BMC Ophthalmology最新文献

Objective: To examine the relationship between retinal vascular geometry and silent brain infarction (SBI) in the Chinese population.

Methods: We conducted a cross-sectional study that retrospectively analyzed the fundus photographs, MRI and other clinical data of 227 SBIs and 227 controls who visited Shanghai Health And Medical Center for physical examination. The retinal vessel fractal dimension (FD), retinal artery fractal dimension (FDa), retinal vein fractal dimension (FDv), central retinal artery diameter in the region from 0.5 ~ 1.0 disc diameter (DD) from the disc margin (CRAEB), central retinal artery diameter in the region from 1.0 ~ 2.0 DD from the disc margin (CRAEC), central retinal vein diameter in the region from 0.5 ~ 1.0 DD from the disc margin (CRVEB), central retinal vein diameter in the region from 1.0 ~ 2.0 DD from the disc margin (CRVEC), retinal arteriovenous diameter ratio in the region from 0.5 ~ 1.0 DD from the disc margin (AVRB), and retinal arteriovenous diameter ratio in the region from 1.0 ~ 2.0 DD from the disc margin (AVRC) were accessed by the Singapore "I" Vessel Assessment (SIVA) software.

Results: FD, FDa, FDv, CRAEB, CRAEC, CRVEB, CRVEC and AVRB in SBI subjects were 1.25 (1.21-1.28), 1.11 (1.08-1.14), 1.09 (1.06-1.13), 168.78 ± 19.39, 163.55 ± 18.97, 235.77 (222.64-254.08), 224.39 ± 23.29, 0.72 ± 0.06, respectively, significantly lower than those of control subjects [1.30 (1.28-1.32), 1.15 (1.13-1.18), 1.14 (1.12-1.16), 196.81 ± 27.94, 183.81 ± 25.46, 273.03 (247.59-296.30), 249.59 ± 32.03, and 0.73 ± 0.08]. Logistic regression results showed that higher FD (OR, 0.04), FDa (OR, 0.07), FDv (OR, 0.06), CRAEB (OR, 0.02), CRAEC (OR, 0.04), CRVEB (OR, 0.03), CRVEC (OR, 0.06), and AVRB (OR, 0.55) were associated with a lower of SBI. There was no significant difference in AVRC between the two groups.

Conclusion: Our study shows the association between retinal vascular geometry and SBI, and the results may provide new biomarkers for the early detection of SBI.

Purpose: Proliferative vitreoretinopathy (PVR) is a complication of retinal detachment which requires multiple vitreoretinal surgical interventions and frequent use of oil endotamponade. In this study, we conducted an in-depth analysis of complications associated with the use of heavy silicone oil in the management of inferior PVR.

Methods: A retrospective cohort study of 20 eyes that underwent vitrectomy for inferior PVR with use of heavy silicone oil (Densiron 68) between March 2021 and October 2022 at Oxford Eye Hospital. Complications were classified into major categories relating to intraocular pressure, inflammation, lens, and oil emulsification/migration. Visual outcomes and surgical success rate were also evaluated.

Results: Fill-induced pressure spikes (> 30 mmHg) within 14 days post-surgery were common after Densiron tamponade, especially in patients previously on glaucoma drops. The number of glaucoma drugs were increased in 45% of patients during Densiron tamponade. In 20% of cases, an increased medication was continued long-term after Densiron removal. Significant cataract progression occurred in all phakic patients. In 25% of pseudophakic cases, posterior capsule opacification was noted. Inflammatory complications, such as anterior uveitis, were rare and any cystoid macular oedema was transient. No unexplained acute loss of vision following Densiron removal was encountered. The anatomical success rate at 30 days after Densiron removal was 70%. The mean (± SD) best-corrected visual acuities were 1.04 (± 0.79), 0.85 (± 0.62) and 0.50 (± 0.51) logMAR prior, during and after Densiron tamponade, respectively.

Conclusion: The outcomes in this cohort treated with Densiron 68 were comparable to previously reported anatomical and functional results in cases with inferior PVR. IOP and lens-related complications require additional treatment during or after Densiron tamponade. Inflammatory complications rarely occurred over tamponade durations of around three months.

Trial registration: Analyses were conducted as an internal quality improvement audit and as such did not require external IRB review.

