BMC Ophthalmology最新文献

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.

Background: Nance-Horan syndrome (NHS) is a rare X-linked dominant disorder caused by pathogenic variants in the NHS gene on chromosome Xp22.2-Xp22.13. Clinical manifestations consist of congenital cataracts, along with dysmorphic facial features and dental anomalies and, in certain instances, intellectual disability. This study aimed to identify the genetic cause responsible for NHS in a Chinese family with four individuals primarily presenting with congenital cataracts.

Methods: Genomic DNA was collected from six family members, including four affected individuals (three females and one male) from a two-generation family. The family history and clinical data were documented. Whole-exome sequencing was performed on the proband, and candidate pathogenic variants were filtered through a series of screening steps and validated by Sanger sequencing. Co-segregation analysis was conducted to confirm the pathogenicity of the identified variant.

Results: Genetic analysis revealed a novel frameshift pathogenic variant in NHS gene (c.1735delA: p.R579Gfs*91) present in all four affected members. All affected members exhibited congenital cataracts, congenital ptosis, strabismus, high myopia as well as dental and facial anomalies, and more severe characteristic features observed in the male patient. These clinical manifestations were consistent with the phenotype of NHS.

Conclusion: This study identified a novel NHS pathogenic variant in a Chinese family, expanding the mutational spectrum of NHS. Contrary to previous reports of female carriers exhibiting mild symptoms, we demonstrated severe ocular phenotypes in three affected females. These findings will assist in providing genetic counseling for NHS patients.

Background: Fibrosis is the primary cause of failure following glaucoma surgery. Wound healing modulation with 5-fluorouracil and mitomycin-C is routinely employed to reduce ocular fibrosis and improve surgical success rates; however, it also increases the risk of postoperative complications.

Case presentation: A 59-year-old patient with a family history of glaucoma presented a decade after bilateral trabeculectomy with an intraocular pressure (IOP) of 30 mmHg in the right eye and 42 mmHg in the left eye. Both eyes underwent multiple cyclophotocoagulations in the past and showed ocular surface inflammation due to eyedrop intolerance as well as scarred blebs without scleral thinning. Simultaneous bilateral bleb needling reduced IOP to 7 mmHg on the right eye and 12 mmHg on the left eye. The postoperative course of the right eye was favorable with a stable IOP at the low teens. However, IOP of the left eye rose to 34 mmHg within 3 days, accompanied by a uveal prolapse into the bleb. A subsequent vitrectomy with Tutopatch^® and anterior chamber washout was performed after 10 days, followed by implantation of the novel Paul^® Glaucoma Drainage Implant after sufficient scleral healing. This resulted in a postoperative IOP of 8 mmHg. After 12 months, no eyedrops were required, there were no signs of ocular surface inflammation, and the IOP was stable at 13 mmHg in the right eye and 12 mmHg in the left eye.

Conclusion: This case highlights a rare occasion of scleral thinning leading to perforation with uveal prolapse after needling, 10 years post-trabeculectomy. Likely causes include the use of antimetabolites, cyclodestructive procedures, and chronic conjunctival inflammation from eyedrops. Although needling is typically low-risk, it can lead to complications similar to trabeculectomy. Preoperative screening for scleral thinning using slit lamp and anterior segment OCT is recommended for high-risk patients. The presented two-stage treatment strategy proved successful in managing this complex case.

The implantable collamer lens (ICL, STAAR Surgical Co.) surgery is popular for its effectiveness and safety, but it carries potential risks. This study presents two unreported cases of hyphema after ICL surgery, highlighting the need for prompt investigation and management of both hyphema and IOP to prevent ocular damage.

Background: Morphological changes in the retina are crucial and serve as valuable references in the clinical diagnosis of ophthalmic and cardiovascular diseases. However, the retinal vascular structure is complex, making manual segmentation time-consuming and labor-intensive.

Methods: This paper proposes a retinal segmentation network that integrates feature channel attention and the Convolutional Block Attention Module (CBAM) attention within the U²Net model. First, a feature channel attention module is introduced into the RSU (Residual Spatial Unit) block of U²Net, forming an Attention-RSU block, which focuses more on significant areas during feature extraction and suppresses the influence of noise; Second, a Spatial Attention Module (SAM) is introduced into the high-resolution module of Attention-RSU to enrich feature extraction from both spatial and channel dimensions, and a Channel Attention Module (CAM) is integrated into the lowresolution module of Attention-RSU, which uses dual channel attention to reduce detail loss.Finally, dilated convolution is applied during the upscaling and downscaling processes to expand the receptive field in low-resolution states, allowing the model to better integrate contextual information.

