BMC Ophthalmology最新文献

Background: Selective laser trabeculoplasty (SLT) is a non-invasive treatment option for glaucoma. It uses a Q-switched Nd: YAG laser. The aim of this study was to evaluate the efficacy of SLT as a treatment option for eyes with primary open-angle glaucoma (POAG) that have previously undergone viscocanalostomy with an Ologen implant, displaying uncontrolled intraocular pressure (IOP).

Methods: This retrospective cohort study included 26 eyes of 26 patients with POAG who had had SLT after viscocanalostomy or phacoviscocanalostomy with Ologen implant. These eyes showed a progression of glaucomatous damage, the IOP was above 21 mmHg, or with intolerable glaucoma medications. SLT was done using Tango Reflex multimodality YAG/SLT laser which is a Q-switched Nd: YAG laser producing a single 532 nm wavelength pulse with a 400 mm spot size and 3 ns pulse duration. The follow-up period was one year.

Results: One year post-SLT, complete success was achieved in 19 cases (73.1%), qualified success in 4 cases (15.4%), and failure in 3 cases (11.5%). The mean decrease in IOP was 5.64 ± 4.05 mmHg, the mean reduction of antiglaucoma medications was 1.00 ± 0.85, and the mean percentage of reduction in IOP was 23.5 ± 16.4. There was a statistically significant decrease in IOP and antiglaucoma medications (p = < 0.01).

Conclusion: SLT is a simple and effective procedure that can be used as a treatment option for eyes with POAG after viscocanalostomy with Ologen implant to reach the target IOP and decrease the number of antiglaucoma medications.

Background: This study aimed to evaluate the efficacy of a simple intravitreal injection of perfluoropropane (C₃F₈) in treating unclosed idiopathic macular holes (IMHs) in patients who had previously undergone primary pars plana vitrectomy (PPV).

Methods: This study was a retrospective, observational clinical study. It included patients diagnosed with unclosed IMHs following primary PPV combined with internal limiting membrane peeling and air tamponade. Optical coherence tomography (OCT) performed 1 week after PPV revealed unclosed IMHs with the presence of the 'cuff' sign and intraretinal cysts. The following day, these patients received a simple intravitreal C₃F₈ injection. Comprehensive evaluations, including best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus photography, and OCT, were performed before PPV, 1 week after surgery, and at follow-up intervals of 1-3 months after the intravitreal gas injection.

Results: The minimum linear diameter (MLD) of the macular holes (MHs) 1 week before C₃F₈ injection was 335.1 ± 74.3 μm. Following C₃F₈ tamponade, the closure rate of the MHs was 100%. The mean BCVA before C₃F₈ tamponade was 0.68 ± 0.17 logMAR (20/100) after primary PPV, which improved to 0.48 ± 0.19 logMAR (20/63) after C₃F₈ tamponade, showing a statistically significant difference (P = 0.01).

Conclusions: For patients with unclosed MHs after primary PPV, the presence of the 'cuff' sign on OCT suggests that retreatment can be effectively achieved through a simple intravitreal gas injection. This approach is straightforward, practical, and effective.

Background: Keratoconus is a common disease in clinical practice, and deep anterior lamellar keratoplasty(DALK) is a conventional treatment for keratoconus, which is effective and not easy to recur after surgery.

Case presentation: The author presents a rare case report involving a 21-year-old patient with Consecutive re-emergences of Keratoconus. He underwent DALK for keratoconus in his left eye in 2012 and experienced re-emergence 3 years later, followed by a second deep lamellar keratoplasty in the same year. In 2019, the patient experienced re-emergence of keratoconus and underwent a third deep lamellar keratoplasty in the same eye. Genetic testing was performed, and no abnormal genes were identified. Postoperative follow-up emphasized the management of chronic allergic conjunctivitis (CAC) and the correction of eye-rubbing habits. To date, he has not experienced any further re-emergence.

Conclusions: Keratoconus is a complex disorder with a multifaceted etiology and pathogenesis, including genetic, environmental, biomechanical, and cellular factors. Its treatment usually requires multiple considerations, including the choice of surgical methods, anti-inflammatory therapy, and correction of eye rubbing habits to guide patients for subsequent treatment interventions.

