BMJ Open Ophthalmology最新文献

Purpose: Continuous curvilinear capsulorhexis (CCC) quality affects posterior capsule opacification and visual outcomes after cataract surgery. We developed a novel metric, the Capsulotomy Proficiency Index (CPI), to objectively evaluate the CCC manipulation during cataract surgery.

Methods: We developed a self-design code using MATLAB software to outline the motion trail of the capsulorhexis forceps, the surgical field motion amplitude, the CCC profile (circularity, deviation, decentration), the number of grasps and the total and effective CCC operating time, etc. Considering the weight of each parameter, an integrated CPI value was used to evaluate each CCC surgical video. A Mann-Whitney U test was used to compare the mean CPI from the two groups.

Results: This study included two surgeons with different total cataract surgery volumes (group A: a surgeon with experience of less than 500 cases, group B: a surgeon with experience of more than 1000 cases). 15 CCC videos from each surgeon during the same working period were randomly selected. Group A demonstrated a significantly lower CPI mean value than group B (0.47±0.32 and 0.89±0.23), indicating a significant difference in surgical level.

Conclusions: Based on the objective CCC surgical video evaluation, the CPI could reflect the surgical level difference in CCC manipulation.

Background/aims: The global increase in childhood myopia underscores the need for effective control strategies. This study compares the effectiveness of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses versus 0.01% atropine eye drops in slowing myopia progression in European children. This report summarises 1-year outcomes from an ongoing 2-year clinical trial.

Methods: A total of 110 Polish children aged 6-16 years, without significant ocular pathology, were randomly assigned to two groups. Group A received single-vision spectacles plus nightly 0.01% atropine drops; group B received DIMS spectacle lenses plus nightly placebo drops. Primary outcomes were changes in cycloplegic spherical equivalent refraction (SER) and axial length, measured every 6 months.

Results: After 12 months, mean axial elongation was 0.19±0.03 mm in group A and 0.11±0.02 mm in group B. Among 6-11-year olds, group A showed greater elongation (0.30±0.05 mm) than group B (0.15±0.02 mm). For 12-16-year olds, axial elongation was 0.10±0.02 mm in group A and 0.07±0.02 mm in group B. Mean SER progression was 0.37±0.06 D in group A and 0.23±0.05 D in group B. In the younger group (6-11 years), SER progression was higher in group A (0.60±0.1 D) than group B (0.25±0.05 D). Among older children (12-16 years), SER changes were similar between groups (0.19±0.05 D vs 0.21±0.08 D).

Conclusion: DIMS spectacle lenses demonstrated superior efficacy to the 0.01% atropine in controlling myopia progression in this cohort, particularly among children aged 6-11 years. These findings support DIMS lenses as an effective intervention for myopia control in Caucasian populations.

Objective: Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy is the standard treatment for neovascular age-related macular degeneration and other retinal vascular diseases. Despite proven efficacy in clinical trials, real-world data suggest suboptimal persistence and adherence. This study aimed to assess therapy continuity in routine practice using pharmacy-based dispensing data in Germany, focusing on treatment with prefilled syringes (PFS).

Methods and analysis: This retrospective cohort study used anonymised nationwide pharmacy sales data from Germany to evaluate patients who initiated anti-VEGF therapy with PFS between 2020 and 2023. Patient trajectories were followed from treatment initiation for up to 12 months. 46 546 therapy beginners with 297 454 anti-VEGF PFS purchases were included. Discontinuation of treatment was defined by not purchasing a relevant medication for >6 months.

Results: Mean time on therapy for all patients was 8.1±8.2 months (median=5.5) with 6.9±6.1 purchases (median=5). 20.5% of patients initiating anti-VEGF treatment stopped therapy before completing the loading phase (first three injections), and more than half of all patients discontinued treatment after 6 months. 49.4% of the patients who completed the loading phase (n all=34 895) adhered to the recommended monthly regimen. Non-adherence significantly decreased the number of injections later on (average of 7.5 vs 8.7 injections). Further, patients who stayed longer on therapy bought more PFSs within the first 6 and 12 months.