Purpose: To assess the clinical efficacy of 0.1% cyclosporine A (CsA) in dry eye patients who have shown inadequate responses to previous treatment with 0.05% CsA.

Design: This study was designed as a switching, prospective, multicenter, 12-week, open-label study.

Methods: Patients with dry eye disease (DED), who experienced inadequate responses to at least 3 months of treatment with 0.05% cyclosporine, were enrolled in this study. Clinical evaluations included the National Eye Institute (NEI) corneal and conjunctival staining scores, tear film break-up time (TF-BUT), Symptom Assessment in Dry Eye (SANDE), ocular discomfort scale (ODS), and tear volume. These parameters were assessed at baseline, and again at 4, 8, and 12 weeks after switching to 0.1% CsA.

Results: Ninety-one patients were enrolled in the study, and 70 patients completed the trial. Statistical analysis was performed on the full analysis set (FAS) using the Markov Chain Monte Carlo (MCMC) method to account for missing data. After switching to 0.1% CsA, subjective symptoms assessed by the Symptom Assessment in Dry Eye (SANDE) and Ocular Discomfort Scale (ODS) showed improvement (p < 0.0001). Objective signs of dry eye, including the National Eye Institute (NEI) score, tear film break-up time (TF-BUT), and tear volume also improved (p < 0.0001).

Conclusions: In patients with dry eye disease (DED) who exhibited inadequate responses to 0.05% cyclosporine A (CsA), switching to 0.1% CsA resulted in significant improvements in both subjective symptoms and objective clinical signs. This finding suggests that higher concentrations of CsA may be more effective in treating individuals with moderate to severe DED.

Purpose: To analyze the outcomes of corneal transplantation procedures over a 13-year period at Farabi Eye Hospital, Tehran, Iran, to identify trends and determinants influencing the frequency and success of primary and re-transplantations.

Methods: Utilizing a comprehensive dataset from the hospital's Hospital Information System, the study reviewed the records of 8,378 patients who underwent corneal transplants between 2009 and 2022. This analysis included demographic information, surgical details, and follow-up data. Statistical methods were applied to assess the impact of variables such as age, gender, surgeon experience, and surgical techniques on the likelihood of re-transplantation.

Results: Of the 8,378 transplants, 7,660 (91.4%) were primary procedures while 718 (8.6%) involved re-transplantation. The most common primary transplant was penetrating keratoplasty (PKP, 50.3%), followed by Descemet's stripping endothelial keratoplasty (DSAEK, 29.3%), and deep anterior lamellar keratoplasty (DALK, 18.5%). Analysis revealed no significant association between re-transplantation rates and patient gender or nationality. Older recipient age correlates with higher re-transplantation rates, likely due to reduced regenerative capacity and increased comorbidities in older patients. Pre-transplant comorbidities (e.g., keratoconus, ulcers), concurrent surgeries (e.g., vitrectomy), and prior procedures (e.g., glaucoma surgeries, IOL implantation) significantly increase re-transplantation risk, likely due to additional ocular stress and inflammation.

Conclusion: The study highlights the importance of patient age, surgeon experience, and the choice of surgical technique in the success rates of corneal transplants. These factors are crucial for optimizing patient outcomes and minimizing the necessity for re-transplantations.

Background: This study aims to comprehensively evaluate the predictive accuracy of six widely used toric intraocular lens (IOL) calculators in eyes undergoing cataract surgery with toric IOL implantation.

Methods: This retrospective study reviewed 53 eyes of 53 patients that underwent cataract extraction with toric IOL implantation using Zeiss 709 M. Six toric IOL calculators were evaluated: Barrett toric calculator (with predicted PCA, measured PCA, and TK), Kane formula (predicted PCA), and EVO 2.0 formula (predicted and measured PCA). Postoperative refractive astigmatism prediction errors were comprehensively calculated and analyzed using vector analysis.

