BMC Ophthalmology最新文献

Background: Maladaptive illness perception and coping strategies have been linked to illness-related quality of life in patients with chronic diseases. However, the impact of illness perception and coping strategies on vision-related quality of life (VRQOL) in patients with diabetic retinopathy (DR), a significant microvascular complication of diabetes mellitus, remains unclear. This study aims to evaluate the associations among illness perception, coping styles, and VRQOL in Chinese patients with DR, and to explore the mediating role of coping styles in the relationship between illness perception and VRQOL.

Methods: This cross-sectional study included 303 adult Chinese with DR recruited from a general Grade-A tertiary hospital in Hunan, China. All participants completed clinical and demographic questionnaires. The Brief Illness Perception Questionnaire (BIPQ), the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25), and the Medical Coping Modes Questionnaire were respectively adopted to assess the illness perception, VRQOL and coping styles. The BIPQ total scores were converted to logit scores using Rasch analysis. The NEI-VFQ-25 composite scores were converted to estimated person measures based on Rasch analysis and the method of successive dichotomizations. The relationships among these variables were assessed through independent-sample t-test, one-way analysis of variance, correlation analyses and multiple linear regression analysis, while SPSS Process model and the bootstrap analysis were utilized to evaluate the mediating effect.

Results: Illness perception was positively correlated with resignation coping style (r = 0.33, P < 0.001) and negatively correlated with VRQOL (r = -0.43, P < 0.001). Resignation coping style was negatively correlated with VRQOL (r = -0.38, P < 0.001). Illness perception significantly predicted resignation coping style (t = 5.91, P < 0.001) and resignation coping style significantly predicted VRQOL (t = -5.30, P < 0.001). The mediating effect through resignation coping was - 0.49 (95% CI: -0.75 to -0.27), accounting for 21.08% of the total effect of illness perception on VRQOL.

Conclusion: The study revealed that the resignation coping style partially mediated the relationship between illness perception and VRQOL among DR patients. Specifically, DR patients may accept their worsening circumstances without attempting to change them due to their perception that their illness is threatening and beyond control. This resignation coping strategy could, in turn, lead to poorer VRQOL. These findings suggest that interventions targeting the improvement of illness perception and coping strategies could enhance the VRQOL of DR patients.

Background: To investigate corneal higher-order aberrations (HOAs) and choroidal characteristics in myopic individuals and explore the association between HOAs and choroidal parameters.

Methods: Myopic participants were categorized into three groups based on axial lengths (ALs). We compared corneal HOAs, including spherical (Z₄⁰), comatic (Z₃ ^- 1 and Z₃¹), and trefoil (Z₃ ^- 3 and Z₃³) aberrations, as well as choroidal vascularity index (CVI) and choroidal thickness (CT). Linear regression analysis was used to assess the relationships among corneal HOAs, CVI, CT, spherical equivalent, and AL.

Results: Groups 1, 2, and 3 included 105, 98, and 118 eyes, respectively. Group 3 exhibited lower spherical HOA root mean square and Z₄⁰ values than group 1(p < 0.05). Group 1 showed lower Z₃¹ levels than other groups (p < 0.001). Groups 1 and 2 had higher mean, central, and I2 vertical CVIs than group 3 (p < 0.05). Group 1 had a larger vertical S1 CVI than group 3 (p < 0.05). Group 3 had smaller horizontal CVI values in all regions except N2 (p < 0.05). Both the mean and CT in all regions decreased as AL increased (p < 0.001). The comatic (Z₃¹) and trefoil (Z₃³) components were predictors of mean horizontal CVI, and the comatic (Z₃¹) component was correlated with both mean vertical and horizontal CT.

Conclusion: Longer AL myopic patients exhibited lower absolute values of spherical aberration and horizontal coma. Alterations in choroid in myopic patients correlated with corneal HOAs. Our results suggest a potential connection between the optical quality and ocular perfusion in myopia.

Background: Keratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia.

Methods: This retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher's exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05.

Results: A total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures.

Conclusion: The findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

In recent years, the global prevalence of myopia has reached an unprecedented level, especially‌ in East Asia. Multitude of studies has shown that the etiology of myopia is complex. Some researchers have suggested that oxidative stress (OS) may contribute to myopia, although there are limited reports on the alterations of related signaling pathways. Notably, the Kelch-like ECH-associated protein 1 (KEAP1) -nuclear factor erythroid 2-related factor 2 (NRF2), which plays a significant role in regulating OS and the mechanism, has not been explored in myopia. To investigate the modulation of KEAP1-NRF2 signaling pathway and its downstream superoxide dismutase (SOD) during the development of form-deprivation myopia, three-week-old guinea pigs were randomly assigned to four groups: negative control (NC), self-control (SC), form-deprivation myopia (FDM), and FDM group treated with tert-butylhydroquinone (TBHQ). Spherical equivalent (SE) and axial length (AL) were measured by retinoscopy and A-scan ultrasound, respectively. The results revealed that TBHQ treatment decelerated the progression in SE and AL changes. Immunohistochemistry (IHC) assessed the distribution and expression of KEAP1, NRF2, and SOD. The results shown that they located in the retinal ganglion cells (RGC). Subsequently, retinal mRNA and protein expression levels of KEAP1, NRF2, and SOD were quantified using real-time polymerase chain reaction (RT-PCR) and Western blot (WB) analysis. The RT-PCR and WB results demonstrated that TBHQ could activate NRF2, induce KEAP1 degradation, and enhance the expression of the antioxidant SOD. In summary, the modulation of KEAP1-NRF2 and it downstream SOD expression could alter the retinal antioxidant capacity and influence the development of myopia.