Conclusions: Real-world adherence and persistence to intravitreal anti-VEGF therapy in Germany are suboptimal, even with the use of PFS formulation. The high rate of early treatment discontinuation, especially during the loading phase, underscores the need for improved patient support, education and flexible treatment approaches to sustain long-term outcomes. A 'breaking point' or sensitive phase already seems to exist right at the beginning of therapy.

Objective: To evaluate the effectiveness of administering additional intravitreal topotecan injections (plus two) in reducing the recurrence rate in patients with advanced retinoblastoma (RB).

Methods and analysis: This retrospective, non-comparative and interventional study encompassed 26 eyes of 25 patients with RB, treated between January 2019 and April 2024. All eyes in this series had received previous intravenous chemotherapy and/or intra-arterial chemotherapy. Patients received intravitreal topotecan (30 µg/0.1 mL) and/or intravitreal melphalan (20-30 µg/0.1 mL) injections every 3-4 weeks until vitreous seeds regression was achieved. Subsequently, two additional injections of topotecan (30 µg/0.1 mL) were administered after complete regression to consolidate subclinical residuals. The control of vitreous seeds, ocular toxicity assessment and clinical characteristics was observed.

Results: The median age of the patients was 26 months, with 57.7% belonging to group D and 42.3% to group E of RB classification. A total of 111 injections were administered in 26 eyes, with a median of 4 injections per eye. Complete vitreous seeds regression was achieved in 100% of eyes, and eye salvage was successful in 24 of 26 eyes (92.3%). There were no recurrences of vitreous seeds. Enucleation was performed in two eyes: one due to phthisis bulbi and one due to optic nerve tumour recurrence. No cases of systemic metastasis or death were reported.

Conclusion: Administering additional intravitreal topotecan injections (plus two) following the complete regression of vitreous seeds may contribute to reducing the recurrence rate in patients with RB. This approach enhances the long-term efficacy of intravitreal injections, thereby contributing to higher eye salvage rates.However, the retrospective, non-randomised design and small sample size remain limitations. Multicentre prospective studies are warranted to validate these findings and refine treatment protocols.

Objective: To evaluate the literature-pooled functional, anatomical and safety outcomes of aflibercept biosimilars compared with reference aflibercept for neovascular age-related macular degeneration (nAMD).

Methods and analysis: Systematic review and meta-analysis. Medline, Embase and CENTRAL were searched from inception to 2 June 2025. Phase 3 randomised controlled trials (RCTs) comparing aflibercept biosimilars with the reference product in patients with nAMD were included. Two independent reviewers conducted screening, data extraction, risk of bias (RoB 2) assessment and certainty of evidence assessment (Grading of Recommendations, Assessment, Development and Evaluation), with a third reviewer resolving discrepancies. Primary outcomes included mean difference (MD) change in best-corrected visual acuity (BCVA) and retinal thickness over time, risk ratio (RR) for proportion of participants gaining >15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters and RR for adverse events. Meta-regression was used to evaluate the temporal stability of continuous outcomes.

Results: Six RCTs involving 2044 participants (1026 biosimilar, 1018 reference) were included. Five aflibercept biosimilars were evaluated, representing more than 50% of the eight biosimilars currently approved worldwide. Meta-regression revealed no significant difference in MD change in BCVA over time between biosimilar and reference aflibercept (slope: 0.0321 letters/week; p=0.1013). For MD change in retinal thickness, an initial anatomical advantage for reference aflibercept at week 0 (intercept: 9.58 µm; p=0.0449) was not sustained over time (slope: -0.1685 µm/week; p=0.2303). The pooled RR for gaining >15 ETDRS letters from baseline was 1.19 (95% CI 0.98 to 1.45; p=0.079). No statistically significant differences were observed across 15 safety outcomes.

Conclusion: This systematic review and meta-analysis found no statistically significant differences in functional, anatomical or safety outcomes between aflibercept biosimilars and the reference product for nAMD, based on moderate to high certainty evidence. Functional and anatomical outcomes appeared stable across multiple timepoints. Further long-term pharmacovigilance studies and real-world data beyond 56 weeks are warranted.

