BMC Ophthalmology最新文献

Objectives: We aimed to investigate the effect of diabetic retinopathy and melatonin treatment on the relative telomer lengths (RTL) in retinal pigment epithelium (RPE) cells in a streptozotocin-induced diabetic rat model.

Background: TL can be used to evaluate diabetes mellitus, its complications, and the effectiveness of its treatment. However, TL assessment has not been performed in retinal cells in a diabetic retinopathy model until now.

Methods: Forty Sprague-Dawley male rats were randomly divided into four groups. The experimental groups were: Control Group (C): non- diabetic rats; Diabetes Mellitus Group (DM): rats induced to diabetes without treatment; Melatonin and Diabetes Mellitus Group (Mel + DM): rats induced to diabetes and after confirmation, treated with melatonin; Melatonin Group (Mel): rats were not induced to diabetes, treated with melatonin. Diabetes was induced by intraperitoneal administration of streptozotocin solution after 12 h food fasting. For eight weeks after the diabetes was induced, melatonin was administered via subcutaneous injection at a dose of 10 mg / kg. RTLs were measured by qPCR method with modifications. The comparison of averaged data among groups was performed using least significant difference (LSD) and Kruskal - Wallis Test and One way ANOVA test.

Results: RTL was significantly similar in control and melatonin group. RTL was thinnest in DM group, in addition melatonin treatment significantly prevented the RTL shortening in DM + Mel group (p = 0.031).

Conclusion: We demonstrated that diabetic retinopathy led to the shortening of RTL in RPE cells in rats and melatonin treatment prevents this shortening.

Background: This study was to evaluate the features of choroidal Sattler's and Haller's layer (CSHL) vessels in adults and explore its relationship with factors such as age, axial length (AL) and body mass index (BMI) by using ultra-widefield swept-source optical coherence tomography angiography (ultra-widefield SS-OCTA).

Methods: 24mm × 20mm fovea centered rectangular SS-OCTA scans were acquired. They were divided into 9 identical grids, with each equal size of 8 mm × 6.7 mm. OCTA artifacts were evaluated. Three-dimensional choroidal vascularity volume index (CVI) and choroidal vascular volume per unit area (CVV/a or CVV) of CSHL were calculated. The correlations of CVI and CVV with age, AL, and BMI were analyzed.

Results: Artifacts account for 19.30%, 18.60%, 30.23% of three inferior grids, respectively. CVI and CVV of left eyes were 30.82 ± 0.28% and 76.76 ± 2.19μm, respectively. Similary, CVI and CVV of right eyes were 31.16 ± 0.34% and 80.49 ± 3.10μm. Strong relationships of CVI (0.877, P = 0.000) and CVV (0.866, P = 0.000) were found between the two eyes in the same individual. The covariance of CVI is lower than that of CVV. Higher CVI was associated with younger age and shorter AL. Neither CVI nor CVV has association with BMI.

Conclusions: CVI can be a more stable parameter for describing choroidal medium and large-sized vessels compared to CVV. Aging and longer AL were associated with attenuated CSHL's vascularity. Taken together, these findings may provide helpful and referential CSHL vascular parameters for retinal specialists to reveal risk factors of choroidal diseases.

Background: Dry eye syndrome (DES) is common but lack of data in quality of life (QoL) of DES patients in Thailand. The primary outcome of this study was to determine QoL and health utility in patients of DES by EuroQol 5-domain (EQ-5D) of the 5-level version (5 L) instrument. The secondary outcome was comparison of the utility in the patients of DES classified by severity and causes including the autoimmune and non-autoimmune diseases.

Method: The study was a cross-sectional study at a hospital in the northern part of Thailand. The inclusions DES patients were followed by Tear Film and Ocular surface Society the Dry Eye WorkShop II definition. The EQ-5D-5 L (Thai version) descriptive system and the EQ visual analogue scale (VAS) was instrument for QoL evaluation.

