BMC Ophthalmology最新文献

Background: To investigate the clinical outcomes and related risk factors following phacoemulsification and posterior chamber intraocular lens implantation (PE & PCL) in East Asian patients with Fuchs endothelial corneal dystrophy (FECD).

Methods: One hundred eighty eyes of 112 FECD patients who underwent PE & PCL at a tertiary hospital in Korea were included. Demographic and ocular biometric characteristics including best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were collected. Risk factors were analyzed for (1) Descemet membrane endothelial keratoplasty (DMEK) requirement and (2) postoperative BCVA < 0.5, using univariate and multivariate regression analyses and receiver operating characteristic curves.

Results: Mean LogMAR BCVA improved from 0.51 to 0.20, CCT increased by 2.6% from baseline, and ECD decreased by 14.6% (all P < 0.05). Ten eyes (5.6%) underwent subsequent DMEK within three months. Baseline CCT was a risk factor for the need for DMEK (odds ratio 1.58, P < 0.05) with a cutoff value of 620 μm, achieving 100% sensitivity and 91% specificity. Baseline BCVA, CCT, and ECD predicted limited postoperative BCVA (all P < 0.05), with cutoff values of 0.35 logMAR (91% sensitivity and 59% specificity), 584 μm (57% sensitivity and 82% specificity), and 1244 cells/mm² (65% sensitivity and 77% specificity), respectively.

Conclusions: In our cohort of Korean FECD eyes that underwent routine PE & PCL, progression to DMEK in the early postoperative period was relatively low. Baseline CCT values provide strong predictive power for both the necessity of DMEK and the likelihood of visual improvement after surgery.

Background: Ocular trauma in children results in long-term visual impairments and affects the child's physical and psychosocial development. The variability in age, gender, and socio-environmental factors significantly determines their epidemiology. Consequently, this study aimed to characterize ocular injuries in children in Poland.

Methods: This retrospective, observational study included patients up to 18 years old, admitted to the Emergency Department of the Regional Specialized Children's Hospital in Olsztyn, Poland, between June 2015 and December 2023, with diagnosed eye or orbital injury. Cases were categorized based on injury mechanism, tool utilized, and perpetrator. The decrease in visual acuity was divided according to ICD-10 - WHO.

Results: Among 590 patients, 66.61% were males, mostly aged 5 to 9 years (32.37%). An active mechanism was responsible for most cases (77.97%), primarily involving the use of objects other than blunt, with a significant proportion of injuries being self-inflicted. Animal-inflicted injuries were most often observed among females. Males most frequently necessitated surgical procedures through active mechanisms. A decrease in visual acuity was observed in 121 cases (20.51%), with blindness diagnosed in 11 patients, mostly males, resulting from an active mechanism. Six of them did not fully recover their vision. Nineteen patients (3.22%) sustained open globe injuries, and two cases (0.34%) of brain injuries were documented.

Conclusions: Eye injuries constitute a diverse category of trauma, often constrained only by the child's creativity and age. These injuries predominantly occur in young males through active mechanisms. While the majority do not result in permanent vision impairment, they frequently cause a temporary reduction in visual acuity.

Background: Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes mellitus and a significant cause of blindness worldwide, In Sub-Saharan Africa (SSA), the epidemic of diabetes is rapidly expanding, with hundreds of millions expected by 2045, and DR is approximated to afflict about one-third of individuals with diabetes in the region Nevertheless, the total burden of DR in SSA has not been methodically estimated.

Objective: We sought to estimate the pooled prevalence of DR in adults with diabetes in SSA and investigate sources of variation.

Methods: We performed a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched PubMed, AJOL, Google Scholar, and other sources through mid-2024 for observational studies (cross-sectional or cohort) that reported DR prevalence in adults with diabetes in SSA. Two reviewers screened records, extracted data (study, country, design, sample size, DR cases), and evaluated quality using the JBI checklist. Random-effects meta-analysis (logit transformation) estimated pooled prevalence and 95% confidence intervals (CI), Heterogeneity was measured by Cochran's Q and I², and τ² was reported. Subgroup meta-analysis by region (East, West, Central, and Southern Africa) and meta-regression by country (fixed categorical moderator) were conducted. Funnel plots and Egger's test (p < 0.05) examined publication bias.

