BMC Ophthalmology最新文献

Background: Intravitreal anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME) may begin with several initial monthly doses. Characteristics, treatment patterns and outcomes were compared for eyes with DME that did and did not receive such initial doses.

Methods: This was a retrospective database study using American Academy of Ophthalmology Intelligent Research in Sight^® Registry data (01/01/15-31/12/20; index period). Eligible adults had documented DME within 2 months of first anti-VEGF treatment (index date), data available for 12 months beforehand, and ≥ 1 visual acuity (VA) recording ≤ 60 days before index date. Eyes must have received intravitreal anti-VEGF injections during the index period, but none in the prior 12 months. Characteristics and outcomes for eyes with initial doses (three injections within 100 days of index date) were compared with those without. Multivariate Cox Proportional Hazards modelling estimated predictors for treatment discontinuation, re-initiation, or switch; Generalized Estimating Equations-adjusted modelling estimated characteristics associated with receiving initial doses. Demographics and characteristics were summarised. Injection frequency and number, and VA were determined annually for ≤ 6 years. Discontinuations, reinitiations and switches were compared.

Results: Included were 217,696 eyes (n = 77,769 initial; n = 139,927 non-initial) from 166,868 patients. Mean (SD) baseline VA was numerically higher for eyes with versus without initial doses (63.0 [18.1] vs. 62.5 [19.8] letters); this remained during follow-up. Based on modelling results, Eyes with initial doses received more injections (mean [standard deviation (SD)] 11.6 [8.9] vs. 6.1 [6.8] injections) more frequently (interval 7.6 [2.8] vs. 12.6 [7.7] weeks) than eyes without. These differences occurred across follow-up years. Discontinuation (45.7% vs. 63.8%), re-initiation (17.2% vs. 25.0%), and switch (24.5% vs. 31.5%) were less common with initial doses. Asian, Black, and patients of other/unknown race were less likely (P < 0.01) to receive initial doses than White patients, as were Medicare/Medicaid-insured patients versus commercially insured patients (P < 0.01).

Conclusions: Various sociodemographic factors associate with initial anti-VEGF doses, including race, ethnicity and insurance. Although eyes with frequent initial doses maintained higher VA than those without, they also receive more injections over time. Further research may elucidate the impact of frequent initial doses versus total injection number on DME outcomes.

Background: This study reports a rare case of delayed spontaneous resolution of double anterior chambers (AC) resulting from non-rhegmatogenous Descemet membrane detachment (DMD) after deep anterior lamellar keratoplasty (DALK). Currently, management guidelines for this condition have not been established.

Case presentation: A 65-year-old woman with lattice corneal dystrophy underwent uncomplicated DALK, during which an unrecognized type 2 big bubble was present. On postoperative day 1, a total DMD was observed, and descemetopexy was attempted. After an unsuccessful air-filled descemetopexy, we opted for observation without further intervention. Spontaneous reattachment of Descemet membrane with a clear cornea was achieved at 3 months postoperatively. The endothelial cell count was 2,165 cells/ mm².

Conclusions: The spontaneous resolution of double AC in patients with DMD without visible perforation after DALK suggests that a "wait and observe" approach can be a reasonable and effective management strategy.

Purepose: The intraoperative femtosecond laser time, Cumulative Dissipated Energy (CDE), Effective Phacoemulsification time (EPT), and intraoperative fluid perfusion volume were compared under different model fragmentation modes using Catalys femtosecond laser system.

Methods: This was a single-center, prospective, randomized controlled study. A total of 120 eyes who underwent femtosecond laser-assisted cataract phacoemulsification combined with intraocular lens implantation in Xiamen Eye Center affiliated to Xiamen University from September 2022 to March 2023 were randomly divided into 4 groups to undergo pre-nucleus splitting in different ways: Group 1: six-split, Group 2: eight-split, Group 3: six-split + gridded softening, and Group 4: eight-split + gridded softening. Patient age, gender, LOCS III grade, intraoperative femtosecond laser time, CDE, EPT, and intraoperative fluid perfusion volume were collected and analyzed.

