British Journal of Ophthalmology最新文献

Impact of microorganism virulence on endophthalmitis outcomes

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-18 DOI: 10.1136/bjo-2024-325605

Aaron Yap, Dilpreet Kaur, Sharmini Muttaiyah, Sarah Welch, Sue Lightman, Oren Tomkins-Netzer, Rachael L Niederer

Aims To determine the impact of microorganism virulence on visual outcomes in endophthalmitis. Methods Retrospective, multicentre cohort study of patients presenting with endophthalmitis between 2006 and 2021. A literature review was conducted to divide cultured microorganisms into low and high virulence subcategories. Results 610 eyes with endophthalmitis were recruited from New Zealand, the UK and Israel. The median age was 69.4 years. The median visual acuity was hand movements at presentation and 20/120 at the final follow-up. Severe visual loss (≤20/200) occurred in 237 eyes (38.9%) at the final follow-up. The culture-positive rate was 48.5% (296 eyes). Highly virulent microorganisms were associated with a 4.48 OR of severe visual loss at the final follow-up (p<0.001) and a 1.90 OR of developing retinal detachment or requiring enucleation or evisceration during the follow-up period (p=0.028). Oral flora were observed in 76 eyes (25.7%), and highly virulent microorganisms were observed in 68 eyes (22.9%). Highly virulent microorganisms were more likely to be found after glaucoma surgery (15 eyes, 34.9%) and vitrectomy (five eyes, 35.7%) compared with intravitreal injections (two eyes, 2.9%) and cataract surgery (22 eyes, 24.2%). On multivariate analysis, the following were associated with poorer visual outcomes: poor presenting vision (p<0.001), glaucoma surgery (p=0.050), trauma (p<0.001), oral microorganism (p=0.001) and highly virulent microorganism (p<0.001). Conclusion This is the first classification of microorganisms into high and low virulence subcategories that demonstrate highly virulent microorganisms were associated with poor visual outcomes and increased likelihood of retinal detachment and enucleation. Data are available upon reasonable request.

目的确定微生物毒力对眼底病视觉效果的影响。方法对 2006 年至 2021 年期间出现眼底病的患者进行回顾性多中心队列研究。通过文献回顾，将培养出的微生物分为低毒性和高毒性亚类。结果从新西兰、英国和以色列招募了 610 名眼底病患者。中位年龄为 69.4 岁。发病时视力中位数为手部运动，最后随访时视力中位数为 20/120。最终随访时，237 只眼睛（38.9%）出现严重视力下降（≤20/200）。培养阳性率为 48.5%（296 只眼）。高致病力微生物与最终随访时严重视力丧失的 OR 值为 4.48（p<0.001），以及随访期间发生视网膜脱离或需要摘除眼球或切除视网膜的 OR 值为 1.90（p=0.028）。在 76 只眼睛（25.7%）中观察到口腔菌群，在 68 只眼睛（22.9%）中观察到高致病性微生物。与玻璃体内注射（2 眼，2.9%）和白内障手术（22 眼，24.2%）相比，青光眼手术（15 眼，34.9%）和玻璃体切除术（5 眼，35.7%）后更容易发现高致病性微生物。在多变量分析中，以下因素与较差的视觉结果相关：较差的现视力（p<0.001）、青光眼手术（p=0.050）、外伤（p<0.001）、口腔微生物（p=0.001）和高致病性微生物（p<0.001）。结论这是首次将微生物分为高毒力和低毒力亚类，表明高毒力微生物与视觉效果差以及视网膜脱离和去核的可能性增加有关。如有合理要求，可提供相关数据。

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引用次数: 0

Progressive inner retinal neurodegeneration in non-proliferative macular telangiectasia type 2 非增生性黄斑毛细血管扩张症 2 型进行性内视网膜神经变性

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-17 DOI: 10.1136/bjo-2023-325115

