BMC Ophthalmology最新文献

Background: To investigate the impact of central corneal astigmatism on postoperative visual outcomes in patients with trifocal intraocular lens (IOL) implantation.

Methods: This retrospective study included 278 eyes of 278 patients who underwent uneventful cataract surgery with implantation of the trifocal IOL (AT LISA tri 839MP). Patients were divided into two groups according to the total corneal refractive power (TCRP) in 3 mm zone centered on the corneal apex: low astigmatism group, TCRP ≤ 0.75 diopter (D); high astigmatism group, TCRP > 0.75D. Postoperative evaluations were conducted at 3 months after surgery, including visual acuity, defocus curves, contrast sensitivity (CS), and objective and subjective visual quality.

Results: The low astigmatism group exhibited significantly better uncorrected near and intermediate visual acuity than the high astigmatism group (both P < 0.05). Significantly higher percentages of eyes in the low astigmatism group achieved uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) of 0.00 logMAR or better compared to the high astigmatism group (UDVA: 67% vs. 54%, CDVA: 76% vs. 64%, both P < 0.05). Defocus curves revealed that the low astigmatism group showed better visual acuity at defocus levels of + 0.5D, 0D, -0.5D, -3.0D, and - 3.5D than the high astigmatism group (all P < 0.05). Moreover, the high astigmatism group showed significantly poorer CS, greater higher-order aberrations, and more symptoms of blurred vision and diplopia. Percentages of spectacle independence and patient satisfaction did not differ between groups.

Conclusions: In eyes with central corneal astigmatism above 0.75D, suboptimal postoperative visual outcomes may be obtained after trifocal IOL implantation.

Background: This study aimed to identify the clinical characteristics of cases that is related to the response rate of adalimumab (ADA) treatment.

Methods: A retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: those with anterior segment inflammation (ASI+) and those without anterior segment inflammation (ASI-). The primary outcome was treatment success rate. Secondary outcomes including best-corrected visual acuity (BCVA), inflammation parameters [anterior chamber cell (ACC), vitreous haze (VH)], retinal nerve fiber layer (RNFL) thickness, fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed.

Results: The study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the ASI + group and 15 patients (28 eyes, 25.42%) in the ASI- group. The treatment success rate in the ASI + group was significantly higher than in ASI- patients (93.18% vs. 20%, p < 0.001). Following 6-month of ADA treatment in the ASI + group, there was a significant improvement in BCVA (p < 0.001), inflammation parameters (p < 0.001), reduced RNFL thickness and reduced FA scores (p < 0.001). Conversely, no significant differences were observed in BCVA, inflammation parameters, RNFL thickness and FA scores in the ASI- group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the ASI+ (p < 0.001) and ASI- groups (p < 0.05). Adverse events observed during the study period included abdominal pain, skin erythema, articular symptoms and respiratory infections.

Conclusion: ADA demonstrates superior efficacy in the treating pediatric non-infectious uveitis with ASI + compared to ASI-.

Objective: We aimed to investigate the occurrence and factors influencing early visual acuity (VA) outcomes and reoperation rates in patients with open globe injuries (OGI) and develop a nomogram for predicting early visual acuity outcomes and reoperation rate.

Methods: We conducted a retrospective review of data from 121 patients with treated OGI. Relevant information of all patients with OGI were collected after a 1-month timeframe post-surgery. Continuous variables were described using descriptive statistics, while categorical variables were described via frequency distributions between different groups. Model performance was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results: There were significant differences between patients with reoperation group and patients without reoperation in term of gender, initial visual acuity, length of stay, and Birmingham Eye Trauma Terminology (BETT) types of injury. The result showed that initial VA, laterality, the BETT types of injury, location, retinal detachment, orbital CT, and intraoperative changes were related to the VA outcome, and initial VA is the most significant factor. Constructed nomogram based on those variables had a good efficiency in predicting the VA outcome. We obtained eight variables related to reoperation, including initial VA, age, length of stay, Gender, BETT, iris prolapse, retinal detachment, and type of anesthesia, and age is the most important factor. The nomogram based on those variables had a good efficiency for predicting the reoperation. Furthermore, the DCA showed that utilizing a reference threshold of 0.71 for VA outcomes and 0.79 for reoperation rates may offer clinical net benefit.

Conclusions: Our models showcase significant predictive efficacy in evaluating early VA outcome and reoperation rate, offering valuable insights to ophthalmologists in their clinical decision-making endeavors.

Significance: Cataract surgery is one of the most performed surgical procedures worldwide. As a potential complication following cataract surgery, dry eye has the potential to impact visual outcomes, lower patient satisfaction, and be detrimental to quality of life.

Purpose: To evaluate the effect of cataract surgery on dry eye outcomes postoperatively.

Methods: We searched Ovid MEDLINE and Embase from 01/01/2010 to 16/08/2021 and included observational studies of participants ≥ 18 years old undergoing any cataract surgical procedure. We compared postoperative dry eye outcomes with baseline including Ocular Surface Disease Index (OSDI), tear break up time (TBUT), Schirmer's I test (ST1), and corneal fluorescein staining (CFS) at short-term (< 1 week) and medium-term (≥ 1 week to 3 months) follow-up.