Prospero registration number: CRD420251048633.

Background/aims: To investigate the landscape to support Europe-wide collaborative real-world data (RWD) collection, exploring whether required resources are available to glaucoma clinicians.

Methods: This cross-sectional study employed a two-phase method, including two consecutive electronic questionnaires. For phase I, a survey was distributed to all European Glaucoma Society members inquiring about use of electronic medical records (EMRs). For phase II, EMR users who expressed their interest in contributing to a European RWD were surveyed regarding EMR data characteristics and technical resources.

Results: Phase I garnered responses from 201 glaucoma specialists, with 68% reporting use of an EMR. Among them, 47% and 65% reported over 90% of coding rates for diagnoses and medications, respectively. Despite the EMR making available report copies for perimetry (27%) and optical coherence tomography (OCT) (37%), automatic data extraction capabilities were limited to only 10% and 8%. 47 participants responded to phase II. Their practices saw an average of 415 glaucoma patients per month. Date of intraocular pressure (IOP) measurement was the most commonly available structured data (67%), followed by visual acuity (59%) and IOP (56%). 46% had access to central computing systems, with 41% reporting past experience in federated learning initiatives and 73% willing contribution. 34% reported involvement in the development of artificial intelligence algorithms.

Conclusion: This study highlights a noteworthy EMR use among European glaucoma specialists, with structured data for metrics like IOP, but identifies gaps in data extraction capabilities. Major challenges include EMR heterogeneity, lack of standardised outcomes, healthcare system differences and cost. A combined approach using structured coding, digitised EMR data and semistructured OCT/perimetry data is recommended.

Purpose: Observational studies suggest that anxiety and depression disorders have significant correlation, but these results may have been influenced by confounding factors, and negative emotions that do not meet the criteria for clinical mental disease diagnosis are more common, the evidence for this association is unclear. This study employed whole-genome linkage disequilibrium score regression (LDSC), Mendelian randomisation (MR), Bayesian colocalisation (colocalisation) to explore association between common negative emotions and glaucoma.

Design: Bidirectional genetic associations between negative emotion and glaucoma.

Participants: Data from UK Biobank and FinnGen R10.

Methods: MR, whole-genome LDSC, Bayesian colocalisation.

Main outcome measures: Genetic causal associations between negative emotion and glaucoma.

Result: At Bonferroni-corrected levels of significance, there was no genetic correlation, causal association or shared genetic mechanism between any negative emotions and glaucoma, except for depression, which showed a genetic link but no causal evidence.

Conclusions: Depression, anxiety and eight other common negative emotions may not be causally associated with glaucoma and there may be no genetic correlation between them.

Objectives: The meningo-orbital foramen (MOF) is an inconsistently present bony canal that connects the orbit with the cranial cavity, commonly the middle cranial fossa. It may transmit the meningolacrimal artery supplying orbital contents, making it clinically relevant in procedures involving the lateral orbital wall. This study aimed to investigate the morphometry and anatomical positioning of the MOF and discuss its surgical implications.

Methods and analysis: A total of 127 adult dry human skulls (254 orbits) were examined. Gender was estimated morphometrically, while ethnicity was unknown. The incidence, laterality and connection patterns of the MOF were evaluated. Additionally, the distance between the MOF and the frontozygomatic suture (FZS) was measured.

Results: Patent MOF was identified in 51.2% of skulls (65/127), with bilateral presence in 41.5% of those. By orbit count, the incidence was 36.2%. Accessory MOFs were found in 3% of orbits, including seven cases with two and one case with three foramina. Nearly half of the MOFs were located in the greater wing of the sphenoid, and over 95% communicated with the middle cranial fossa. The mean MOF-FZS distance on the left side was significantly greater in males (p=0.02), while the right side showed no significant gender difference.