Alec L Amram, S Scott Whitmore, Cheryl Wang, Christine Clavell, Lance J Lyons, Alexander M Rusakevich, Ian Han, James Folk, H Culver Boldt, Edwin M Stone, Stephen R Russell, Kyungmoo Lee, Michael Abramoff, Charles Wykoff, Elliott H Sohn

Purpose Patients with non-proliferative macular telangiectasia type 2 (MacTel) have ganglion cell layer (GCL) and nerve fibre layer (NFL) loss, but it is unclear whether the thinning is progressive. We quantified the change in retinal layer thickness over time in MacTel with and without diabetes. Methods In this retrospective, multicentre, comparative case series, subjects with MacTel with at least two optical coherence tomographic (OCT) scans separated by >9 months OCTs were segmented using the Iowa Reference Algorithms. Mean NFL and GCL thickness was computed across the total area of the early treatment diabetic retinopathy study grid and for the inner temporal region to determine the rate of thinning over time. Mixed effects models were fit to each layer and region to determine retinal thinning for each sublayer over time. Results 115 patients with MacTel were included; 57 patients (50%) had diabetes and 21 (18%) had a history of carbonic anhydrase inhibitor (CAI) treatment. MacTel patients with and without diabetes had similar rates of thinning. In patients without diabetes and untreated with CAIs, the temporal parafoveal NFL thinned at a rate of −0.25±0.09 µm/year (95% CI [−0.42 to –0.09]; p=0.003). The GCL in subfield 4 thinned faster in the eyes treated with CAI (−1.23±0.21 µm/year; 95% CI [−1.64 to –0.82]) than in untreated eyes (−0.19±0.16; 95% CI [−0.50, 0.11]; p<0.001), an effect also seen for the inner nuclear layer. Progressive outer retinal thinning was observed. Conclusions Patients with MacTel sustain progressive inner retinal neurodegeneration similar to those with diabetes without diabetic retinopathy. Further research is needed to understand the consequences of retinal thinning in MacTel. All data relevant to the study are included in the article or uploaded as supplementary information.

目的非增生性黄斑毛细血管扩张症 2 型（MacTel）患者会出现神经节细胞层（GCL）和神经纤维层（NFL）缺失，但目前还不清楚这种变薄是否是进行性的。我们对患有和未患有糖尿病的 MacTel 患者视网膜层厚度随时间的变化进行了量化。方法在这项回顾性、多中心、对比性病例系列研究中，我们使用爱荷华参考算法对至少两次光学相干断层扫描（OCT）间隔时间大于 9 个月的 MacTel 患者的 OCT 进行了分割。计算早期治疗糖尿病视网膜病变研究网格总面积和内颞区的平均 NFL 和 GCL 厚度，以确定随时间推移的变薄率。混合效应模型适用于每个层和区域，以确定每个亚层随时间的视网膜变薄情况。结果共纳入了 115 名 MacTel 患者，其中 57 人（50%）患有糖尿病，21 人（18%）有碳酸酐酶抑制剂（CAI）治疗史。患有和未患有糖尿病的 MacTel 患者变薄的比例相似。在没有糖尿病且未接受 CAI 治疗的患者中，颞侧视网膜旁 NFL 的变薄率为 -0.25±0.09 µm/ 年（95% CI [-0.42 至 -0.09]；P=0.003）。与未接受治疗的眼睛（-0.19±0.16；95% CI [-0.50, 0.11]；p<0.001）相比，接受 CAI 治疗的眼睛第 4 子场的 GCL 变薄速度更快（-1.23±0.21 µm/年；95% CI [-1.64 to -0.82]），核内层也出现了同样的效应。观察到视网膜外层逐渐变薄。结论 MacTel 患者的视网膜内层神经退行性病变与无糖尿病视网膜病变的糖尿病患者相似。要了解 MacTel 视网膜变薄的后果，还需要进一步的研究。与该研究相关的所有数据均包含在文章中或作为补充信息上传。

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引用次数: 0

The aqueous humour dynamics in primary angle closure disease: a computational study 原发性闭角型角膜病的泪液动力学：一项计算研究