Results: The evaluation across multiple clinical datasets demonstrated excellent performance on various metrics, with an accuracy (ACC) of 98.71%.

Conclusion: The proposed Network is general enough and we believe it can be easily extended to other medical image segmentation tasks where large scale variation and complicated features are the main challenges.

Background: To compare anterior scleral thickness (AST) in Turkish patients with open-angle glaucoma (primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG)) with healthy controls.

Methods: This prospective study involved 41 patients with PEG, 69 patients with POAG, and 46 healthy controls. We obtained spectral domain anterior segment optical coherence tomography (AS-OCT) images from the nasal and temporal quadrants and made AST measurements of 1 mm (AST), 2 mm (AST2), 3 mm (AST3), and 4 mm (AST4) posterior to the scleral spur (SS). Schlemm's canal (SC) diameter and area measurements were performed using the ImageJ software. The results were compared statistically.

Results: The average ASTs of the groups did not differ significantly (p > 0.05 for each). The analysis of the nasal SC diameter revealed a significant decrease in the POAG group in comparison with the PEG group, with no difference observed between the POAG and control groups (p = 0.038*). The mean nasal and temporal SC area was significantly smaller in the PEG and POAG groups compared with the control group (p < 0.001** and p < 0.001**, respectively).

Conclusions: There was no significant difference in nasal and temporal AST between groups; however, the SC area was found to be smaller in glaucoma groups compared with healthy controls. The present findings should be supported by further studies.

Background: To explore the changes of iris-trabecular contact (ITC) and intraocular pressure (IOP) in patients who underwent penetrating keratoplasty (PK) during early postoperative period.

Methods: This prospective study finally included 46 eyes of 46 patients who underwent PK or triple surgery. Slit lamp examinations, IOP and anterior segment optical coherence tomography (AS-OCT) scans were examined before surgery, and at one-day, one-week, and one-month follow-ups. The parameters of anterior segment, IOP values and ITC ranges were compared. Additionally, the correlation analyses were performed to reveal risk factors of high IOP and postoperative ITC.

Results: The anterior segment underwent a significant reconstruction in the early postoperative period. Preoperative ITC was present in one-third of subjects. ITC significantly decreased on the first postoperative day, but showed marked regression at one-week follow-up. For patients without preoperative ITC, there was a small incidence (10%) of new ITC occurrence. The correlation analysis indicated that the most related factor of postoperative ITC was the presence of preoperative ITC. A high IOP was measured in 15 patients during one month, and it was inclined to occur on the first postoperative day and in patients who accepted triple surgery.

Conclusions: The incidence of new ITC was relatively low, but unfortunately, the preoperative ITC ranges would predominantly reoccur during one month. ITC was not associated with IOP elevation during the early postoperative period in this study. Thus, AS-OCT were helpful to monitor changes of anterior segment and forecast postoperative ITC.

Background: Primary open-angle glaucoma (POAG) leads to elevated intraocular pressure (IOP) and gradual optic nerve damage. In a study by Abushanab et al., high-frequency deep sclerotomy (HFDS) effectively treated patients with POAG. HFDS creates channels through the trabecular meshwork (TM) using a high-frequency electrocautery probe tip, promoting aqueous humor outflow and reducing IOP. In Taiwan, HFDS has been rarely used to treat POAG patients. Therefore, we conducted the first trial and presented the outcomes of two cases to evaluate its effectiveness.

Case presentation: Both patients had long-term primary open-angle glaucoma (POAG) with significant optic nerve damage and visual field loss despite multiple medications. Case 1: A 66-year-old female with a preoperative intraocular pressure (IOP) of 20 mmHg and a history of diabetes mellitus (DM) underwent high-frequency deep sclerotomy (HFDS). Postoperatively, the IOP initially decreased to 12 mmHg without Abstract Pagemedications but reintroduced drops to maintain 13-15 mmHg during follow-up. Case 2: A 50-year-old female with a preoperative IOP of 18 mmHg underwent HFDS. The IOP remained stable between 11 and 13 mmHg postoperatively with a consistent medication regimen.