Result: Result SNK test and Bonferroni test showed no significant difference in the nuclear hardness of lens, age, gender, AL, ACD, WTW and LT among the four groups (P > 0.05). Femtosecond laser time: Group 1: 44.87 ± 21.08s; Group 2: 43.10 ± 16.57s; Group 3: 50.70 ± 17.30s; Group 4: 64.04 ± 30.08s. There was no significantly different among groups 1, 2 and 3 (P > 0.05). However, the difference between group 4 and Group 1&2 was statistically significant (P_1.4= 0.006, P_2.4=0.00 2). There were no significant differences in CDE, EPT, and fluid perfusion between the four groups.

Conclusions: Short axial length patients may benefit more from the Catalys femtosecond laser system's six or eight-split nucleus mode Settings, which produce the same or even more effective pre-split treatment than the mesh softening mode while using less femtosecond laser time.

Purpose: To evaluate early response of retinal sensitivity (RS) and retinal morphology in diabetic macular edema (DME) patients after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.

Methods: Sixteen eyes of 12 DME patients were included in this study conducted prospectively. All eyes underwent functional and morphologic examination of the macular area using microperimetry and optical coherence tomography (OCT) before and after intravitreal anti-VEGF injection. To determine significant differences between the values, paired t test was used. A correlation between CMT and RS was made using Spearman's test.

Results: Patients were evaluated at baseline, one week and one month after injection. The central macular thickness (CMT) decreased significantly from 449.33 ± 100.79 μm to 427.94 ± 85.76 μm to 357.93 ± 75.92 μm. The RS improved significantly from 7.94 ± 6.43 dB to 11.09 ± 7.42 dB at one week and to 14.22 ± 7.66 dB at one month after treatment. The CMT was significant negatively correlated to RS (r=-0.259, p = < 0.001), with decay of 0.025 dB for every 1 μm increase of CMT.

Conclusions: Retinal thickening due to DME can be adequately quantified using OCT, while microperimetry can offer information about retinal sensitivity in the exact location. Therefore, microperimetry can be a useful tool in predicting the functional outcome and determining the efficacy of anti-VEGF treatment for DME patients.

Background/aim: Mucosa-associated lymphoid tissue (MALT) lymphomas occur in not only the ocular adnexa, but rarely in the sclera or uvea. Histopathological confirmation contributes to a better understanding of the pathogenesis and treatment. We report a case of uveoscleral MALT lymphoma with angle-closure glaucoma.

Case report: A 73-year-old man was referred to our hospital for a detailed examination of a choroidal mass oculus sinister (OS). At the initial examination, best-corrected visual acuity (BCVA) was 0.4 OS, intraocular pressure was 37 mmHg OS, the left eye had a narrow angle with anterior chamber inflammation. Optical coherence tomography (OCT) showed marked choroidal elevation. Anterior segment OCT showed tumor invasion into the inferior angle and ultrasound B-mode echography demonstrated choroidal thickening and a banded hypoechoic area posterior to the eye. Magnetic resonance imaging showed isointensity in the tumor on heterogeneous enhancement on gadolinium contrast-T1WI. A tumor biopsy of the left sclera was performed one month after the initial visit. Based on pathological findings, he was diagnosed with uveoscleral MALT lymphoma. Two months after the initial visit, left eye irradiation was performed. Nine months after the initial visit, the tumor was in remission with open angle.

Conclusion: Angle-closure glaucoma caused by the uveoscleral MALT lymphoma was treated with radiotherapy, leading to IOP normalization as well as tumor remission.

Objectives: To analyze the influence of daily activity-related factors associated with COVID-19 infection on the occurrence of acute angle closure (AAC).