Background: Multifocal intraocular lenses (IOLs) are designed to reduce dependence on spectacles by providing multiple focal points. However, they are associated with photic phenomena such as halos and glare, and may reduce contrast sensitivity. The BIOS Trifocal is a single-piece acrylic diffractive IOL with a closed-loop haptic design, optimized for centration and stability. It features an aspheric, aberration-neutral surface and a precisely engineered diffraction grating for effective energy distribution across multiple distances. This study aims to evaluate the visual, clinical, and quality of life outcomes of the BIOS Trifocal IOL for treatment of cataract and presbyopia.

Methods: Participants who met the inclusion criteria underwent implantation of the BIOS Trifocal IOL and were assessed at 30 and 90 days post-surgery. The evaluations included measurements of patient-reported outcomes using the NEI-VFQ 25 at postoperative day 30 and uncorrected and corrected distance visual acuity and defocus curves at postoperative day 90. Additionally, intraoperative and postoperative complications were documented. Visual acuity assessments were performed under photopic conditions, with a range of defocus from + 1.5 D to -3.0 D.

Results: Significant improvements were observed in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and near visual acuity (UNVA) at both 30 and 90 days post-surgery (p < 0.001). The defocus curve demonstrated functional vision from + 1.5 D to -3.0 D, supporting the lens's efficacy for near, intermediate, and far distances. Quality of life, as assessed by the NEI-VFQ 25, showed marked improvement across all domains (p < 0.05), with no significant complications directly attributable to the IOL.

Conclusions: The BIOS Trifocal IOL presented satisfactory effectivity in the treatment of cataract and presbyopia, providing functional vision across near, intermediate and far distances and maintaining good patient satisfaction.

Trial registration: This trial was registered at the ReBEC (Registro Brasileiro de Ensaios Clínicos - Brazilian Registry of Clinical Trials)database under the registration code RBR-772s6y at April 6th, 2020.

Purpose: To explore the potential of crystalline lens decentration and tilt as indicators for screening cataract patients for presbyopia-correcting intraocular lens (IOL) implantation.

Methods: Prospective observational study. Patients undergoing phacoemulsification with bifocal (Tecnis ZMB00) or extended depth-of-focus (EDOF) (Tecnis ZXR00) IOL implantation were consecutively enrolled. The decentration and tilt of the crystalline lens and the IOL were quantified through the utilization of swept-source optical coherence tomography (SS-OCT, Casia2). Postoperative visual acuity (VA), contrast sensitivity (CS), objective optical quality, and patient-reported outcomes were assessed at a 3-month follow-up. A LOWESS (LOcally WEighted Scatterplot Smoothing) curve was employed to analyze the changes in VA, CS, and objective optical quality relative to the decentration or tilt of crystalline lenses. A further comparison of visual outcomes was conducted based on the inflection points suggested by the curves.

Results: Eighty‑seven patients with ZMB00 IOL and 76 patients with ZXR00 IOL were included. Multiple 6-mm internal aberrations showed a nonlinear increase with greater crystalline lens decentration. The inflection points for the steep increase were observed to be 0.28 mm for the bifocal group and 0.35 mm for the EDOF group. Beyond these points, internal aberrations such as coma increased significantly (all P < 0.01). Patient satisfaction decreased (P < 0.01). Moreover, the bifocal group exhibited a decline in spectacle-independence from 98.67% to 83.33% (P = 0.049), along with a reduction in CS (P < 0.05).

Conclusions: The increased decentration of crystalline lenses compromises specific visual quality aspects in eyes implanted with ZMB00 and ZXR00 IOLs, with cut-off values of 0.28 mm and 0.35 mm, respectively.

Background: This study aimed to evaluate the effects of guanfacine on the anterior and posterior segments of the eye.

Methods: This prospective study included 32 children and adolescents with Attention-deficit/hyperactivity disorder (ADHD). The participants underwent a detailed ophthalmologic evaluation before and 6 months after the beginning of guanfacine treatment. The following data were recorded for each participant: refraction error, intraocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT), corneal aberrations using corneal topography, retinal nerve fiber layer (RNFL) analysis of seven quadrants (central, nasal, naso-superior, naso-inferior, temporal, temporo-superior, temporo-inferior), central macular thickness (CMT), and choroidal thickness (CT). Assessments were made of these parameters obtained from images using an optical coherence tomography (OCT) instrument.