Results: Our search yielded 11,133 records. After title and abstract, and then full text screening, we included 20 studies with 1,694 eyes. There was some evidence indicating a decrease in the TBUT during the short-term (within 1 week) and medium-term (1 week up to 3 months) periods following cataract surgery. There was a considerable degree of heterogeneity between studies across other outcomes. At medium-term follow-up most studies that reported ST1 and CFS showed deterioration of these outcomes but there was conflicting evidence of the effect of cataract surgery on OSDI. The review is limited by variability in follow-up timeframes which were unable capture potential clinical course like peak occurrence and duration.

Conclusion: Dry eye may persist up to three months postoperatively following cataract surgery. Further studies are required to determine if dry eye outcomes return to baseline at longer term follow-up.

Background: Aniridia is a rare panocular disease caused by gene mutation in the PAX6, which is essential for eye development. Aniridia is inherited in an autosomal dominant manner, but its phenotype can vary significantly among individuals with the same mutation. Animal models, such as drosophila, zebrafish, and rodents, have been used to study aniridia through Pax6 deletions. Recently, patient-derived limbal epithelial stem cells (LESCs) and human-induced pluripotent stem cells (hiPSCs) have been used to model the disease in vitro, providing new insights into therapeutic strategies.

Methods: In this study, corneal organoids were generated from hiPSCs derived from aniridia patients with three different PAX6 nonsense mutations, allowing for a detailed comparison between diseased and healthy control models. These organoids structurally mimicked the human cornea and were used to investigate histologic and metabolomic differences between healthy and aniridia-derived samples.

Results: Untargeted metabolomic analysis revealed significant metabolic differences between wild-type (WT) and aniridia-associated keratopathy (AAK) hiPSCs. Further metabolomic profiling at different time points demonstrated distinct metabolic shifts, with amino acid metabolism pathways being consistently enriched in AAK organoids.

Conclusions: This study emphasizes the profound impact of AAK mutations on metabolism, particularly in amino acid biosynthesis and energy metabolism pathways.

Purpose: To compare the prevalence, magnitude, and type of astigmatism among patients with different Duane Retraction Syndrome (DRS) types.

Method: This retrospective cross-sectional study reviewed the records of 312 DRS patients. Patients were categorized into DRS Types 1, 2, 3, and bilateral cases. Refractive errors and visual acuity were analyzed, emphasizing the prevalence of astigmatism types, specifically with-the-rule (WTR), against-the-rule (ATR), and oblique, as well as the power vectors for each DRS subtype.

Results: Our study included 312 patients with DRS, comprising 44.6% males and a median age of 18.5 years (interquartile range [IQR]: 7-27). Of these, 280 had unilateral DRS and 32 had bilateral DRS. The median age for unilateral DRS patients was 19 years (IQR: 7-27; 43.2% males), whereas for bilateral DRS patients, it was 16 years (IQR: 6-29.2; 56.3% males). In all DRS patients, 180 (57.7%) were diagnosed with Type 1 DRS, 87 (27.9%) with Type 2 DRS, and 45 (14.4%) with Type 3 DRS. In unilateral cases, WTR astigmatism was the most prevalent (56.8%), followed by oblique (23.6%) and ATR astigmatism (19.6%). Bilateral DRS patients exhibited a similar distribution in both eyes, with WTR astigmatism also being predominant. The comparative analysis of power vectors indicated that Type 1 DRS exhibited a greater prevalence of WTR and oblique astigmatism, whereas ATR astigmatism was the predominant pattern in Types 2 and 3. A comparison of cylindrical powers and power vectors among fellow eyes of different DRS subtypes revealed that Type 2 DRS had significantly higher cylindrical power (p = 0.017) and a greater tendency toward ATR astigmatism (p = 0.038) than fellow eyes in other subtypes, suggesting that astigmatic changes may also occur in fellow eyes.

Conclusion: Our study demonstrates a high prevalence of astigmatism, particularly WTR astigmatism, in DRS patients. Furthermore, we found significant associations between specific astigmatism patterns and DRS subtypes, suggesting a potential link between extraocular muscle innervation, co-contraction, and corneal shape. These findings highlight the importance of comprehensive astigmatism assessment in DRS patients for optimal refractive management.

Background: Cutaneous melanoma is the leading cause of death from cutaneous malignancy and tends to metastasize lymphatically and hematogenously to the lung, liver, brain, and bone; it is a rare source of metastatic disease to the eye. Herein we provide a case report of cutaneous melanoma metastatic to the ciliary body and choroid involving clinical examination, slit lamp photography, and B-scan ultrasonography.

Result: A 55-year-old female with known metastatic cutaneous melanoma presented with pain, a large ciliochoroidal mass, visual decline, and diffuse intraocular inflammation. The examination and testing were consistent with intraocular metastasis from her primary cutaneous melanoma. Given the extent of intraocular disease, the patient elected for enucleation of the involved eye. The patient's intraocular disease demonstrated significant regression on combination immunotherapy with nivolumab and ipilimumab and surgery was subsequently deferred. The metastatic ciliochoroidal lesion ultimately regressed completely with systemic dual checkpoint inhibitor therapy.