Results: The mean absolute prediction error (APE) ranged from 0.56 ± 0.37 D (Barrett TK) to 0.63 ± 0.46 D (Barrett predicted PCA, PPCA). The proportions of eyes achieving APE ≤ 1.0 D were highest for Barrett TK and Kane predicted PCA (90.6%). The highest proportions of eyes achieving APE ≤ 0.25 D and ≤ 0.50 D were observed with Barrett measured PCA (18.9% and 56.6%, respectively), while the lowest with Barrett PPCA (9.4% and 50.9%, respectively). The study found no statistically significant differences in mean absolute prediction error (APE) among the six calculators (χ² = 6.88, P = 0.23) and the centroid of PE (P = 0.93). A difference in mean APE was observed between the Barrett predicted PCA and Barrett TK calculators (P = 0.02).

Conclusion: The study confirms the importance of considering posterior corneal astigmatism remains essential to achieving precise refractive outcomes but also underscores the need for ongoing refinement and evaluation to optimize surgical outcomes.

Purpose: To evaluate the impact of Implantable Collamer Lens (ICL) implantation on anterior chamber angle parameters and posterior segment structures in highly myopic eyes and explore potential correlations between these changes. The study aimed to assess alterations in superficial and deep vessel density (SVD, DVD), foveal avascular zone (FAZ) area, and retinal nerve fiber layer (RNFL) thickness to clarify the safety profile of ICL implantation.

Methods: Prospective observational study, included 36 highly myopic eyes undergoing ICL implantation in surgery group and 23 non-surgical control eyes in non-surgery group. Anterior chamber parameters were assessed using AS-OCT, and posterior segment changes, including SVD, DVD, FAZ, and RNFL, were evaluated using OCT and OCTA preoperatively and at intervals up to 3 months postoperatively. Statistical analyses included paired t-tests, Wilcoxon tests, and Spearman correlation.

Results: ICL implantation significantly improved uncorrected distance visual acuity (UDVA) (p < 0.01). Anterior chamber depth (ACD) and angle parameters, such as AOD and TISA, decreased initially but stabilized by 3 months. SVD and DVD showed early postoperative fluctuations, returning to baseline by 3 months, while the FAZ area and subfoveal choroidal thickness remained stable. Significant correlations were identified between anterior segment narrowing and posterior vascular changes, particularly in the pericentral region.

Conclusions: ICL implantation effectively and safely corrects high myopia, with stable anterior and posterior structural changes by 3 months. Transient vascular density fluctuations correlated with anterior chamber angle alterations, highlighting the need for long-term studies to further understand these dynamics and ensure retinal safety postoperatively.

Trial registration: The study was approved by the ethics committee of Aier Eye Hospital, Jinan University (No. GZAIER2023IRB25; China Clinical Trial Record No. MR-44-24-009241).

Purpose: Reoperations in strabismus are reportedly needed in 20-40% of cases undergoing surgery. The present study investigated the outcomes of reoperations based on preoperative imaging of extraocular muscle insertions, and whether the Anterior Segment Optical Coherence Tomography (ASOCT) was of value.

Methods: Patients with strabismus requiring reoperation with/without previous surgical records at the Advanced Eye Centre, PGIMER, Chandigarh were recruited. All patients underwent a thorough clinical examination and imaging of extraocular muscle insertions on the Swept Source Anterior Segment Optical Coherence Tomography. The accuracy of measuring muscle insertions with the ASOCT was compared with intraoperative caliper readings.

Results: Forty-seven muscles (28 patients) were imaged on ASOCT with confirmation intraoperatively during re-operation. The mean age of the patients was 21.6 ± 5.6 years. After looking at the imaging findings, the decision of which muscle to operate on changed in eleven patients (39.2%). The accuracy of ASOCT to measure muscle insertion ± 1 mm was seen in 78.7% (38/47 muscles). The ASOCT could give additional information, such as a slipped muscle and stretched scar in three patients.

Conclusions: Imaging can be beneficial in achieving successful results in strabismus reoperations with high accuracy. It can be pivotal in surgical planning in reoperations (~ 40%).

Purpose: To report a rare case of a Coats-like response developing after vitreoretinal surgery for proliferative diabetic retinopathy (PDR) and its successful management with retinal laser photocoagulation and adjunctive intravitreal steroids.