Result: Total patients of DES were fifty-six. The most patients were female. The mean age was 57.7(± 13.9) years. The mean of EQ-5D-utility and EQ-VAS were 0.76 (± 0.18) and 72.56 (± 15.19), respectively. The mean of EQ-5D-utility in these patients who were classified by severity including mild, moderate and severe were 0.84 (± 0.16), 0.78 (± 0.14) and 0.71 (± 0.22), respectively. There is no statistic significant in the EQ-5D-utility and EQ-VAS among severity and the causes of these patients.

Conclusions: This study demonstrated the importance of assessing QoL in DES. The EQ-5D-utility was accorded with the severity of DES. However, no statistic significant was showed in the mean of EQ-5D-utility and EQ-VAS between the severity and between the causes including the autoimmune and non-autoimmune diseases of these patients.

Background: In thyroid-associated ophthalmopathy (TAO), orbital decompression is a critical surgical approach for functional and aesthetic reasons. Meanwhile, the presence of surgical complications, especially the new onset of primary gaze diplopia, also influences postoperative patient satisfaction. This research investigates the effectiveness and potential risks associated with different orbital decompression in patients with TAO.

Methods: Systematic searches were conducted to identify pertinent studies from PubMed, Embase, and the Cochrane Library databases. The search was completed on October 11, 2023. And after retrieval, the publication dates of the articles included in the analysis ranged from January 1, 2008, to February 22, 2023. The overall postoperative outcomes were determined using random-effects meta-analyses with corresponding 95% confidence intervals (CI). A network meta-analysis was performed to integrate both direct and indirect evidence. The primary outcomes were defined as the status of exophthalmos and the new onset of primary gaze diplopia.

Results: From 1,538 identified records, 87 studies were selected, encompassing 5102 patients and 8,779 procedures. The studies reported varying degrees of exophthalmos reduction based on different surgical techniques: -3.46 mm (95% CI -3.76 to -3.15 mm) for fat removal orbital decompression, -4.02 mm (95% CI -5.14 to -2.89 mm) for the medial wall technique, -3.89 mm (95% CI -4.22 to -3.55 mm) for the lateral wall technique, -5.23 mm (95% CI -5.69 to -4.77 mm) for the balanced wall technique, -3.91 mm (95% CI -4.37 to -3.46 mm) for the infero-medial wall technique, and - 5.80 mm (95% CI -6.47 to -5.13 mm) for the three-wall technique. The incidence of new-onset primary gaze diplopia was reported in 31 studies involving 214 out of 2001 patients, resulting in a weighted proportion of 0.11 (95% CI 0.06-0.14). Notably, the lowest rates were associated with the lateral approach and fat removal orbital decompression, with pooled proportion (95% CI) rates of 3% (1-6) and 3% (2-4), respectively, suggesting that these two techniques may be more effective in preventing the occurrence of this complication during the postoperative period.

Conclusions: This meta-analysis establishes that orbital decompression is a beneficial and safe surgical approach. While this study enhances the evidence hierarchy for orbital decompression in treating TAO, it requires further validation through larger, prospective, and randomized studies with long-term follow-up periods.

Background: Long-term hyperopia shift is a rare complication following cataract surgery, presenting significant clinical challenges in analysis and management.

Case presentation: A 52-year-old female with a history of high myopia and laser-assisted in-situ keratomileusis (LASIK) surgery presented with decreased vision in her left eye at the very fifth year after cataract surgery. The spherical equivalent in her left eye had increased to + 6.63 D. After thorough evaluation, the patient underwent secondary piggyback intraocular lens (IOL) implantation in the ciliary sulcus, resulting in high satisfaction.

Conclusions: This case of long-term hyperopia shift following cataract and LASIK surgeries provides valuable insights into potential etiologies and interventions for this uncommon complication.

Background: Leopard spots can appear in a variety of diseases; however, they are extremely rare in children with rhegmatogenous retinal detachment. This study presents two such rare cases in which leopard spot retinopathy was the initial manifestation of rhegmatogenous retinal detachment.