Methods: A multicenter hospital-based study was conducted at 23 ophthalmic centers in 17 provincial-level regions across China to recruit patients with confirmed AAC during the post-lockdown time of COVID-19 (P-TOC) from Dec 7, 2022, to Jan 17, 2023, and three lockdown time of COVID-19 (TOC) periods, which included the TOC-2022 (Sep 7, 2022 - Dec 6, 2022), TOC-2021(Sep 7, 2021 - Jan 6, 2022) and TOC-2020 (Sep 7, 2020 - Jan 6, 2021). Patient information, including demographic, a questionnaire on daily activity changes during the AAC period, COVID-19 history, and eye examination results, was collected.

Results: The study involved 3216 AAC cases, with 76.2% being female and 78.9% aged over 60 years. AAC occurrences during P-TOC was nearly tripled compared to the corresponding months in TOC-2021 and TOC-2020. Patients with AAC comorbidity and COVID-19 had significantly higher water intake (37.3% vs. 2.2%, p < 0.001) and poorer sleep quality (49.16% vs. 4.07%, p < 0.001) than those without COVID-19 comorbidity, while about 58.4% of these patients received antipyretic analgesic drugs for symptom management. The COVID-19 group showed higher intraocular pressure as well as worse uncorrected distance visual acuity, when compared to non-COVID-19 patients.

Conclusions: The relationship between AAC occurrence and daily activity factors associated with COVID-19 suggests that patient management should account for changes in daily activities.

Background: acquired exotropia mostly manifests as an intermittent form, and very few cases show constant exotrpia. However, the differences in the clinical features of the constant and intermittent exotropia patients has not been clear yet.

Methods: We retrospectively evaluated 6159 patients with exotropia from 2012 to 2022 in Farabi Eye Hospital, Tehran, Iran. The preoperative data collected were best corrected distance visual acuity (BCVA), spherical equivalent refractive error, amount and laterality of exotropia, presence of amblyopia and anisometropia.

Results: The mean age at the time of surgery was 21.9 ± 13.8 (range, 2-77) years and 3104 (50.4%) cases were male. Constant and intermittent exotropia were observed in 4244 (68.9%) and 1915 (31.1%) cases, respectively. BCVA was significantly worse in the constant than in the intermittent group (P < .05). In cases with dominancy, the non-dominant eye in intermittent exotropia patients showed significantly more minus spherical equivalent (-1.28 ± 3.03 diopter) compared to the constant group (-0.63 ± 4.41 diopter) (P < .001). Moreover, the mean angle of horizontal and vertical deviation at distance and near in patients with constant exotropia was significantly higher than in the intermittent cases, either when there was a dominance in one eye or in cases with no dominance (P < .001). Amblyopia was found in 38.3% of cases with constant and 13.1% with intermittent exotropia (P < .001). Anisometropia was observed in 821 (19.34%) with constant and 88 (4.6%) with intermittent exotropia (P < .001).

Conclusion: Constant exotropic patients had worse BCVA, larger angle of deviation, and higher prevalence of amblyopia and anisometropia compared to the intermittent cases.

This meta-analysis aims to evaluate the efficacy and safety of diabetic vitrectomy for treating tractional retinal detachment (TRD) by assessing visual acuity improvements, retinal reattachment success rates, and the frequency of postoperative complications. A comprehensive literature search identified 1,211 studies, 30 of which met the inclusion criteria and were analyzed. The meta-analyses were conducted via random effects models to account for heterogeneity. The primary outcomes were visual acuity improvement and retinal reattachment success, whereas postoperative complications were analyzed as secondary outcomes. Funnel plots, trim-and-fill methods, and Egger's regression tests were employed to assess and adjust for publication bias. The meta-analysis included data from 1,844 eyes across 30 studies. The pooled mean difference (MD) in visual acuity following diabetic vitrectomy was 0.80 logMAR (95% CI: 0.58-1.01, p < 0.0001), with significant heterogeneity (I² = 95%). The trim-and-fill method adjusted the MD to 1.15 (95% CI: 0.85-1.45), indicating potential publication bias. The pooled proportion of retinal reattachment success was 94.63% (95% CI: 90.88-96.89%), with substantial heterogeneity (I² = 82.2%). Egger's regression test confirmed publication bias in the retinal reattachment data (t = 6.07, df = 25, p < 0.0001). The most common postoperative complications were vitreous hemorrhage (8.2%, 0-41%), elevated intraocular pressure (7.3%, 0-25%), and cataract formation (10.3%, 0-43%). Diabetic vitrectomy significantly improves visual acuity and achieves high retinal reattachment success rates in patients with TRD despite considerable heterogeneity across studies. However, a critical limitation of the current literature is the lack of comprehensive reporting of essential markers of perfusion, such as the choroidal vascularity index and choriocapillaris flow area, which are crucial for a thorough understanding of the impact of vitrectomy on ocular perfusion and its correlation with structural and functional outcomes. These findings also highlight the need for vigilant postoperative management to mitigate common complications. Adjustments for publication bias via the trim-and-fill method suggest that the initial estimates of efficacy may be optimistic, but the overall benefits of the procedure remain substantial. Further research is warranted to standardize surgical techniques, include detailed perfusion outcomes, and enhance the reliability of future meta-analyses. Trial registration: Retrospectively registered.