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-09 DOI: 10.1136/bjo-2023-325109

Lin Fu, Xinyi Liu, Longqian Zhang, Jiangtao Lou, Xiaobo Zheng, Xiaojue Wang, Haishuang Lin, Liang Guo, Kezhao Wang, Yan Wang, Min Kan, Yuanbo Liang

Purpose To create a computational fluid dynamics (CFD) model of ocular anterior segment for primary angle closure diseases (PACD) and assess the aqueous humour (AH) dynamics in different angle closure ranges (ACRs). Methods The ocular anterior segment geometry was obtained from an optical coherence tomography image by SOLIDWORKS. Three different angle opening distance at 750 µm from the scleral spur (AOD750) values were established to mimic three widths of anterior chamber angle. The AH dynamics were modelled using the Navier-Stokes equation. The 3D CFD model of the ocular anterior segment was created in COMSOL Multiphysics. The major outcome was the maximum flow velocity (MFV) and pressure in the ocular anterior segment. An in vitro simulation model was used to validate the computational results of the pressure and ACRs. Results The MFV and pressure both showed a non-linear association with ACR in the CFD models of PACD. The MFV and pressure started to elevate when ACR was larger than 180°, and increased dramatically when the ACR was larger than 270°. The in vitro experiment of the pressure changes was consistent with the CFD model. No significant differences of the MFV and pressure among the three AOD750 models. Conclusions The association among the ACR, MFV and pressure is an ascending curve in PACD, and ACR of 180° and 270° are two critical turning points. Our results are consistent with clinical phenomenon and may be used to provide better guidances for the clinical management of PACD in different stages. Data are available upon reasonable request. Data can be acquired from the corresponding author upon reasonable request.

目的为原发性角闭合疾病（PACD）创建眼球前段计算流体动力学（CFD）模型，并评估不同角闭合范围（ACR）下的泪液（AH）动力学。方法通过 SOLIDWORKS 从光学相干断层扫描图像中获得眼球前段的几何形状。在距巩膜距 750 微米处建立了三种不同的开角距离（AOD750）值，以模拟三种宽度的前房角。AH 动态模型采用 Navier-Stokes 方程。眼球前段的三维 CFD 模型是在 COMSOL Multiphysics 中创建的。主要结果是眼球前段的最大流速（MFV）和压力。体外模拟模型用于验证压力和 ACR 的计算结果。结果在 PACD 的 CFD 模型中，MFV 和压力均与 ACR 呈非线性关系。当 ACR 大于 180° 时，MFV 和压力开始升高，当 ACR 大于 270° 时，MFV 和压力急剧升高。体外实验的压力变化与 CFD 模型一致。三种 AOD750 模型的 MFV 和压力无明显差异。结论在 PACD 中，ACR、MFV 和压力之间的关系是一条上升曲线，而 180° 和 270° 的 ACR 是两个关键转折点。我们的结果与临床现象一致，可为不同阶段 PACD 的临床治疗提供更好的指导。如有合理要求，可提供相关数据。如有合理要求，可向通讯作者索取数据。

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引用次数: 0

Effect of intravenous methylprednisolone on serum antibody levels in thyroid eye disease 静脉注射甲基强的松龙对甲状腺眼病患者血清抗体水平的影响

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-09 DOI: 10.1136/bjo-2024-325180