Discussion and conclusions: HFDS is a minimally invasive glaucoma surgery (MIGS) that effectively lowers the IOP in patients unresponsive to conventional treatments. This report presents two of Taiwan's first patients with POAG treated by HFDS, showing IOP reductions of 30% and 33.3% over one year with mild corneal endothelial cell loss, which is consistent with previous studies. HFDS demonstrated a significant IOP reduction compared to that in other MIGS techniques and fewer complications than traditional surgeries. Further research should optimize the postoperative management, consider the anatomical differences and pocket healing.

Purpose: To describe the clinical features and outcomes of neurotrophic keratopathy (NK) patients treated with minimally invasive corneal neurotization (MICN).

Methods: Medical records of patients with NK who were treated with neurotization surgery between January 2022 and December 2023 were retrospectively reviewed. Eleven patients underwent neurotization surgery via sural nerve grafts from the supraorbital nerves to the affected contralateral cornea. Ocular examinations as well as Cochet Bonnet esthesiometry (CBA) of the affected cornea were performed.

Results: The baseline corneal conditions were as follows: Mackie stage 2 (3, 27%) and Mackie stage 3 (8, 63%). All the patients demonstrated improvements in corneal sensibility and corneal epithelial healing postoperatively. The CBA measurements improved from 1.8 ± 4.0 mm at baseline to 46.4 ± 13.4 mm at 12 months after surgery (P < 0.05). The mean best-corrected visual acuity of 11 patients improved from logMAR values of 1.8 ± 0.3 at baseline to 0.8 ± 0.7 at 12 months postoperatively (p < 0.05). Before surgery, corneal nerves at subbasal levels were completely absent at IVCM in all the patients. Corneal nerve morphology improved and the mean corneal nerve fibre density (CNFD) was 14.1 ± 11.8 n/mm² 12 months postoperatively. The limbal vascular density decreased from 34.1 ± 4.6% at baseline to 6.4 ± 1.7% at 12 months after surgery (p < 0.05). Two patients underwent successful penetrating keratoplasty after MICN due to corneal leucoma.

Conclusion: MICN is a useful surgical treatment for facilitating corneal epithelium healing and improving corneal sensitivity and visual acuity in patients with severe NK.

Trial registration: This study protocol was reviewed and approved by the Ethics Committee of Zhongshan Ophthalmic Center (no. 2024KYPJ129).

Background: This study aimed to investigate the self-reported dissatisfaction rates and associated risk factors among patients who underwent cataract surgery using different types of presbyopia-correcting intraocular lenses (IOLs).

Methods: This retrospective case-control study analyzed the medical records in 340 eyes from 211 cataract surgery patients with presbyopia-correcting IOLs. The analyzed IOL types included bifocal (ReSTOR®), trifocal (PanOptix®), and extended depth-of-focus (EDOF; Symfony®) IOLs. The rates of self-reported dissatisfaction related to vision or photic disturbances were compared between these IOLs. Various factors, including sex, age, preoperative visual acuity and refractive status, and biometric indices, were analyzed to identify potential risk factors for dissatisfaction.

Results: The overall dissatisfaction rate was 18.5% (63/340). Among the IOL types, Symfony®-implanted eyes had the highest rate of near-vision dissatisfaction, while PanOptix®-implanted eyes showed similar proportions of photic disturbances and near-vision discomfort. The major risk factor identified for overall dissatisfaction, regardless of IOL type, was preoperative myopia, which aligns with the risk factor for near discomfort. Meanwhile, the risk factors for photic phenomena were revealed to be thinner corneal thickness and greater corneal astigmatism. By IOL types, preoperative myopia caused near-vision discomfort in Symfony® eyes, whereas greater corneal astigmatism and thinner corneas were linked to photic disturbances in PanOptix® eyes.

Conclusions: It suggests that near-vision discomfort is related to myopic factors, whereas photic disturbances are associated with ocular aberrations. The types of dissatisfaction vary depending on the designs of presbyopia-correcting IOLs.

Trial registration: This retrospective study adhered to the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Seoul National University Hospital on March 13, 2023 (IRB No: 2303-025-1409).