BMC Ophthalmology最新文献

Background: The injection of local anesthetics, an extremely painful procedure, leads to a reduction of patients' acceptance.

Objective: To investigate the efficacy and adverse reactions of 4% tetracaine gel (TG) and lidocaine-prilocaine cream (LPC) on reducing the local anesthetic injection pain for upper eyelid blepharoplasty.

Methods: Sixty participants were equally divided into three groups. Each patient in two treatment groups was assigned a pair of eutectic mixture of local anesthetics (EMLA) and 4% TG, and the blank control group did not receive any topical anesthetic. The primary outcome was the pain score associated with anesthetic injection. The secondary outcomes included the local cutaneous reactions and eyelid edema in 24 h postoperatively.

Results: The NRS score in the control group was 6.65 ± 1.60, in the 4% TG and EMLA sides of 5.75 ± 1.62 and 6.25 ± 1.48 in group A, without statistically significant (p = 0.334, 0.067, respectively). While in group B, the injection pain scores in 4% TG and EMLA sides were 4.65 ± 1.66 and 5.5 ± 1.73 (p < 0.001 and p = 0.031, respectively). A negative correlation was observed between age and LAIP (regression coefficient = -0.022), whereas gender had almost no impact (regression coefficient = 0.368). The administration duration of 4%TG and EMLA had no statistically significant effect on the cutaneous reactions observed on the patients' eyelids (p = 0.723, p = 0.507, respectively). However, the incidence of cutaneous reactions was 35% for EMLA, significantly lower than 72.5% for 4% TG (p < 0.001). The postoperative edema score of the control group was 1.5 (1.0,2.0), while in group A both 4% TG and EMLA sides scored 2.0 (1.0,2.0) and in group B they scored 2.0 (1.0,2.0) and 1.0 (1.0,2.0), respectively. Neither group showed significant differences in postoperative edema score compared to the control group, and there's also no significant difference was revealed comparing the 4% TG or EMLA side with the paired side in one group or the same side in the other group.

Conclusion: In comparison to LPC, 4% TG showed a stronger anesthetic effect on reducing injection pain after 60-minute application. It also generally presented a higher frequency of cutaneous reactions but didn't affect the eyelid edema 24 h postoperatively.

Trial registration: This study was registered at chictr.org (the first registration date is 03/04/2023, and the registration number is ChiCTR2300070153).

Background: Trabeculectomy (TRAB) traditionally has been the gold-standard surgical treatment for primary open-angle glaucoma (POAG), while gonioscopy-assisted transluminal trabeculotomy (GATT) is an emerging minimally invasive surgery used for the treatment of various open-angle glaucoma (OAG) types. In this study, we aimed to compare the efficacy and safety between GATT and TRAB for the treatment of POAG.

Methods: This cohort study included eyes with POAG that underwent a single GATT (30 eyes) or TRAB (34 eyes). Follow-up was conducted at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraocular pressure (IOP), the numbers of glaucoma medication, visual field mean deviation, peripapillary retinal nerve fiber layer thickness, surgical time, and complications were analyzed. Success criteria were defined as IOP ≤ 21 mmHg and ≥ 20% IOP reduction from baseline. Qualified and complete surgical success rates were also compared.

Results: IOP and antiglaucoma drug use decreased significantly at 12 months postoperatively in the both groups (P < 0.001), with no significant differences between the two groups pre- and postoperatively (P > 0.05). The success rates at 12 months were 70% (95% confidence interval [CI] = 52.6-87.4%) in the GATT group and 76.5% (95% CI = 61.4-91.5%) in the TRAB group (P = 0.559).Visual field loss remained unchanged at 12 months postoperatively compared with preoperative levels in both groups (P > 0.05); however, peripapillary retinal nerve fiber layer thickness decreased significantly at 12 months postoperatively compared with preoperative levels in the GATT group (P < 0.001). The most frequent complications after TRAB and GATT were bleb-related complications and hyphema, respectively.

Conclusions: GATT demonstrated an efficacy comparable to that of TRAB for the treatment of POAG with regards to lowering IOP, reducing medication use, and preserving visual fields. Thus, GATT is a minimally invasive technique that enables an effective and safe decrease in IOP.

Purpose: To evaluate the clinical outcomes of implanting two symmetrical Kerarings via a femtosecond laser in grade three keratoconus.