Results: A significant increase in total root mean square (RMS) (p = 0.029*), RMS low-order aberration (LOA) (p = 0.014*), Coma 0° (p < 0.001*), and Coma 90° (p = 0.037*) corneal aberrations was observed at the sixth month of guanfacine treatment in comparison with the baseline examination. Other ocular parameters demonstrated no significant change from the baseline examination findings at the sixth month of guanfacine treatment. (p > 0.05, for each).

Conclusion: Oral guanfacine in the treatment of ADHD had no effect on ocular structures such as the retina, choroid, optic nerve, refraction, or corneal thickness, although it increased corneal aberrations. The results require support through further studies with extended follow-up and a larger patient group.

Purpose: To describe the prevalence and the cumulative 6-year incidence of fundus tessellation in a rural Chinese adult population.

Methods: The Handan Eye Study was a population-based longitudinal study, with 6830 eligible subjects included in the baseline period, and 5394 subjects (follow-up rate: 85.3%) took part in the follow-up study. Participants had detailed eye examinations and physical examinations; a detailed questionnaire was also well administered. Fundus tessellation was defined as well-defined choroidal vessels that can be observed clearly around the fovea as well as around the arcade vessels.

Results: Among 6830 subjects who participated in the baseline study, the prevalence of fundus tessellation was 9.89% (95%CI: 9.22-10.58%). The prevalence of fundus tessellation increased with age; that of subjects aged younger than 50 years and those aged 50 years or older was 2.5% and 14.5%, respectively. Six years later, the cumulative 6-year incidence of fundus tessellation was 1.21% (95%CI: 1.03-1.40%). Similarly, the incidence of fundus tessellation also increased with age; that of participants aged younger than 50 years and those aged 50 years or older was 0.20% and 1.86%, respectively. The progression rate of fundus tessellation in those with fundus tessellation at baseline was 1.5% (95% CI: 0.82%, 2.38%). By multivariable analysis, subjects being older (OR: 1.079, P < 0.001) and havingβ-parapapillary atrophy at baseline (OR: 2.657, P = 0.002) were associated with a higher risk of incidence of fundus tessellation.

Conclusions: The prevalence and 6-year incidence of fundus tessellation were 9.89% and 1.21% in rural Chinese adults aged 30 + years, respectively. The progression rate in participants with fundus tessellation indicates the importance of regular follow-up for these patients.

Background: The post-operative evaluation of trabeculectomy blebs has traditionally relied on subjective clinical grading systems performed at the slit-lamp. This study explores the use of swept source anterior-segment optical coherence tomography (AS-OCT) to objectively measure bleb internal reflectivity and morphology, and to distinguish blebs with surgical success vs. failure.

Methods: Cross-sectional study of patients with glaucoma who had undergone trabeculectomy at least one year prior. Swept source AS-OCT was used to capture filtering blebs in the sagittal plane. Standardised regions of interests on the sagittal plane were segmented, and pixel intensity values and bleb height were measured. Receiver operating characteristic curves were used to examine the discriminatory ability of pixel intensity values and bleb morphology to classify blebs with surgical success or failure.

Results: 100 eyes of 65 patients were included, with a median post-operative follow up of 7.0 years (IQR 3.2-16 years). The proportion of complete success, qualified success and failure was 45%, 33%, and 22% respectively. The maximum bleb height was significantly greater in the blebs with complete success (1.74 vs. 1.25 vs. 1.23 mm in CS vs. QS vs. F, one-way ANOVA, p < 0.0001). Mean pixel intensity was significantly lower in blebs with complete success (150.8 vs. 157.4 vs. 167.4 in CS vs. QS vs. F, p = 0.0001). Bleb intensity standard deviation (AUC 0.81), maximal bleb height (AUC 0.76), mean pixel intensity (AUC 0.75) and minimum pixel intensity (AUC 0.75) offered the best discrimination between surgical success and failure.

Conclusions: Swept-source AS-OCT can be used to quantify bleb internal reflectivity and morphology, which can be used to distinguish between well vs. poorly functioning blebs. These parameters may assist surgeons in the objective evaluation of post-operative bleb outcomes.

Background: To evaluate the associations between anatomical changes and visual outcomes after membrane peeling in eyes with different stages of idiopathic epiretinal membrane (iERM) using optical coherence tomography angiography (OCTA).