Chaeyeon Lee, Jung Eun Lee, Kyunga Kim, Kyung In Woo

Background/aims We evaluated longitudinal autoantibody changes after intravenous methylprednisolone (IVMP), compared them with those in untreated patients and identified prognostic factors for treatment response. Methods In this single-centre, retrospective, observational study, a total of 163 individuals diagnosed with moderate-to-severe thyroid eye disease were enrolled and followed for 12 months. Depending on whether IVMP was administered, we divided the patients into treatment and control groups. Based on the effect of IVMP on TSH receptor (TSH Rc) antibody level, we divided the patients into Ab declined and Ab not declined groups. We evaluated the time, group and interaction associations with the longitudinal autoantibody titres over 12 months using generalised estimating equations. Using multivariable logistic regression, we investigated the prognostic factors for a poor response to IVMP. Results In the IVMP group, the TSH Rc antibody (Ab) titre decreased rapidly for 6 months and then decreased slowly until 12 months, becoming similar to the control group at 12 months. This suggests a difference in the decreasing pattern over time between the IVMP and control groups (group and time interaction p=0.029). Total cholesterol (OR 1.0217 (95% CI 1.0068 to 1.0370), p=0.0043) was a significant prognostic factor for the steroid response. The threshold total cholesterol value to distinguish between Ab declined and Ab not declined was 186 mg/dL. Conclusion IVMP significantly decreased the TSH Rc Ab level for the 3 months after treatment, compared with the no-treatment group, but the groups did not differ significantly after 12 months. Patients with high total cholesterol levels generally showed a poor response to IVMP. Data are available on reasonable request. The datasets produced during and/or examined in the course of our present study can be obtained if requested to the author.

背景/目的我们评估了静脉甲基强的松龙（IVMP）治疗后自身抗体的纵向变化，将其与未经治疗的患者进行了比较，并确定了治疗反应的预后因素。方法在这项单中心、回顾性、观察性研究中，共招募了163名被诊断为中重度甲状腺眼病的患者，并对他们进行了为期12个月的随访。根据是否使用 IVMP，我们将患者分为治疗组和对照组。根据 IVMP 对 TSH 受体（TSH Rc）抗体水平的影响，我们将患者分为抗体下降组和抗体未下降组。我们使用广义估计方程评估了时间、组别和交互作用与 12 个月内纵向自身抗体滴度的关系。我们使用多变量逻辑回归法研究了对 IVMP 反应不佳的预后因素。结果在 IVMP 组中，TSH Rc 抗体（Ab）滴度在 6 个月内迅速下降，然后在 12 个月前缓慢下降，在 12 个月时与对照组相似。这表明，IVMP 组和对照组的下降模式随时间推移存在差异（组与时间的交互作用 p=0.029）。总胆固醇（OR 1.0217 (95% CI 1.0068 to 1.0370)，p=0.0043）是类固醇反应的重要预后因素。区分 Ab 下降和 Ab 未下降的临界总胆固醇值为 186 mg/dL。结论与未治疗组相比，IVMP 可明显降低治疗后 3 个月的 TSH Rc Ab 水平，但 12 个月后各组间无明显差异。总胆固醇水平高的患者对 IVMP 的反应一般较差。如有合理要求，可提供相关数据。如向作者索取，可获得本研究过程中生成和/或检查的数据集。

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引用次数: 0

Retinal curvature in Chinese children with myopia measured by ultra-widefield swept-source optical coherence tomography. 通过超宽视场扫源光学相干断层扫描测量中国近视儿童的视网膜曲率。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-07 DOI: 10.1136/bjo-2024-325704

Hotin Wu, Bo Zhang, Jun Chen, Ziyi Qi, Xun Xu, Huo Li, Xiangui He

Aims: To quantitatively measure retinal curvature (RC) in children with myopia and explore its association with refractive status.

Methods: This cross-sectional study included participants aged 5-18 years who underwent comprehensive ocular examinations, including cycloplegic refraction and macula 24×20 mm optical coherence tomography (OCT) scans. RC was derived from OCT data using a three-dimensional reconstruction system. Mean RC was assessed in concentric circles (RC I-VI) with diameters of 1, 3, 6, 9, 12 and 15 mm around the fovea, as well as in four orientations (RC S/I/N/T).