Patients and methods: This was a retrospective nonrandomized controlled clinical study. The study included one eye from each of twenty-three patients, all with Grade 3 keratoconus as classified by the Amsler-Krumeich classification. The ICRS surgery was performed with the patient under topical anaesthesia (benoxinate hydrochloride 4 mg/mL 0.4%). A tunnel channel was created by a femtosecond laser using a 60-kHz infrared neodymium glass femtosecond laser at a wavelength of 1053 nm (Abbott Laboratories Inc., Abbott Park, Illinois, USA). Two symmetrical Kerarings (Mediphacos Inc., Belo Horizonte, Brazil) were implanted in all the cases with 160° arcs and 250,300 µm thicknesses according to the corneal thickness at the implantation site. After surgery, the patients underwent a full ocular evaluation on Days 1, 7, and 14 and after one month. For a period of 1 year, corneal topography readings were taken quarterly, and the numbers of Pentacam measurements were averaged.

Results: Twenty-three eyes of twenty-three patients were included in this study. The mean value (± SD) of age was 22.8 (± 6.84) years. Six (26.09%) eyes were from males, and 17 (73.91%) were from females. The cone location was central for all patients. Spherical error, cylindrical error, spherical equivalent (SE), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) significantly improved after 3, 6, 9, and 12 months compared with the preoperative values (P value < 0.001). There was no significant difference in the axial and pachymetry readings before and after surgery. Kmax flattened insignificantly at 3 and 6 months of follow-up, whereas significant flattening was achieved at 9 and 12 months (P values = 0.046 and 0.042, respectively). The K mean, K1, K2, anterior elevation, topographic cylinder, and Q value posterior to the corneal surface were significantly lower at the 3-, 6-, 9- and 12-month follow-up visits than preoperatively (P value < 0.05). Posterior elevation and the Q value of the anterior corneal surface were significantly greater after surgery (3, 6, 9, and 12 months) than before surgery (P value < 0.05). With respect to the Belin ABCD grading system, A and D significantly improved throughout the follow-up visits (3, 6, 9, and 12 months) (P value < 0.001), whereas B and C did not significantly differ between the 3-, 6-, 9- and 12-month follow-up visits and the preoperative values.

Conclusion: Grade 3 KC, with the central cone managed with two symmetrical kera-rings, showed favourable results with respect to clinical and topographic outcomes, with improvements in the ABCD staging system of KC.

Purpose: To assess the correlation of body mass index (BMI), diet and lifestyle with allergic conjunctivitis (AC) in children.

Methods: This prospective case-control study included 105 children with AC and 105 age- and sex-matched children with no AC. Clinical data were collected, including BMI, dietary habits, physical activity, and sleep time. Multivariate regression analysis was used to analyze the risk factors for AC.

Results: Dietary habits including vitamin A supplement use (χ2 = 0.00; P = 1.00), the consumption of sweet food (χ2 = 6.70; P = 0.08), fast food (χ2 = 3.74; P = 0.29), beverages (χ2 = 1.17; P = 0.76), and seafood and fish (χ2 = 6.15; P = 0.10) and snacking before sleep (χ2 = 2.23; P = 0.53), were not associated with AC. There were significant differences in physical activity (χ2 = 12.64; P < 0.01) between the children with AC and healthy children. Physical activity of less than 1 h per day is more found among AC and more than 2 h of exercise per day is more found in healthy children. There were no differences in sleep duration (χ2 = 5.39; P = 0.07). Multivariate regression analysis revealed that a high BMI (overweight and obesity) (OR = 3.05; 95% CI: 1.30-7.20; P = 0.01) was a significant risk factor for AC. The consumption of fish oil supplements (OR = 0.38; 95% CI: 0.17-0.81; P = 0.01) and having been breastfed (OR = 0.34; 95% CI: 0.16-0.72; p = 0.005) were protective factors against AC.

Conclusion: A high BMI (overweight and obesity) can increase the incidence of AC. Breastfeeding and dietary supplementation with fish oil are recommended for children susceptible to AC.

Objective: This study aimed to conduct a network meta-analysis to evaluate the efficacy of various non-surgical treatments for intermittent exotropia(IXT).

Methods: A comprehensive search of the PubMed, EMbase, and Cochrane Library databases was performed to identify relevant randomized controlled trials (RCTs) up to June 2024. Following independent screening, data extraction, and bias assessment by two researchers, network meta-analysis was conducted using R 4.2.2 software.