Case presentation: Case 1 involved a 4-year-old boy had previously been diagnosed with left eye uveitis and received systemic steroid therapy at a local hospital, but symptoms persisted. Extensive leopard-spot changes were observed in the posterior pole of the left eye and optical coherence tomography (OCT) showed multifocal, shallow retinal detachment in the left eye. Case 2 involved a 16-year-old girl who visited for decreased vision in her right eye. Examination of the right eye revealed leopard-spot changes at the posterior pole and a retinal hole in the fundus; multifocal retinal detachment was noted on OCT. In both cases, subretinal fluid was significantly absorbed after retinal laser photocoagulation or scleral buckling, with no recurrence of retinal detachment at late follow-up.

Conclusions: When leopard-spot changes are observed, the fundus must be carefully examined for any potential retinal holes, especially in pediatric patients.

Background: To compare the effectiveness of a brief binocular vision screening protocol to a comprehensive examination for detecting binocular vision anomalies before and after cataract surgery.

Methods: A comprehensive binocular vision test battery as a gold standard were administered on recruited patients before the first surgery and at the third visit after surgery on the second eye. A receiver operating characteristic (ROC) curve was plotted to illustrate the diagnostic ability of each test. In addition, a univariate logistic regression analysis was performed to further determine the contribution of each preoperative test to the prediction of pre- and post-surgical binocular vision anomalies.

Results: Significant differences were shown for the difference in phoria from distance to near measured by the cover test (Area Under Curve [AUC] = 0.96, P < 0.01), step vergence testing of positive fusional vergence at distance (AUC = 0.71, P < 0.01) and near (AUC = 0.77, P < 0.01). The other tests did not show statistically significant differences. The ROC curve generated by combining the difference in distance and near phoria with positive fusional vergence at both distance and near demonstrated a more robust measure of diagnostic accuracy. (AUC = 0.98, P < 0.01).

Conclusion: Distance and near phoria difference measured by cover test has similar effectiveness as a comprehensive binocular vision testing protocol for the diagnosis of binocular vision anomalies. Distance and near positive fusional vergence measured by step vergence testing also have significant predictive value. A combination of the two tests is an outstanding screening protocol for binocular vision anomalies before cataract surgery.

Trial registration: The study was registered at ClinicalTrials.gov (NCT03592615, Date of registration: July 19, 2018).

Background: Patient-reported outcome measures (PROMs) have become crucial in assessing cataract surgery, especially with increasing patient expectations. The RayPro database offers a platform for tracking PROMs after surgery. The purpose of this study is to investigate determinants of patient satisfaction following cataract surgery by analysing PROMs.

Methods: A multicentre, retrospective, observational study was conducted analysing the PROMs recorded in the RayPro database (Rayner, Worthing, UK) from May 2019 to February 2024. Inclusion criteria were age ≥ 18 years, uneventful cataract surgery, valid consent to the study, and at least 1 questionnaire response. Email questionnaires were sent at 1 week, 3 months, and 12 months postoperatively, in which patients scored their outcome satisfaction, surgeon and hospital satisfaction, spectacle independence, and dysphotopsia on a 0-10 scale. Correlations of PROMs with outcome satisfaction were determined for the overall cohort and for eyes categorized by type of implanted intraocular lens (IOL).

Results: 2589 patients (2589 eyes) from 119 hospitals (26 countries) were included. Outcome satisfaction showed strong to moderate negative correlation with daytime and nighttime dysphotopsia at 3 months (r=-0.522, p < 0.001; r=-0.430; p < 0.001, respectively), strengthening at 12 months (r=-0.609, p < 0.001; r=-0.541; p < 0.001, respectively). Outcome satisfaction showed weak to no correlation with spectacle independence for distance, intermediate, and near vision at 3 months (r = 0.209, p < 0.001; r = 0.160, p < 0.001; r = 0.071, p = 0.007, respectively). Similar correlations between outcome satisfaction and dysphotopsia and between outcome satisfaction and spectacle independence were observed in monofocal as well as presbyopia-correcting IOLs. In the overall cohort, surgeon and hospital satisfaction at 1 week were strongly correlated with each other (r = 0.592, p < 0.001), while both were moderately correlated with outcome satisfaction at 3 months (r = 0.344, p < 0.001; r = 0.339, p < 0.001, respectively) and 12 months (r = 0.307, p < 0.001; r = 0.314; p < 0.001, respectively).