Results: A total of 443 eyes were included in the analysis. The values from RC I to RC VI were 0.51±0.19, 0.53±0.19, 0.62±0.19, 0.76±0.23, 0.86±0.23 and 0.81±0.18 10^-2mm^-2, respectively. RC I exhibited the smallest curvature, while RC V displayed the highest (p<0.001). High myopia (HM) group demonstrated larger RC I and smaller RC III/IV/V/VI compared with low myopia (LM) group (p<0.01). Significant differences among RC S/I/N/T were observed in HM group (pairwise comparison, p<0.001), but not in LM group. Multiple regression analysis revealed that age, sex, corneal curvature radius and subfoveal choroidal thickness (SFCT) were associated factors with foveal RC, while age, SFCT and axial length (AL) were associated factors of peripheral RC.

Conclusion: RC can quantitatively characterise retinal shape and the morphological changes induced by myopia. Myopia progression results in a bulging macular retina accompanied by a flattening peripheral retina in children, and also increases the irregularity among the four quadrants. Age, AL and SFCT are associated factors of RC.

目的：定量测量近视儿童的视网膜曲率（RC），并探讨其与屈光状态的关系：这项横断面研究的参与者年龄在 5-18 岁之间，他们接受了全面的眼科检查，包括屈光度数和黄斑 24×20 毫米光学相干断层扫描（OCT）扫描。利用三维重建系统从 OCT 数据中得出 RC。以眼窝周围直径为 1、3、6、9、12 和 15 毫米的同心圆（RC I-VI）以及四个方向（RC S/I/N/T）评估平均 RC：共有 443 只眼睛参与了分析。从 RC I 到 RC VI 的值分别为 0.51±0.19、0.53±0.19、0.62±0.19、0.76±0.23、0.86±0.23 和 0.81±0.18 10-2mm-2。RC I 的曲率最小，而 RC V 的曲率最大：RC 可以定量描述视网膜的形状以及近视引起的形态变化。近视发展导致儿童黄斑视网膜隆起，周边视网膜变平，同时增加了四个象限之间的不规则性。年龄、AL 和 SFCT 是 RC 的相关因素。

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引用次数: 0

Carbon dioxide laser excision as a novel treatment for large xanthelasma palpebrarum: long-term efficacy and safety 二氧化碳激光切除术作为治疗大面积睑黄褐斑的新疗法：长期疗效和安全性

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-05 DOI: 10.1136/bjo-2024-325581

Dingqiao Wang, Zhen Mao, Zuohong Li, Wuyou Gao, Yixin Qu, Xingyi Li, Yuzhen Jiang, Xianchai Lin

Aims This study evaluates the long-term efficacy and safety of carbon dioxide (CO₂) laser excision as a novel treatment for large xanthelasma palpebrarum. Methods The study included 295 patients diagnosed with xanthelasma palpebrarum, categorised as 246 patients with grade I, 16 with grade II, 22 patients with grade III and 11 with grade IV lesions. All underwent CO₂ laser excision and were followed up for a 12-month period. Treatment efficacy was assessed through clearance and recurrence rates, evaluated using digital photography and complications were recorded. Results The participant group consisted of 66 males and 229 females, with an average age of 41.7±11.6 years. Clearance rates exceeded 99% for grades I–III and were around 95% for grade IV lesions. The recurrence rate was 6.8%, with higher recurrence rates observed in lesions over 2 mm in height compared with those under 2 mm (p<0.001). The main complications over the 12-month follow-up were scarring (4.4%), hyperpigmentation (8.1%) and hypopigmentation (8.5%), with no severe complications reported. Conclusion CO₂ laser excision emerges as a precise, minimally invasive and effective modality for treating xanthelasma palpebrarum, marking a significant advancement in treatment modalities. Further research is required to reinforce these results and refine treatment protocols. Data are available on reasonable request. The data including deidentified participant photographs are available on reasonable request (wangdq5@mail2.sysu.edu.cn).