Conclusion: Combination therapy with ipilimumab and nivolumab immunotherapy may be effective in the treatment of aggressive intraocular metastatic cutaneous melanoma.

Background: Retinal pigment epithelium (RPE) tear is a well-known complication of RPE detachment and is typically associated with significant visual acuity decline. However, in this case, despite the occurrence of an RPE tear there was an unexpected improvement in visual acuity.

Case presentation: A 68-year-old male presented with blurred vision in his right eye of a month's duration. Pachychoroid neovasculopathy was diagnosed. After monthly anti-vascular endothelial growth factor injections over a three months period. the choroidal neovascular membrane gradually diminished. While the pigment epithelial detachment expanded and the subretinal fluid increased. This was accompanied by deterioration in the visual acuity of the patient. The anti-VEGF treatment was discontinued, expectant management was adopted. Three months later, a retinal pigment epithelium tear was observed near the fovea, unexpectedly accompanied by complete resolution of the subretinal fluid, partial reattachment of the RPE detachment, and a significant improvement in visual acuity.

Conclusions: This case presents a rare instance of significant improvement in visual acuity and anatomical reconstruction of macular structure following the development of a retinal pigment epithelial (RPE) tear in a patient with pachychoroid neovasculopathy. We suggest that the fovea-sparing nature of the RPE tear in our case and the resulting "incision and drainage" effect may explain this unexpected outcome.

Background: To evaluate the biosafety, reduction in anterior capsule opacification, and fluctuation in intraocular pressure (IOP) of a new phakic refractive lens (PRL) with a sinusoidal drainage groove design.

Methods: This self-controlled experiment was performed on eight eyes of four rabbits. Each rabbit was implanted with a sinusoidal PRL (PRL-S5) in the right eye and a conventional posterior chamber PRL (PC-PRL) in the left eye. Slit-lamp examinations, optical coherence tomography, and IOP evaluation were performed before surgery and at 1 day, 1 week, 3 months, 6 months, and 1 year postoperatively in each eye. Gross examination, histopathology, and electron microscopy of the capsule and PRL were performed 1 year postoperatively.

Results: On slit-lamp examination, the inflammatory reactions recovered one week after surgery. The PC-PRL group developed anterior subcapsular cataracts at 3 months postoperatively and diffuse and dense opacification of the cortex at 1 year. PRL-S5 showed mild local opacification in the optical zone 6 months postoperatively, which did not progress significantly. At 1 year, PC-PRLs had greater opacification (27.37-72.17%) than PRL S5 (6.63-66.96%). Three months after surgery, one eye in the PC-PRL group had scleral staphyloma, one eye had corneal edema, and one eye experienced nasal hepatic prolapse into the anterior chamber. One eye in the PRL-S5 group had papillary membranes but recovered 6 months postoperatively. Histopathological examination revealed liquefaction and necrosis of the opacified area in the center of the subcapsular membrane in both groups. Numerous granular bodies and fibrous precipitates were observed in epithelial cells in the opaque area. Electron microscopy showed that epithelial cells proliferated on the surface of all anterior capsule membranes, with no significant differences between the two groups. The capsular PC-PRL group showed anterior cortical proliferation and fibrosis. An IOP elevation was noted on the first postoperative day (18.8 to 37.9 mmHg). However, both the PC-PRL and PRL-S5 groups exhibited relatively stable IOP levels 1 week, 3 months, 6 months, and 1 year postoperatively.

Conclusions: The new PRL exhibited robust long-term biocompatibility. The sinusoidal groove design facilitated the maintenance of IOP stability without necessitating iridectomy and effectively mitigated the onset and progression of cataracts.

Background: This study aimed to explore ocular and periocular injuries resulting from animal and bird attacks among patients referred to a tertiary referral eye hospital of Iran over ten years (2014-2024).

Methods: In this retrospective analysis, we collected data on patient demographics, the species of the attacking animal and bird, the nature of the ocular and periocular injuries, details of ophthalmological examinations, therapeutic interventions, and surgical treatments.

Results: One hundred and twenty-nine patients, with an average age of 36 ± 23 years (range: 1-77 years), were included in this study, of whom 81 were male. Among these patients, 70 (54.3%) experienced open globe injuries, and seven were diagnosed with endophthalmitis during their hospital stay. Specifically, of the 60 injuries caused by birds, 47 patients (78.3%) experienced open globe injuries, whereas this rate was 21 out of 66 (31.8%) for injuries caused by quadrupeds (P-value ≤ 0.001). Rural patients had a significantly longer time interval from trauma occurrence to hospital admission (83.58 ± 31.46 h in the rural group vs. 29.85 ± 6.48 h in the urban group, P-value = 0.012) and from hospital admission to the first surgical intervention (8.8 ± 1.14 h in the rural group vs. 6.83 ± 6.13 h in the urban group, P-value = 0.020). Additionally, final visual acuity was significantly better in urban patients than in rural patients.

Conclusions: Animal and bird-related ocular trauma in Iran predominantly involves injuries caused by birds, with rural patients experiencing worse visual outcomes and delayed referral.