Background: Recent studies have indicated that oxidative stress is a crucial pathophysiological process in glaucoma. We hypothesized that Posner-Schlossman syndrome (PSS) is a vascular inflammation in the ciliary body due to oxidative stress and endothelial dysfunction. Thus, we investigated serum uric acid (UA) and lipid levels in patients with refractory PSS with the aim of providing basic evidence for the mechanism of PSS.

Methods: This is a retrospective, case-control study. A total of 81 refractory PSS and 409 control participants were included in this study. Clinical and laboratory characteristics were reviewed using an electronic medical system. Propensity score-matched (PSM) analysis was performed to reduce demographic differences. The t-test, Mann-Whitney U test, and χ2 test were used to assess the differences between the PSS and control groups. Logistic regression analysis was used to identify the predictors of PSS.

Results: The higher serum UA (364.14 ± 98.72µmol/L vs. 322.38 ± 72.09µmol/L), higher low-density lipoprotein (LDL) / High-density lipoprotein (HDL) ratio (2.50 ± 0.97 vs. 1.95 ± 0.72) and lower HDL (1.29 ± 0.32 mmol/L vs. 1.59 ± 0.38 mmol/L) can be noticed in refractory PSS than control group. Logistics regression identified UA > 420 µmol/L (OR = 4.461) and the HDL < 1.03 mmol/L (OR = 3.896) were the independent risk factors for refractory PSS.

Conclusions: Increasing serum UA and decreasing HDL levels were positively correlated with the incidence risk of refractory PSS. Further prospective longitudinal studies and animal models are needed.

Aims/introduction: To investigate the related risk factors of retinopathy in young and middle-aged diabetic patients in order to improve the prognosis of patients.

Materials and methods: Using clinical practice data from a cohort study at our two research centers, we developed a bivariate logistic regression model to investigate the frightening risk factors potentially for retinopathy in young and middle-aged patients with diabetes, including diabetes type, physical activity level, treatment-related characteristics and laboratory tests.

Results: A total of 453 patients with diabetes were investigated, 197 (43.5%) developed retinopathy. The risk of retinopathy was closely related to place of residence (OR: 0.275, 95% CI: 0.093-0.814), education level (OR: 0.522, 95% CI: 0.363-0.749), medical payment method (OR: 2.152, 95% CI: 1.308-3.539), BMI (OR: 1.187, 95% CI: 1.091-1.291), disease course (OR: 1.072, 95% CI: 1.028-1.118), hyperlipidemia (OR: 2.547, 95% CI: 1.260-5.150), physical activity level (OR: 0.312, 95% CI: 0.220-0.443), and dietary compliance (OR 0.871, 95% CI: 0.806-0.940). The area under the receiver operator characteristic curve was 0.915. Goodness of fit (Hosmer-Lemeshow) was 0.658.

Conclusions: The risk of young and middle-aged patients with increased as a result of certain patient characteristics and complications, especially lower dietary compliance and physical activity level.