目的本研究评估了二氧化碳（CO₂）激光切除术作为治疗大面积睑黄褐斑新方法的长期疗效和安全性。方法该研究纳入了 295 名确诊为睑黄褐斑的患者，分为 246 名 I 级患者、16 名 II 级患者、22 名 III 级患者和 11 名 IV 级患者。所有患者都接受了 CO₂ 激光切除术，并接受了为期 12 个月的随访。治疗效果通过清除率和复发率进行评估，使用数码照片进行评估，并记录并发症。结果参试者包括 66 名男性和 229 名女性，平均年龄为（41.7±11.6）岁。I-III级病灶的清除率超过99%，IV级病灶的清除率约为95%。复发率为 6.8%，高度超过 2 毫米的病灶复发率高于高度低于 2 毫米的病灶（P<0.001）。随访 12 个月的主要并发症是瘢痕（4.4%）、色素沉着（8.1%）和色素减退（8.5%），没有严重并发症的报告。结论 CO₂激光切除术是治疗睑黄褐斑的一种精确、微创、有效的方法，标志着治疗方法的重大进步。要巩固这些成果并完善治疗方案，还需要进一步的研究。如有合理要求，可提供相关数据。如提出合理要求，可提供数据（包括去身份化的参与者照片）(wangdq5@mail2.sysu.edu.cn)。

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引用次数: 0

Clinical spectrum and possible pathogenesis of progressive outer retinal necrosis 进行性视网膜外层坏死的临床表现和可能的发病机制

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-05 DOI: 10.1136/bjo-2023-325113

Xiaohu Ding, Robert T Chang, Xiongze Zhang, LiLi Liu, Yangfan Yang, Lin Lu, Xiaofeng Lin

Objective Progressive outer retinal necrosis (PORN) is an alphaherpesvirus-caused panuveitis with devastating consequences for the eye. Our study aims to describe new findings in the clinical spectrum and propose a mechanism for the pathogenesis of PORN. Methods Observational, consecutive case series. Seven eyes from five patients diagnosed with PORN were enrolled. Detailed case histories, ocular examination findings and multimodal images of retina were collected. Optic nerve and brain imaging were obtained by MRI. Results All eyes were confirmed human alphaherpesviruses positive in ocular fluid by qPCR. Optic nerve oedema was observed on MRI in all eyes. A relative afferent pupillary defect was recorded in the affected eye for the unilateral cases. Two patients with unilateral involvement had a history of viral encephalitis and focal encephalomalacia found in the temporal lobe on brain MRI. The affected eyes were characterised by sensory retinal necrosis sparing retinal pigment epithelium, starting at the end of the retinal nerve fibre (horizontal raphe or peripheral area of the retina) and progressing rapidly along the nerve fibre. The wall of the retinal artery and vein was destroyed, resulting in blood flow interruption on fluorescein angiography and retinal haemorrhages along the large vessels. Conclusions Combination the neurotropic characteristics of alphaherpesviruses and the signs of PORN, we hypothesised that the reactivated PORN virus originated from the lateral geniculate nucleus, then propagated along the optic nerve and was released at the terminals, causing necrosis of the entire sensory retina rather than just affecting the outer segment. All data relevant to the study are included in the article or uploaded as online supplemental information.

目的进展性视网膜外坏死（PORN）是一种由阿尔法疱疹病毒引起的泛葡萄膜炎，对眼睛具有破坏性后果。我们的研究旨在描述临床谱系的新发现，并提出 PORN 的发病机制。方法观察性连续病例系列。共纳入五名确诊为 PORN 患者的七只眼睛。收集了详细的病史、眼部检查结果和视网膜多模态图像。通过核磁共振成像获得了视神经和大脑图像。结果通过 qPCR，证实所有患者的眼液中人类阿尔法疱疹病毒均呈阳性。所有眼球的核磁共振成像均观察到视神经水肿。在单侧病例中，受累眼的瞳孔相对传入缺损。两名单侧患者有病毒性脑炎病史，脑部核磁共振检查发现颞叶有局灶性脑瘤。受累眼睛的特征是感觉性视网膜坏死，视网膜色素上皮缺失，从视网膜神经纤维末端（视网膜水平剑突或周边区域）开始，沿神经纤维迅速发展。视网膜动脉和静脉壁遭到破坏，导致荧光素血管造影显示血流中断，大血管沿线出现视网膜出血。结论结合α-疱疹病毒的神经滋养特性和 PORN 的体征，我们推测重新激活的 PORN 病毒源于外侧膝状核，然后沿视神经传播并在终端释放，导致整个感觉视网膜坏死，而不仅仅影响外节。与该研究相关的所有数据都包含在文章中，或作为在线补充信息上传。