Results: A total of 11 RCTs involving 1411 patients were included. Treatment options included overminus lenses (OML), conventional prisms(base-in prism) (CP), part time occlusion (PTO), and binocular vision training (BVT). OML demonstrated superior efficacy in improving distance and near control(1.1, 95% confidence interval (CI), 0.22 ∼ 1.8); 0.67, 95% CI :0.027 ∼ 1.2), as well as reducing near exodeviation compared to observation(4.5, 95% CI, 1.9 ∼ 6.9), but failed to reduce distance angle of deviation(3.2, 95%CI, -1.1 ∼ 6.4). No significant effect in improving control and reducing exodeviation angle at both distance and near was observed in PTO, BVT, and CP. Probability ranking indicated that the top-ranking three non-surgical interventions were OML, BVT and PTO for improving distance control and reducing near exodeviation; the top three non-surgical interventions for reducing distance exodevition were OML, PTO and BVT; the best non-surgical intervention for improving near control was OML, BVT、 PTO and CP have similar effects. The four non-surgical treatments had no significant impact on near stereoacuity.

Conclusion: Overall, OML ranks first among the four conservative treatment methods. These four commonly used non-surgical interventions did not significantly impact near stereoacuity. Clinicians should tailor personalized treatment strategies for patients with intermittent exotropia based on disease severity, characteristics, efficacy, and cost considerations.

Purpose: Frontalis sling surgery is a common method for ptosis correction for both pediatric and adult populations. This study aims to compare the characteristics and outcomes of this surgery in these two populations.

Methods: A retrospective cohort study. Patients who underwent frontalis sling surgery between the years 2009 and 2024, with complete medical chart data, and had at least a one-month follow-up period were included. Age, gender, ptosis type, type of sling, complications, and re-surgery were analyzed.

Results: A total of 62 patients were included, with 41 patients in the pediatric group and 21 patients in the adult group. The mean age was 4.7 ± 5.0 and 46.04 ± 18.33 years old in the pediatric and adult groups, respectively. The most common etiology of ptosis in the pediatric group was simple congenital (70%), while the most common etiology in the adult group was myogenic ptosis due to a systemic condition (47%) (p < 0.001). Baseline pre-operative MRD1 (marginal reflex distance 1) was lower in the adult group compared to the pediatric ( -0.37 ± 1.21 mm vs. 0.36 ± 0.65 mm respectively (t-test, p = 0.04)). However, the mean change in MRD1 (pre-operative to postoperative) was not significantly different for both groups (t-test, p = 0.5). A higher rate of sling extrusion was observed among the adult group (0% of pediatrics vs. 14% of adults, chi-square, p = 0.013). A higher number of previous sling surgeries were found to be positively correlated (r = 0.672) with overall postoperative complications (Pearson correlation. p = 0.006).

Conclusion: Frontalis sling surgery varies between adult and pediatric patients regarding etiology, preoperative findings, surgical approach, and complications. Adults experienced higher rates of complications such as sling extrusion and dry eye. Moreover, an increased number of previous sling surgeries was associated with a rise in postoperative complications such as suture dehiscence, extrusion, and granuloma formation. Consequently, frontalis sling procedures should be regarded as a last resort for ptosis correction in adults due to the elevated risk of complications.

Background: To investigate the spatial and morphologic features of lenses with different axial length (ALs) in cataract patients using swept-source optical coherence tomography (SS-OCT).

Methods: Totally 105 eyes of 105 patients scheduled to have cataract surgery were included. Eyes were divided into the control (AL < 24.5 mm), moderate myopia (MM, 24.5 ≤ AL < 26 mm) and high myopia (HM, AL ≥ 26 mm) groups. Spatial features including lens vault (LV) and iris-to-lens distance (ILD), and morphologic features including radii of curvature of anterior and posterior surface (Ra, Rp), lens diameter (LD) and lens thickness (LT) were measured in eight directions by SS-OCT.

Results: Spatially, the HM group had larger LV and ILD than the control group (both P < .05). LV and ILD were negatively correlated with AL, respectively (LV: r = -.484, P < .0001; ILD: r = -.656, P < .0001). Morphologically, both MM and HM groups had greater Ra and Rp than the control group. Ra was positively correlated with AL (r = .622, P < .0001), while the relationship between Rp and AL was non-linear. Moreover, the MM and HM groups had larger LD than the control group (both P < .001). Anterior LT was thinner in the HM than in the MM group (P = .026), while posterior LT between these two groups was similar. When compared in eight directions, similar trends were seen in Ra, Rp and LD, and the HM group showed a greater difference in Ra between horizontal and vertical directions.

