BMC Ophthalmology最新文献

Background: While the role of peripheral retinal defocus in myopia progression has been established, systematic comparisons of defocus patterns across different retinal regions and refractive statuses remain limited. Furthermore, the specific defocus characteristics that can predict axial length (AL) and spherical equivalent (SE) progression warrant further investigation. This study aimed to characterize the regional distribution of peripheral retinal defocus in children and adolescents with varying refractive statuses using multispectral refractive tomography (MRT), and to evaluate its association with SE and AL.

Methods: Retinal defocus values (RDVs) in different eccentricities and quadrants were measured in different refractive groups under cycloplegic conditions using Multispectral Refractive Tomography (MRT). Statistical analysis included group comparisons and correlation analyses between RDVs and SE/AL. Multiple linear regression analyses were performed to analyze the predictors of SE/AL.

Results: There were statistically significant differences in RDVs and TRDV in various eccentricities and quadrants among the groups. The RDVs in the low and moderate myopia groups were significantly higher than those in the emmetropia group; RDV20-30 in the moderate myopia group was higher than that in the low myopia group. RDV in the vertical direction showed asymmetry in all three groups, while RDV in the horizontal direction showed asymmetry in the emmetropia and low myopia groups. SE was negatively correlated with age, flat keratometry (Kf), steep keratometry (Ks), TRDV, and RDVs in all eccentricities and quadrants. AL was positively correlated with age, TRDV, and RDVs in all eccentricities and quadrants, while being negatively correlated with Kf and Ks. Age, Kf, Ks, RDV0-10, and RDV10-20 were significant predictors of SE; age, Kf, RDV0-10, RDV10-20, and RDV20-30 were significant predictors of AL.

Conclusions: Retinal defocus in the vertical direction was observed to exhibit asymmetry across all groups, while the horizontal defocus asymmetry appeared to diminish in the moderate myopia group. Furthermore, RDV0-10, RDV10-20, and RDV20-30 were identified as potential significant predictors of AL.

Background: While immune checkpoint inhibitors like the anti-PD-1 agent tislelizumab have revolutionized the treatment of cancer, they pose a risk of immune-related adverse events (irAEs). Vogt-Koyanagi-Harada (VKH)-like uveitis is a rare, vision-threatening ocular irAE that poses significant diagnostic and therapeutic challenges, often mimicking its idiopathic counterpart.

Case presentation: Following ten cycles of adjuvant tislelizumab treatment, a 52-year-old female with a past medical history of esophageal cancer presented with acute monocular vision loss. Comprehensive ophthalmic evaluation revealed left optic disc edema, exudative retinal detachment, and characteristic serous retinal detachments on optical coherence tomography (OCT). Extensive systemic workup excluded infectious, neoplastic, and primary autoimmune etiologies. Notably, cerebrospinal fluid (CSF) analysis revealed a lymphocyte-dominant profile but no pleocytosis, a finding atypical for classic VKH disease. The uveitis responded markedly to systemic corticosteroid pulse therapy but flared unequivocally upon two subsequent tislelizumab infusions, establishing a clear drug-effect temporal relationship. After completing the planned 12 cycles of tislelizumab alongside a prolonged, carefully tapered oral corticosteroid regimen, the patient's ocular inflammation resolved completely. At one-year follow-up, visual acuity remained stable with no recurrence, demonstrating sustained remission after cessation of the inciting agent.

Conclusion: This case strongly implicates tislelizumab as a trigger for VKH-like uveitis and highlights two critical learning points: the potential lack of CSF pleocytosis as a differentiating feature from primary VKH, and the risk of recurrence upon drug rechallenge. It underscores the necessity for close collaboration between oncologists and ophthalmologists to navigate the dual imperatives of cancer control and vision preservation.

Clinical trial number: Not applicable.

Purpose: This study aimed to explore the agreement of biometric measurements and evaluate a parameter-hybrid strategy for intraocular lens (IOL) power calculations among CASIA2, IOL Master 700, and OA2000 in cataract patients.

Methods: Preoperative measurements were obtained from all three devices. Parameters included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometry (Km, Kf, Ks), white-to-white distance (WTW), and corneal cylinder (CYL). Since the CASIA2 does not provide AL measurement, a hybrid calculation strategy was designed. IOL power was calculated using the Barrett Universal II formula in four configurations: (1) IOLMaster 700 (standalone), (2) OA2000 (standalone), (3) CASIA2-derived anterior segment parameters + IOL Master 700 AL, and (4) CASIA2-derived anterior segment parameters + OA2000 AL. Refractive prediction accuracy was evaluated at one month postoperatively. Statistical analyses included repeated-measures ANOVA, the Friedman test, intraclass correlation coefficient (ICC), and Bland-Altman plots.

Results: The three SS-OCT devices showed excellent agreement for most parameters. However, clinically significant differences were observed in corneal curvature (Km, Kf, Ks) measurements among devices. The calculated IOL power providing emmetropia showed a statistically significant result. The standard strategy using IOL Master 700 parameters yielded the highest prediction precision (lowest mean absolute error) and the highest percentage of eyes within ± 0.50 D of the target refraction. Both hybrid strategies resulted in a systematic hyperopia bias, higher prediction errors, and a reduced proportion of eyes within ± 0.50 D. All strategies maintained safety, with over 91% of eyes within ± 1.00 D.

Conclusions: The hybrid strategy introduces a hyperopia bias and reduces refractive prediction accuracy. Using a single, consistent device for preoperative measurements is recommended for routine cataract surgery. The hybrid approach may serve only as a contingency in complex cases.