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引用次数: 0

Short-term choroidal changes as early indicators for future myopic shift in primary school children: results of a 2-year cohort study. 将短期脉络膜变化作为小学生未来近视转移的早期指标：一项为期两年的队列研究结果。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-03 DOI: 10.1136/bjo-2024-325871

Hao Wu, Mengqi Liu, Yuanyuan Wang, Xiang Li, Weihe Zhou, Haoer Li, Zhu Xie, Pengqi Wang, Tingting Zhang, Wei Qu, Jing Huang, Yunpeng Zhao, Jiefang Wang, Sen Zhang, Jia Qu, Cong Ye, Xiangtian Zhou

Background: To assess predictive value of short-term choroidal changes for future myopic shift in children.

Methods: 577 eyes of 289 primary school children were prospectively followed for 2 years. Cycloplegic refractions at baseline, 1 year and 2 years, and choroidal measurements by optical coherence tomography at baseline and 3 months, were used for analyses. Myopic shift was defined as refraction change of at least -0.50 dioptre/year, at 2 years compared with baseline.

Results: 228 participants (455 eyes) completed 2-year follow-up. Approximately 37.6% of 311 initially non-myopic eyes and 73.6% of 144 initially myopic eyes developed a myopic shift. Notably, at 3 months greater reductions were found in initially myopic eyes with myopic shift, than in those without myopic shift-in choroidal thickness (ChT), luminal area (LA), stromal area (SA) and total choroidal area (TCA), but no significant differences in any choroidal parameters were observed between non-myopic eyes, with and without myopic shift. Multivariable analyses showed that in myopic eyes, each percentage increase in ChT, LA, SA and TCA was associated with reduced odds of myopic shift (all p<0.001). Similar associations were observed in non-myopic eyes, with smaller effects than in myopic eyes. Adding a 3-month percentage change of each choroidal parameter to a basic model including age, gender, parental myopia and baseline refraction significantly improved the predictive performance in myopic eyes (area under the receiver operating characteristic curves increasing from 0.650 to approximately 0.800, all p<0.05), but not in non-myopic eyes.

Conclusion: Short-term choroidal changes could act as early indicators for future myopic shift in children.

背景：评估短期脉络膜变化对儿童未来近视度数变化的预测价值：方法：对 289 名小学生的 577 只眼睛进行为期 2 年的前瞻性随访。基线、1 年和 2 年的屈光度数以及基线和 3 个月的光学相干断层扫描脉络膜测量值均用于分析。结果：228 名参与者（455 只眼睛）完成了为期 2 年的随访。在 311 只最初为非近视眼的眼睛中，约有 37.6% 出现了近视度数改变；在 144 只最初为近视眼的眼睛中，约有 73.6% 出现了近视度数改变。值得注意的是，3 个月后，发现有近视转移的初始近视眼的脉络膜厚度（ChT）、管腔面积（LA）、基质面积（SA）和脉络膜总面积（TCA）比没有近视转移的近视眼减少得更多，但在有近视转移和没有近视转移的非近视眼之间，没有观察到任何脉络膜参数的显著差异。多变量分析表明，在近视眼中，ChT、LA、SA 和 TCA 每增加一个百分点，近视度数发生改变的几率就会降低（所有 p 均为 0）：短期脉络膜变化可作为儿童未来近视度数改变的早期指标。

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引用次数: 0

At a glance 一览

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-09-01 DOI: 10.1136/bjo-2024-326260