Case description: A 52-year-old woman with a five-year history of type 2 diabetes mellitus and hypertension presented with decreased vision in the left eye (counting fingers at 1 m). Examination revealed high-risk PDR in both eyes, with a subtotal macula-off combined retinal detachment in the left eye. The patient underwent pan retinal photocoagulation for the right eye and vitreoretinal surgery with silicone oil tamponade for the left eye. Postoperatively, the retina remained attached, but progressive increase in hard exudates in the inferotemporal quadrant was noted in the left eye. Wide-field fluorescein angiography showed temporal capillary dropout and leakage corresponding to the exudates, consistent with a Coats-like response.

Results: Silicone oil removal combined with targeted endolaser photocoagulation and intravitreal triamcinolone acetonide injection resulted in a complete resolution of the subretinal lipid exudation. Two weeks postoperatively, the retina remained well-attached, but best-corrected visual acuity declined to 6/60 due to posterior subcapsular cataract progression. Optical coherence tomography confirmed the resolution of subretinal lipid exudation, and the patient was advised to undergo cataract surgery.

Conclusion: This case highlights the occurrence of a Coats-like response following vitreoretinal surgery for PDR, potentially triggered by retinal ischemia and surgical inflammation. Timely intervention with laser photocoagulation, and adjunctive intravitreal corticosteroids can effectively manage such responses.

Background: Epiphora and secondary ocular surface damage are increasingly impairing the quality of life of people, particularly elderly women. We aimed to investigate the changes in tear cytokine and lactoferrin levels in postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) complicated with obstructed meibomian gland dysfunction (OMGD) and preliminary explore the pathological mechanisms of OMGD in patients with PANDO.

Methods: The prospective study involved 43 and 41 postmenopausal women with and without PANDO, respectively. Based on the presence or absence of OMGD, the participants were subdivided. Tear fluid was collected from affected eyes of all participants using Schirmer I test and tested for cytokine concentrations (interleukin (IL)-6, IL-8, IL-1β, interferon-gamma, tumour necrotic factor (TNF)-α, IL-10, epidermal growth factor (EGF)) using the Multiplex Luminex Assay. Tear lactoferrin levels was determined using ELISA.

Results: In the PANDO with OMGD group, the IL-8, IL-1α, IL-1β, and macrophage inflammatory protein-1α levels were significantly higher than those in the other groups. The IL-6 and TNF-α levels were significantly higher than those in the controls. The lactoferrin level in the PANDO with OMGD group was lower than that in the Non-PANDO with OMGD group. The IL-10 and EGF levels were not significantly different among the groups.

Conclusion: The level of pro-inflammatory factors in the tears of patients with PANDO complicated with OMGD was significantly increased, which is likely to cause further damage to ocular surface. Anti-inflammatory therapy may help protect ocular surface in postmenopausal women with PANDO.

Background: Human anterior lens capsules (ALCs) have great potential in the treatment of multiple eye diseases, including corneal ulcers, glaucoma, age-related macular degeneration and macular holes. ALCs are also regarded as promising scaffolds for various ocular cells. Here, we investigated different decellularization methods for removing lens epithelial cells (LECs) that adhered to ALCs.

Methods: Human ALCs were treated with various solutions, including 2% lidocaine, 10% sodium chloride, 50% glucose and sterile water. Trypan blue and alizarin red (TB-AR) staining, H&E staining and hydroxyproline assays were used to assess the degree of decellularization. The impacts of acellular ALCs on cell viability and cell-tissue interaction were investigated in vitro.

Results: These findings revealed that 2% lidocaine, 10% sodium chloride, 50% glucose, and sterile water had the capacity to decellularize ALCs at 37 °C. The structure of ALCs in all decellularization groups was similar to that of intact ALCs. The effects of 10% sodium chloride and sterile water on decellularization were significantly better than those of 2% lidocaine and 50% glucose. The H&E staining revealed that the different decellularization methods maintained the integrity of the lens capsular structure. Compared with sterile water, 10% sodium chloride preserved a better level of hydroxyproline. The ALCs in the 10% sodium chloride-treated group and the sterile water-treated group were shown to be suitable for cell adhesion in vitro.

Conclusion: This study identified two optimal decellularization methods for acellular ALCs: using 10% sodium chloride and using sterile water. The obtained acellular ALCs could be promising scaffolds for ocular cells. In addition, acellular ALCs do not need resterilization and may be directly used for autologous lens capsule transplantation in clinical applications.