Conclusion: MOF has high surgical relevance due to its frequency and association with critical vascular structures. Precise morphometric knowledge can help minimise intraoperative risk. Further cadaveric investigation is suggested to investigate the course of the meningolacrimal artery and improve surgical outcomes.

Background/aims: This retrospective comparative study evaluated the 3-year outcomes of two mitomycin C (MMC) delivery techniques in trabeculectomy for medically uncontrolled glaucoma: innovative two-stage intra-Tenon injection versus conventional sponge application, assessing efficacy and safety parameters.

Methods: From January 2014 to December 2017, 110 eyes (55 intra-Tenon injections, 55 sponge applications) underwent standardised trabeculectomy by a single surgeon. Comprehensive evaluation included serial intraocular pressure (IOP) measurements, glaucoma medication requirements, surgical success rates (complete: IOP 5-21 mm Hg with ≥20% reduction without medications; qualified: with medications), needling interventions and complication profiles.

Results: At the 3-year follow-ups, the intra-Tenon injection group demonstrated superior outcomes: significantly greater mean IOP reduction (from 31.51 to 12.8 mm Hg and from 29.02 to 15.02 mm Hg, respectively, p=0.012), more substantial antiglaucoma medication reduction (from 4.80 to 0.85 and from 4.59 to 1.53, respectively, p=0.011), higher overall success rates (94% vs 82.22%) and lower needling frequency (1.62 vs 4.07 procedures/eye, p=0.006) than the sponge group after trabeculectomy. Complication rates were comparable, with no significant difference in visual field preservation.

Conclusion: The two-stage intra-Tenon MMC injection provides significantly better IOP control, reduced dependence on medications and more durable surgical outcomes than sponge application, with comparable safety, supporting its potential as the preferred method of MMC delivery in modern trabeculectomy.

Aims: To develop a multidimensional imaging model to detect primary open-angle glaucoma (POAG) by combining fundus photographs with the retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness maps and deviation maps.

Methods: 1054 eyes of 546 patients were included. Images were randomly divided into training, validation and test datasets at 64%, 16% and 20%. Four basic convolutional neural network algorithms were used to develop the multidimensional imaging model by combining fundus photographs, RNFL and GCIPL deviation maps, with RNFL and GCIPL thickness maps. POAG structure damage was defined as RNFL and GCIPL thinning with neuroretinal rim thinning.

Results: Multidimensional imaging model obtained an area under the receiver operating characteristic curve (AUC) of 0.970 (95% CI 0.958 to 0.979), which was superior to the fundus photographs model (AUC, 0.945 (95% CI 0.929 to 0.958); p＜0.05), RNFL and GCIPL deviation maps model (AUC, 0.931 (95% CI 0.915 to 0.946); p＜0.001), RNFL and GCIPL thickness maps model (AUC, 0.958 (95% CI 0.944 to 0.969)) in the test dataset. There was a significant difference between the multidimensional imaging model (AUC, 0.969 (95% CI 0.934 to 0.988)) and three glaucoma ophthalmologists (attending ophthalmologist 1: AUC, 0.847; attending ophthalmologist 2: AUC, 0.842; resident ophthalmologist: AUC, 0.755; p＜0.001 for both) in one fold of the test dataset. Furthermore, the overall AUCs were lower in the myopic group than in the non-myopic group. The overall AUC for lesion detection by each model (p=0.159) was: low myopia group (AUC, 0.968 (95% CI 0.940 to 0.985)) > moderate myopia group (AUC, 0.966 (95% CI 0.936 to 0.984)) >high myopia group (AUC, 0.958 (95% CI 0.927 to 0.978)). The multidimensional imaging model outperformed unimodal models in diagnosing myopia combined with POAG.

Conclusion: The multidimensional imaging model, combining fundus photographs, RNFL and GCIPL deviation maps, with RNFL and GCIPL thickness maps, could perform better than unimodal models. Its potential to improve the diagnostic accuracy of myopia combined with POAG for various myopia levels is promising. This means it could be a valuable tool for assisting with POAG diagnosis in the clinic, offering hope for improved patient care.