Frank Larkin

High-risk factors for intraoperative zonular complications due to pre-existing zonular dehiscence in eyes with pseudoexfoliation syndrome were poor mydriasis, a shallow anterior chamber, and large lens decentration, emphasising the importance of preoperative assessment of these clinical parameters. Ocular inflammatory events following COVID-19 vaccination are rare, the most commonly reported phenotype being anterior uveitis. Lower corneal hysteresis was significantly associated with the presence of glaucoma, primary open angle glaucoma and exfoliation glaucoma in a general Japanese population. Corneal hysteresis provides additional information for elucidating the aetiology of glaucoma. Advanced glaucoma is the major risk factor for lifetime blindness. This study presents evidence that surgery is a cost-effective strategy compared with medical treatment in patients with advanced glaucoma over the patient’s lifetime. This post hoc analysis showed a trend for loss of vision gains in patients with macular oedema due to retinal vein occlusion …

假性角膜外翻综合征患者术中出现角膜外翻并发症的高危因素是瞳孔散大、前房变浅和晶状体分散度大，因此术前对这些临床参数进行评估非常重要。接种 COVID-19 疫苗后发生眼部炎症的情况很少见，最常见的表型是前葡萄膜炎。在日本普通人群中，较低的角膜滞后与青光眼、原发性开角型青光眼和剥脱性青光眼的存在明显相关。角膜滞后为阐明青光眼的病因提供了额外的信息。晚期青光眼是导致终生失明的主要风险因素。本研究提供的证据表明，在晚期青光眼患者的一生中，手术治疗与药物治疗相比是一种经济有效的策略。这项事后分析表明，视网膜静脉闭塞导致黄斑水肿的患者有视力丧失的趋势...

引用次数: 0

Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye 义眼患者的泪液分泌得以保留，但睑板腺的面积却缩小了，从而导致干眼症状的出现

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-08-31 DOI: 10.1136/bjo-2024-325777

Elin Bohman, Johanna Berggren, Olof Neumann, Rafi Sheikh, Malin Malmsjö

Background/aims It is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test which may be affected by the pooling of tears behind the prosthesis. In this study, direct imaging of the lacrimal gland has been performed to measure tear secretion in anophthalmic sockets. The relation between the area of meibomian glands and dry eye symptoms was also assessed. Methods 12 patients were included. The amount of tear secretion was measured by direct imaging of the lacrimal gland while the presence of meibomian glands was determined using meibography. The 5-item Dry Eye Questionnaire was used to assess symptoms of dry eye. Results No difference was found in tear secretion between the anophthalmic socket and the contralateral eye. The area of meibomian glands was significantly reduced in eyelids on the side of the prosthetic eye, compared with the contralateral eye. Seven patients reported symptoms indicative of dry eye in the anophthalmic socket, compared with only two in the contralateral eye. Conclusions The effects of an eye prosthesis on meibomian glands may contribute to the frequently perceived symptoms of dry eye despite unaffected in tear secretion. All data relevant to the study are included in the article.

背景/目的目前还不清楚泪液分泌减少是否会导致义眼患者感到不适。迄今为止，泪液分泌量只能通过施尔默试验来测量，而施尔默试验可能会受到义眼后泪液汇集的影响。在这项研究中，对泪腺进行了直接成像，以测量无眼窝患者的泪液分泌情况。同时还评估了睑板腺面积与干眼症状之间的关系。方法共纳入 12 名患者。泪液分泌量是通过泪腺直接成像测量的，而睑板腺的存在则是通过睑板腺造影术确定的。采用 5 项干眼症问卷评估干眼症状。结果无眼窝者与对侧眼的泪液分泌量没有差异。与对侧眼相比，义眼一侧眼睑的睑板腺面积明显减少。有七名患者在义眼窝出现干眼症状，而在对侧眼只有两名患者出现干眼症状。结论尽管泪液分泌不受影响，但义眼对睑板腺的影响可能是导致干眼症症状频发的原因之一。与研究相关的所有数据均包含在文章中。

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