Results: We pooled 30 studies (N = 16,329 individuals) from 18 SSA countries, Most were hospital-based and cross-sectional; no study was excluded due to high bias. The overall pooled prevalence of DR among individuals with diabetes was 25.5% (95% CI: 20.7%-31.0%) (Logit = -1.072, 95% CI -1.345 to -0.799; p < 0.001). Heterogeneity was very high (I² ≈ 96%, τ² = 0.433). Subgroup analysis revealed differences by sub region: East Africa 31.8%, Southern Africa 29.6%, West Africa 27.4%, and Central Africa 13.7%. A meta-regression with country as moderator was not statistically significant (F = 0.94, p = 0.560). Egger's test demonstrated significant asymmetry (p < 0.001), although the weighted regression test was no significant (p = 0.154), which suggests potential publication bias.

Conclusion: About a quarter of diabetics in SSA have DR. This is similar to regional estimates (28% in East Africapubmed.ncbi.nlm.nih.gov) but slightly lower than the overall Africa average (~36%)pubmed.ncbi.nlm.nih.gov. The high heterogeneity suggests that the prevalence of DR is highly variable throughout SSA. Restricted access to eye care, late diagnosis, and inadequate glycemic control in SSA are probably responsible for this, these findings highlight the urgent need for systematic diabetic retinopathy screening and management programs in sub-Saharan Africa.

Background: To compare the clinical outcomes and visual quality following bilateral implantation of Vivity IOLs with mini-monovision.

Methods: Patients who underwent sequential bilateral cataract surgery with implantation of Vivity EDOF IOLs at our institution were divided into two groups: Group A was designed with a myopic refraction of ≥ 0.5 D and < 1.0 D in the non-dominant eye, while the refractive target for the dominant eye was emmetropia. Group B exhibited emmetropic refractive targets bilaterally. Outcome measures evaluated at 1 month postoperatively included: monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), monocular objective visual quality, monocular and binocular uncorrected defocus curves, VF-14 score, Quality of Vision (QoV) score and patient satisfaction.

Results: The study comprised a total of 61 patients (122 eyes). Statistically significant differences were not observed between the groups in terms of UDVA, UIVA, mean modulation transfer function (MTF), Strehl ratio (SR), aberrations, VF-14 scores, QoV scores and satisfaction. In Group A, the UNVA of the non-dominant eye was superior to that of Group B (0.36 ± 0.05 vs. 0.54 ± 0.06 LogMAR, P=0.024). The defocus curve of the non-dominant eye revealed that Group A attained superior visual performance at defocus levels ranging from - 2.0D to -3.5D (0.50 m to 0.29 m). However, these differences did not achieve statistical significance.

Conclusion: The findings of this study indicate that bilateral implantation of EDOF IOLs with a mini-monovision design improves near visual acuity without significantly compromising distance visual acuity, visual quality or increasing aberrations.

Background: Uveal effusion is a sight threatening condition, due to possible acute angle-closure glaucoma and maculopathy. We present a case of bilateral uveal effusion after taking racecadotril, an enkephalinase inhibitor used as a medical treatment for diarrhea. Uveal effusion after the use of racecadotril has not been described in literature.

Case presentation: A 76-year-old woman presented with blurred vision in both eyes. Fundoscopy and B-scan ultrasound showed bilateral choroidal effusion. The anterior chamber was narrow, but the intra ocular pressure remained normal. The medication review showed that the only recently added medication was racecadotril. Other potential causes of uveal effusion were excluded. Topical steroids and atropine were started. After cessation of racecadotril, a complete resolution of the uveal effusion was observed.

Conclusions: This case of bilateral uveal effusion was probably caused by racecadotril, since this was the only recently started drug, and we observed a complete resolution of the effusion after cessation of the drug. It is possible that the increase in enkephalins caused by racecadotril intake, leads to changes in the choroid, causing choroidal effusion. It is important to recognize uveal effusion as a rare side effect of racecadotril, because of its possible sight threatening character.