Conclusions: This SS-OCT-based study showed that longer axial length is associated with a flatter lens, which was mainly attributed to the increase of Ra and LD. Longitudinal studies would be necessary to establish a causal relationship and temporal progression.

Background: The purpose of the study was to evaluate the relationship between prediction errors (PEs) and ocular biometric variables in cataract surgery using nine intraocular lens (IOL) formulas with an explainable machine learning model.

Methods: We retrospectively analyzed the medical records of consecutive patients who underwent standard cataract surgery with a Tecnis 1-piece IOL (ZCB00) at a single center. We calculated predicted refraction using the following IOL formulas: Barrett Universal II (BUII), Cooke K6, EVO V2.0, Haigis, Hoffer QST, Holladay 1, Kane, SRK/T, and PEARL-DGS. We used a LightGBM-based machine learning model to evaluate the explanatory power of ocular biometric variables for PEs and assessed the relationship between PEs and ocular biometric variables using Shapley additive explanation (SHAP) values.

Results: We included 1,430 eyes of 1,430 patients in the analysis. The SRK/T formula exhibited the highest R² value (0.231) in the test set among the machine-learning models. In contrast, the Kane formula exhibited the lowest R² value (0.021) in the test set, indicating that the model could explain only 2.1% of the PEs using ocular biometric variables. BUII, Cooke K6, EVO V2.0, Haigis, Hoffer QST, Holladay 1, PEARL-DGS formulas exhibited R² values of 0.046, 0.025, 0.037, 0.194, 0.106, 0.191, and 0.058, respectively. Lower R² values for the IOL formulas corresponded to smaller SHAP values.

Conclusion: The explanatory power of currently used ocular biometric variables for PEs in new-generation formulas such as BUII, Cooke K6, EVO V2.0 and Kane is low, implying that these formulas are already optimized. Therefore, the introduction of new ocular biometric variables into IOL calculation formulas could potentially reduce PEs, enhancing the accuracy of surgical outcomes.

Background: To evaluate the change in time in visual acuity, central macular thickness (CMT), and microperimetry (MP) findings in Behçet uveitis (BU) patients who were in remission with maintenance therapy.

Methods: This single center, retrospective, observational cohort study included twenty-five eyes of 25 patients with BU who were in remission during maintenance therapy. Best corrected visual acuity (BCVA), CMT, macular integrity index, average threshold, and fixation stabilities (P1 and P2) evaluated at six-month intervals were recorded. The changes in time were statistically analyzed. Paired samples t-test was used for normally distributed data and Wilcoxon rank test was performed for non-normally distributed data.

Results: The mean BCVA and CMT showed no significant changes after six months. Although the mean macular integrity index decreased and the mean fixation stabilities increased after six months, these findings were not statistically significant. The mean average threshold was 16.8 dB at baseline and it increased significantly to 19.3 dB in the sixth month (p < 0.001).

Conclusions: The results of our study suggest that although visual acuity and CMT showed no change in patients with Behçet uveitis receiving maintenance therapy, MP could detect an improvement in macular function.

Background: The EyeCee^® ONE intraocular lens (Nidek, Gamagori, Japan) has been withdrawn from the market due to a high number of reports of severe ocular hypertension (OHT) following phacoemulsification with implantation of this intraocular lens (IOL). In this case series, we report the results of a toxicological analysis and the surgical management of five patients with severe OHT following the implantation of defective EyeCee^® ONE IOLs during cataract surgery.

Cases presentation: Five patients developed early, severe OHT refractory to maximal medical therapy following uneventful phacoemulsification (PCE) cataract surgery with implantation of an EyeCee^® ONE IOL from a defective lot. Glaucoma filtering surgeries were required to control intraocular pressure (IOP). Toxicological analyses were carried out on the aqueous humor of one patient. IOP levels were monitored during postoperative follow-up, but three patients required postoperative adjustments (reintroduction of IOP-lowering therapy, goniopuncture or needling) in order to maintain IOP at satisfactory levels. Toxicological analysis revealed a high concentration of silicon in the aqueous humor of the patient from whom the sample was obtained.

Conclusions: These cases of OHT following cataract surgery with a defective IOL were of early onset severe, all requiring filtering surgery. The exact mechanism of this OHT has not been determined, but we did find high concentrations of silicon in the aqueous humor of one of these patients. Patients who received EyeCee^® ONE IOLs during the same period of time should have their IOP and optic nerve monitored to detect any potential OHT or glaucoma that might appear over time.