.2 cycles per degree (cpd) under mesopic conditions where CS decreased significantly (p < 0.05). Correlations between CS and NEI VFQ-25 Rasch scores were stronger in the worse eye (WE) at HFA24-2, 10 - 2, and foveal sensitivity thresholds. The measurement results strongly correlated under photopic conditions. Comparing the correlations at HFA24-2, 10 - 2, and foveal sensitivity thresholds, the correlation was strongest at the foveal sensitivity threshold.

Conclusions: CS declines with progression in the visual field stage or severity. QOV score tends to decreases with a decline in CS.

Purpose: To evaluate the progress in Qatar's eye care since 2009, focusing on effective cataract surgical and refractive error coverages, leading to enhanced eye health strategies and action plans.

Methods: A modified Rapid Assessment of Avoidable Blindness (RAAB) survey was employed using multi-stage sampling in all persons 50 years and older in Qatar. The study focused on uncorrected refractive errors, cataract surgery coverage and effectiveness, and visual acuity assessment.

Results: There were 339 individuals out of 3,206 examined participants who underwent cataract surgery, out of which 66.1% of 559 operated eyes obtained good post-operative outcomes (presenting visual acuity ≥ 6/12). Age -sex - adjusted eCSC for a cataract surgical threshold < 6/12 was 61.2% (95%CI 54.9-67.4). A poor post-operative outcome (presenting visual acuity < 6/60) was observed in 9.3% of all operated eyes, lower than the 14.9% reported in 2009. Cataract surgical coverage at the 6/18 threshold showed good coverage (94%) improving since 2009 (87%). Effective refractive coverage (eREC) was 74.3% (95%CI 70.9-77.7). Effective coverage of both services was lower among Qatari women compared to other population groups.

Conclusion: Qatar's CSC improved since the 2009 RAAB, but there are disparities in effective coverage based on gender and nationality. WHO set a global target to achieve a 30%-point increase in eCSC and a 40%-point increase in eREC by 2030; accordingly, Qatar's targets should be 91.2% and 100% retrospectively by 2030. To meet these targets, efforts are needed to improve the quality of cataract surgery and access to refractive correction.