Background: This study aimed to present a case of bilateral symmetric onset of acute idiopathic maculopathy after high fever with peripheral vascular occlusion.

Case presentation: A 54-year-old yellow female experienced acute binocular visual acuity decrease after 1 day of high fever, and binocular visual acuity decreased to index or anterior. OCT in the external hospital showed dome-shaped cortical detachment in the symmetrical macular area of both eyes with subretinal fluid, discontinuity in the ellipsoid zone and the chimera. The patient autonomously administered antibiotics and non-steroidal anti-inflammatory agents, including amoxicillin and ibuprofen. Following a three-day period, the patient's visual acuity demonstrated significant improvement. Additionally, macular edema demonstrated a notable reduction as indicated by optical coherence tomography, while the presence of peripheral retinal vascular occlusions was also observed on fluorescein fundus angiography. At the onset of 6 days, oral hormone therapy was given in the outside hospital, with no significant improvement in visual acuity.23 days after the onset of the disease, the patient was admitted to our hospital, and was finally diagnosed as acute idiopathic maculopathy combined with the imaging findings of FFA, ICGA and OCT. During the follow-up, the visual acuity of both eyes improved spontaneously.

Conclusions: This case is a rare acute idiopathic macular lesion with bilateral involvement, accompanied by highly symmetrical peripheral retinal vascular occlusion in both eyes, which deepens our understanding of acute idiopathic maculopathy with a view to providing guidance for subsequent clinical practice.

Purpose: This study aimed to identify novel prognostic factors for Morbihan disease (MD) treatment outcomes and evaluate the efficacy of combination therapy in an Asian population, addressing the gaps in current understanding of this rare condition.

Methods: We conducted a retrospective analysis of MD patients diagnosed and treated at a tertiary hospital between 2017 and 2023. Patients received combinations of oral medications (tetracycline, isotretinoin, corticosteroids), topical treatments (tacrolimus, ivermectin), and intralesional steroid injections. Treatment response (TR) was defined as complete symptom remission, while partial remission or recurrence was considered a poor response (PR). Clinical, histological, and biochemical parameters were analyzed to identify prognostic factors.

Results: The study included 24 patients (18 men; mean age 61.3 years). Ten patients (41.7%) achieved TR, while 14 (58.3%) showed PR. Significant prognostic factors for TR included shorter symptom duration (≤ 3 months, p = 0.016), lower LDL cholesterol levels (≤ 89 mg/dL, p = 0.046), combination treatment with oral and topical medications (p = 0.033 at 6 months), and partial response at 1 month (p = 0.017). GLMM analysis identified the number of visits (p < 0.001), symptom duration (p = 0.020), and dyslipidemia (p = 0.006) as significant prognostic factors. Histologically, perivascular and perifollicular lymphocytic infiltration were the most common findings (83.3%). Notably, 50% of patients were ANA-positive, challenging previous diagnostic criteria.

Conclusion: This study identifies novel prognostic factors for favorable outcomes in MD, including early intervention and lipid management. Combination therapy, particularly with tacrolimus ointment, shows promise in improving treatment responses. These findings suggest a potential link between lipid metabolism and MD pathophysiology, opening new avenues for targeted therapies.

Background: This report aims to present the causes, clinical features, and surgical outcomes of persistent exudative retinal detachment (ERD) in a single tertiary referral center experience.

Methods: We retrospectively analyzed 48 patients who underwent vitreoretinal intervention for persistent ERD between 2017 and 2024. The study assessed patient demographics, underlying causes of ERD, the success rate of surgical interventions, and postoperative visual outcomes.

Results: Of the 2040 eyes with retinal detachment treated at our center, 48 (2.35%) were diagnosed with ERD. Coats disease was the most frequent underlying cause, identified in 18 (37.5%) of ERD cases. Choroidal hemangioma (n = 6, 12.5%) and nanophthalmos (n = 5, 10.4%) were the next most common etiologies. The study population comprised 48 patients (30 males and 18 females) with a mean age of 37.48 years (range, 4-88 years). The mean best-corrected visual acuity remained stable from baseline to follow-up. The recurrence rate following primary surgery was 29.2%. Patients underwent a mean of 1.75 ± 1.00 surgeries. Globe preservation was achieved in 44 eyes (91.7%), while phthisis bulbi developed in 4 eyes (8.3%).

