BMC Ophthalmology最新文献

Purpose: Diabetic macular edema (DME) is a leading cause of vision loss in patients with diabetes. In developed countries, intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) injections are the standard-of-care first-line treatment for DME. However, despite the efficacy of anti-VEGF and associated improvements in prognosis, some patients show only a partial response and continue to require monthly injections. The aim of this study was to investigate the effect of switching from aflibercept 2.0 mg to faricimab (which targets both angiopoietin-2 [Ang-2] and VEGF-A) on visual function, retinal anatomy and intraretinal fluid (IRF) dynamics in patients with refractory DME.

Methods: A single-center, observational study of patients with aflibercept-resistant DME who switched to IVT faricimab treatment, comprising a 3-month loading phase, during which faricimab was administered monthly (total of four injections), followed by a treat-and-extend regimen. Visual acuity, anatomical parameters, and fluid dynamics were assessed from baseline to Month 6 in an interim analysis.

Results: Fourteen eyes from 10 patients were included. At Month 6, mean best-corrected visual acuity improved by + 2.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (not statistically significant). Mean changes in central macular thickness and outer nuclear layer (ONL) thickness at Month 6 were not significant. However, ONL thickness was significantly reduced in multiples ETDRS macular grid subfields at Month 4. Subretinal fluid volume was negligible through Month 6, with most fluid located in the intraretinal layers (97.8-100%). Total IRF decreased by 22% at Month 4, reaching a nadir of - 37% at Month 2. There was no significant change in mean vascular density from Month 0 to Month 4.

Conclusion: Faricimab treatment led to modest early improvements in visual acuity and retinal anatomy overall in patients with refractory DME. The reduction in total IRF at Month 4 may be attributable to Ang-2 inhibition in these patients, who had previously not responded to anti-VEGF treatment alone. Longer-term studies are needed to evaluate the durability and long-term efficacy of faricimab for the treatment of refractory DME.

Objective: The increasing prevalence of refractive errors in children has raised interest in exploring potential associations with physical development. This study aimed to explore a potential relationship between refractive status and growth parameters among children aged 7-10 years.

Methods: A multistage stratified random sampling method was adopted to select 1260 primary school students in Pinggu District of Beijing in 2023, to measure their height and weight to calculate the body mass index (BMI). The height-for-age z-score (HAZ) and body mass index z-score(z-BMI) were calculated using the Least Mean Squares (LMS) method. Cycloplegic refraction was performed to determine spherical equivalent (SE). Ocular biometric data were collected, including axial length (AL) and anterior chamber depth (ACD). The ratio of AL to average corneal curvature (AL/CR) were calculated. Group comparisons used χ² test, t-test, analysis of variance (ANOVA) and Wilcoxon rank-sum test. Multiple linear regression models were used to analyze correlations between HAZ, z-BMI and ocular parameters.

Results: The myopia rate was 21.19% and increased with age. Compared to girls, boys had significantly longer AL, deeper ACD, steeper CR, and higher AL/CR. As myopia severity increased, AL lengthened, ACD deepened, CR steepened and AL/CR increased. In the overall group, HAZ showed a positive correlation with AL (β = 0.208, Adjusted R²=0.084) and CR (β = 0.201, Adjusted R²=0.049), z-BMI showed a positive correlation with AL (β = 0.136, Adjusted R²=0.084) and AL/CR (β = 0.108, Adjusted R²=0.014), and a negative correlation with SE (β=-0.069, Adjusted R²=0.007). In the emmetropia group, pre-myopia group, and myopia group, HAZ showed a positive correlation with both AL and CR, while z-BMI demonstrated a positive correlation with AL.

Conclusions: This exploratory study suggests that accelerated physical growth shows statistically significant but clinically modest correlations with axial elongation and myopia development. The findings do not demonstrate causal relationships between growth and refractive changes. AL/CR appears to be a key biometric predictor of refractive error. These hypothesis-generating results underscore the potential value of growth monitoring in myopia prevention and for further investigation into distinct physiological pathways in ocular development.

Purpose: To evaluate corneal endothelial morphology in patients with retinal vein occlusion (RVO) and to investigate the differential impact of ischemic versus non-ischemic status on endothelial cell integrity, while controlling for therapeutic interventions.

Methods: This prospective observational study enrolled 42 patients (84 eyes) with unilateral RVO. All participants were receiving intravitreal anti-VEGF therapy as part of their standard clinical care for retinal vein occlusion-related macular edema. Based on fundus fluorescein angiography findings, participants were stratified into ischemic (n = 21) and non-ischemic (n = 21) subgroups. Detailed endothelial assessment-including endothelial cell density (ECD), average cell area, coefficient of variation (CV), and hexagonality-was performed using non-contact specular microscopy. The fellow unaffected eyes served as internal controls to calculate intra-individual differences (delta analysis), thereby minimizing the impact of inter-subject variability. The study also assessed the potential confounding roles of intravitreal anti-VEGF injections and retinal laser photocoagulation.

Results: Direct intergroup comparison of absolute endothelial values showed no significant differences between ischemic and non-ischemic eyes (p > 0.05). However, intra-individual analysis revealed significant subclinical endothelial compromise specific to the ischemic phenotype. Ischemic RVO eyes demonstrated a significant reduction in ECD (p = 0.010), decreased analyzable cell count (p = 0.010), and increased average cell area (p = 0.002) compared to their healthy fellow eyes. Conversely, non-ischemic RVO eyes exhibited preserved endothelial structure comparable to fellow eyes, with no significant morphometric alterations. Importantly, the frequency of anti-VEGF injections did not differ significantly between the groups (p = 0.130), suggesting that the observed endothelial changes were ischemia-driven rather than treatment-induced.

Conclusion: Corneal endothelial alterations in RVO are predominantly ischemia driven, whereas non-ischemic eyes maintain structural integrity. This study highlights the importance of anterior segment monitoring in ischemic RVO and support the role of ischemic burden in subclinical endothelial compromise.

Objective: To evaluate whether sub-Tenon anesthesia used during cataract surgery has a potential effect on pupillary dynamics by assessing late-term pupillary responses, and to compare these outcomes with those under topical anesthesia to ensure the safety of sub-Tenon anesthesia.

Methods: The medical records of 63 eyes of 63 patients aged 50-70 who underwent cataract surgery between January 2022 and December 2023 were retrospectively analyzed. Demographic data and medical histories were reviewed. Comprehensive eye examinations including visual acuity, biomicroscopic and detailed fundus examination, and pupillography measurements (photopic, mesopic, scotopic, and dynamic responses) were recorded preoperatively and at postoperative week 1 follow-up.

Results: The mean ages of patients in the topical and sub-Tenon anesthesia groups were 67.25 ± 10.29 and 68.84 ± 9.31 years, respectively. A total of 21 patients were male and 42 were female. Topical anesthesia was applied to 31 eyes and sub-Tenon anesthesia to 32 eyes. Both groups showed significant changes in pre- and postoperative scotopic, mesopic, and dynamic 10-second pupillary responses (p < 0.05). However, there was no statistically significant difference in static and dynamic pupil diameters between the two groups (p > 0.05).

Conclusions: Sub-Tenon's anesthesia does not cause clinically significant changes in pupillary dynamics one week postoperatively, suggesting it is a safe alternative to topical anesthesia in terms of autonomic pupillary response.