Methods: All iERM eyes were graded into four stages based on the presence of ectopic inner foveal layers (EIFL) and underwent 23-gauge vitrectomy combined with ERM and internal limiting membrane (ILM) peeling, while their fellow eyes were treated as the control group. OCTA was used to measure retinal thickness(RT), foveal avascular zone (FAZ)-related parameters and superficial and deep capillary plexus (SCP and DCP) layers using 6 × 6 mm scans before, 1 month and 3 months after surgery. In addition, best corrected visual acuity (BCVA), metamorphopsia and macular features were assessed.

Results: Forty-six subjects were included in this study. In comparison to the preoperative data, visual acuity and metamorphopsia improvement was statistically significant in four stages(P < 0.05) and the higher stage (3 and 4) achieved more pronounced improvements (P = 0.002). For higher stage, RT reduced with an increase in stage(P < 0.001), superficial and deep foveal vessel density (SFVD and DFVD) and parafoveal vessel density (PRVD) in SCP declined remarkably, FAZ area was enlarged obviously, FAZ perimeter (PERIM), foveal vessel density (FD) and PRVD in DCP increased significantly after surgery (P < 0.05). Similar to high-stage patients, those with stage 2 iERMs demonstrated a decreasing trend in central macular thickness (CMT), paraRT (parafoveal thickness), SFVD, and DFVD(P < 0.05). Nevertheless, no notable alterations were observed in other indicators. Distinct from other groups, only CMT and FD increased slightly in stage 1 iERMs (P < 0.05). Post-LogMAR BCVA and LogMAR BCVA-d (pre-LogMAR BCVA -3-month post-LogMAR BCVA) were positively correlated with preoperative stages, CMT, pre-LogMAR BCVA, SFVD, and vascular tortuosity(P < 0.05). but negatively correlated with FAZ area and DFVD (P < 0.05). Preoperative and postoperative metamorphopsia had a certain positive correlation with preoperative CMT (P < 0.05).

Conclusions: According to OCTA analysis, different EIFL stages of iERMs showed significantly functional and anatomic differences before and after membrane peeling. Low-stage patients have better post-op visual function, while high-stage patients benefit more from surgery. It also demonstrated EIFL staging system contribute doctors to manage iERMs.

Objective: This study aims to investigate the correlation between the development of diabetic retinopathy (DR) and the changes in corneal sub-basal nerve plexus (SNP) and corneal dendritic cells (DCs).

Methods: 58 patients with type 2 diabetes mellitus (T2DM) and 30 age- and sex-matched healthy participants underwent assessment of the corneal nerve. The DR group was divided into no diabetic retinopathy (NDR) and 29 eyes with mild to moderate non-proliferative diabetic retinopathy (NPDR). We collected the clinical data (gender, age, body mass index), laboratory indicators (fasting blood glucose, glycosylated hemoglobin), and confocal laser scanning microscopy images for further analysis. Spearman rank correlation or Pearson correlation analyses were used to evaluate the relationships.

Results: Compared to the control group, all parameters of corneal nerves in the case group were significantly reduced (all P < 0.001). Similarly, the density of immature dendritic cells (DCs) in the NDR group (70.40 [49.10-87.50]) was significantly higher than that in patients with DR (22.80 [14.30-34.50]), while the density of mature DCs (27.80 [17.70-39.60]) was significantly lower than that in patients with DR (70.80 [47.20-90.40]) (all P < 0.001). The morphological score of DCs in the NPDR group (2.6 [2.4-2.8]) was significantly higher than that in the NDR group (1.80 [1.80-2.20]) (all P < 0.001). As diabetes progresses to the stage of diabetic retinopathy, there were significant negative correlations between inferior whorl length (IWL) (rho = -0.802, P < 0.001) and average nerve fiber length ( ANFL) (rho = -0.487, P < 0.001) with the occurrence of DR. Additionally, there were significant positive correlations between the density of mature DCs (rho = 0.704, P < 0.001) and corneal dendritic morphology (DCM)(rho = 0.791, P < 0.001) with the occurrence of DR.

Conclusion: Compared to patients with NDR, those with NPDR exhibited a reduction in corneal nerve fiber density (CNFD)and corneal nerve fiber length (CNFL), and the length of corneal nerves in the inferior whorl (IW) was also reduced and showed a significant negative correlation with the presence of fundus lesions. Patients with DR had an increased density and morphological score of mature DCs in the cornea. These findings suggest that we should focus on the changes in corneal nerves when screening and diagnosing DR, and treatment should be considered for better prognosis.