Background: Retinal vascular diseases, including diabetic retinopathy (DR) and retinal vein occlusion (RVO), and neovascular macular diseases such as neovascular age-related macular degeneration (nAMD) are leading causes of vision loss worldwide. With the rapid growth of artificial intelligence (AI), multimodal approaches that integrate diverse imaging modalities and clinical data have emerged as powerful tools for improving diagnosis, prognosis, and risk stratification.

Methods: This systematic review, conducted according to PRISMA 2020 guidelines, synthesized evidence on the diagnostic and prognostic applications of multimodal AI in retinal vascular diseases. Six databases (PubMed, Embase, Scopus, Web of Science, IEEE Xplore, and Cochrane Library) were searched for English-language studies published between 1 January 2019 and 1 November 2025. Eligible studies applied AI or machine learning models integrating two or more data modalities for diagnosis, prognosis, or prediction in DR, RVO, or AMD. Data extraction, quality appraisal, and narrative synthesis were performed.

Results: From 11,659 identified records, 12 studies met the eligibility criteria. Multimodal AI systems consistently outperformed unimodal models and, in several cases, exceeded expert ophthalmologist performance. Diagnostic accuracy for AMD and polypoidal choroidal vasculopathy (PCV) ranged from 87% to 96%, with fusion-based approaches achieving area under the curve (AUC) values up to 0.989. Prognostic models predicting treatment response or recurrence in nAMD and RVO achieved AUCs between 0.972 and 0.980, surpassing both clinician and single-modality baselines. Hybrid and foundation models integrating imaging, clinical, and textual data demonstrated promising results but variable robustness. Most studies were retrospective, single-center, and exhibited moderate-to-high risk of bias, emphasizing the need for larger, prospective, multicenter validation to establish clinical applicability and generalizability.

Conclusion: Multimodal AI demonstrates superior diagnostic and prognostic performance compared to unimodal models and, in some cases, outperforms expert clinicians in managing retinal vascular diseases. Integrating complementary data sources, such as OCT, fundus imaging, and clinical information, enhances model accuracy and generalizability.

Background: To compare oculomotor behavior and reading performance along with conventional visual outcomes in patients following implantation of an enhanced depth of focus (EDOF) intraocular lens (IOL) versus a monofocal IOL.

Methods: In this prospective, exploratory, randomized, clinical trial patients underwent either bilateral implantation with a non-diffractive EDOF IOL DFT015 (Acrysof IQ Vivity, Alcon, USA) or an aspheric monofocal IOL SN60WF (Acrysof IQ, Alcon, USA). 106 eyes of 53 patients with bilateral age-related cataract were evaluated (EDOF IOL group: n = 25; Monofocal IOL group n = 28). At 3 months after surgery, along with visual acuity at various distances, halometry, and patient-reported quality of vision, silent reading performance and oculomotor behavior were assessed at 66 cm with an infrared eye tracker under photopic and mesopic light levels. Data analysis included computation of reading speed and a range of oculomotor indices.

Results: Median mesopic silent reading speed in words per minute (wpm) and fixation duration in milliseconds (ms) were 205 wpm and 277 ms for the EDOF group and 168 wpm (p = 0.04) and 301 ms (p = 0.02) for the monofocal control IOL group, respectively. No significant differences were observed under photopic conditions. Binocular means expressed in logarithm of the minimum angle of resolution for postoperative corrected distance, uncorrected distance, uncorrected intermediate, and uncorrected near visual acuities were - 0.04 ± 0.07, 0.00 ± 0.07, 0.12 ± 0.09, and 0.27 ± 0.13 for the EDOF group and - 0.08 ± 0.06 (p = 0.08), -0.04 ± 0.07 (p = 0.10), 0.19 ± 0.13 (p = 0.01), and 0.41 ± 0.14 (p = < 0.001) for the control group, respectively. Postoperative halo size and visual disturbances were similar in both groups.

Conclusions: Silent reading speed at 66 cm distance is found improved with EDOF compared to monofocal IOLs only at mesopic light levels, mainly due to the improvement in average fixation duration. Further studies are needed to confirm these preliminary findings.

Trial registration: Jan 4, 2022: NCT05194657 ( https://clinicaltrials.gov/study/NCT05194657 ).