Conclusion: Dysphotopsia was strongly correlated with patient dissatisfaction, and the correlation strengthened over time. Outcome satisfaction was weakly correlated with spectacle independence, and moderately correlated with surgeon and hospital satisfaction. Thus, postoperative visual quality and quality of care provided by surgeon and hospital can influence patient satisfaction.

Background/aims: Submacular haemorrhages (SMH) cause significant visual impairment. Until now, the comparative effectiveness of different treatment approaches remains inconclusive without clear treatment guidelines. The aim of our study was to evaluate the effectiveness of 5 surgical treatment modalities in terms of visual prognosis and success rate.

Methods: This retrospective study included 201 patients with SMH. Primary endpoint was best corrected visual acuity (BCVA), secondary endpoints included haemorrhage size and complications. Group 1 was treated with pneumatic displacement and rtPA-injection. Group 2 followed the "Manchester protocol" with rtPA-injection and-if needed-a standardised secondary procedure with pars plana vitrectomy (ppV) and subretinal rtPA. Group 3 underwent vitrectomy with subretinal rtPA, group 4 vitrectomy only and group 5 received subretinal lavage.

Results: Baseline characteristics were a mean age of 79 years and a follow-up of 4.6 months. Pre-intervention BCVA of 1.7 logMAR improved to 1.4 logMAR at follow-up. A gain of > 0.2 logMAR was achieved in 47% of patients, while 20% lost > 0.2 logMAR. Only group 2 achieved a statistically significant visual gain. While group 5 was statistically larger in haemorrhage size preoperatively (p < 0.05), all groups were statistically equal in SMH size at follow-up. Complications led to additional interventions in 20% of patients.

Conclusions: No significant change in visual prognosis could be achieved depending on the intervention. As more invasive techniques seem to lack the benefit of a better postoperative prognosis while carrying higher risks, it may be beneficial considering a less invasive option first.

Background: The "fellow-eye effect" in anti-vascular endothelial growth factor (anti-VEGF) therapy is a rare phenomenon, particularly with aflibercept. This case report documents the first instance of this effect in Pakistan, highlighting its significance in a resource-limited setting where recent regulatory changes have restricted treatment options for age-related macular degeneration (AMD).

Case presentation: A 62-year-old male presented with bilateral central vision loss due to neovascular AMD. Optical Coherence Tomography revealed serous subretinal fluid in both eyes. Due to financial constraints, only the right eye received a single 2 mg intravitreal aflibercept injection. Remarkably, at the four-week follow-up, both eyes showed significant improvement. Visual acuity improved from 6/12 to 6/9 in the treated right eye and from 6/15 to 6/12 in the untreated left eye. OCT scans demonstrated bilateral resorption of subretinal fluid. At three months, complete fluid resorption was observed in both eyes, with visual acuity improving to 6/6 bilaterally.

Conclusions: This case underscores the potential of the "fellow-eye effect" in anti-VEGF therapy, particularly with aflibercept, in treating bilateral AMD. It highlights a possible strategy for optimizing treatment regimens and reducing costs in resource-limited settings. However, it also raises concerns about systemic absorption and potential risks. The findings emphasize the need for further research on the pharmacokinetics of anti-VEGF agents, personalized treatment plans, and alternative therapies. This case is particularly significant in the context of Pakistan's recent ban on bevacizumab, underscoring the urgent need for accessible and affordable AMD treatments in developing countries.