Conclusion: Vitreoretinal surgery may be considered as a salvage procedure in cases where persistent ERD threatens the posterior pole. In our study, Coats' disease, choroidal hemangioma, and nanophthalmos were identified as the most common etiologies associated with persistent ERD. Surgical intervention has the potential to preserve vision, but the high recurrence rate necessitates a cautious approach and the possibility of multiple surgeries.

Objective: The cross-sectional study was designed to evaluate the association of ocular surface inflammation with systemic conditions in patients with systemic lupus erythematosus (SLE).

Methods: The study enrolled 30 SLE patients and 30 controls. Ocular symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Tear samples from all participants were collected for tear multi-cytokine and chemokine concentration analysis. All participants were assessed for dry eye disease (DED), including Schirmer I test, tear break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland secretion (MGS), lid-parallel conjunctival folds (LIPCOF), corneal clarity, and symblepharon. Besides, all participants were also examined for conjunctival impression cytology to measure the density of conjunctival goblet cells (CGCs). The peripheral blood indicators from SLE patients were also collected to measure the SLE-associated autoantibody specificities and systemic inflammatory indicators. Pearson and Spearman's analysis were uesd to examine the correlation between tear cytokines, CGCs, DED-related indicators, and systemic conditions.

Results: The two groups were matched for age and gender in this study. 36.67% of eyes (11 in 30) of SLE patients and 13.33% of eyes (4 in 30) of controls were diagnosed with DED. OSDI scores, abnormal TBUT percentages, CFS percentages, and DED grading were all higher in SLE patients than in control group, while density of CGCs was lower. There were no significant differences in Schirmer I test, MGS, LIPCOF, corneal clarity, and symblepharon between SLE patients and controls. The levels of tear chemokine (C-X-C motif) ligand 11 (CXCL11) and cytokine interleukin-7 (IL-7) in patients with SLE were significantly higher than those in control group. Moreover, among SLE patients, the severity of DED and the level of tear chemokine CXCL11 were significantly positively correlated with SLE-associated autoantibody specificities.

Conclusion: Dry eye and tear cytokines and chemokines-mediated ocular surface inflammation persist in SLE patients and are associated with systemic conditions. Therefore, it is necessary for patients with SLE to combine systemic and ocular assessments.

Purpose: The aim of this study was to investigate the level of peripheral blood systemic immune indexes in pseudoexfoliation syndrome (PXS) patients and to compare the results with healthy controls.

Methods: This study included 143 healthy controls (group 1) and 100 patients (group 2). Peripheral blood samples were collected from all participants. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SIII), systemic inflammation response index (SIRI), systemic inflammation modulation index (SIMI) and aggregate systemic inflammation index (AISI) were calculated.

Results: According to complete blood count, leukocyte, monocyte and platelet counts showed a statistically significant difference between the two groups (p < 0.001 for all). Systemic immune indexes (NLR, PLR, SIII, SIRI, SIMI and AISI) in group 2 were statistically significantly higher compared to group 1 (PLR for p = 0.011, others p < 0.001).

Conclusion: In conclusion, systemic immune indexes (NLR, MLR, PLR, SIII, SIRI, AISI and SIMI) were elevated in PXS patients compared to healthy controls. These indexes may serve as an easy, simple and cost-effective tool to assess the degree of systemic inflammation in patients, playing an important role in recognizing the underlying mechanisms of diseases and thus potentially guiding treatment.

Purpose: To research the therapeutic effects of 577 nm micropulse laser photocoagulation (MLP) treatment in early-stage central serous chorioretinopathy (CSCR) patients.

Methods: Twenty-two CSCR patients with 24 CSCR eyes were examined prior to MLP treatment. The examinations included best-corrected visual acuity (BCVA), fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and microperimetry. After MLP treatment, all the subjects were reviewed at 30 days. The BCVA, macular function on microperimetry, subretinal fluid (SRF) height of the macula on OCT, and choroid vascular density (VD) of the macular area on OCTA were compared before and after MLP treatment. The correlations between SRF height and visual function, choroid VD was analyzed separately.

Results: BCVA and macular function significantly increased and the SRF height of the macula significantly decreased after MLP treatment. BCVA and macular function were significantly negatively correlated with SRF height. The choroid VD was significantly increased after MLP treatment, and choroid VD in the leakage site part of the macula were significantly negatively correlated with the height of the SRF. A recurrent patient who received two MLP treatments also had a negative correlation between SRF and choroid VD during the course of disease.

Conclusions: 577 nm MLP is safe and effective for early-stage CSCR patients, and treatment can restore macular structure and function. The increase in choroid VD of leakage site part after treatment is one of the key effects of MLP treatment for early-stage CSCR patients.