Louis Arnould, Elise Balsat, Yohei Hashimoto, Andrew White, George Kong, Hamish Dunn, Leo Fan, Pierre-Henry Gabrielle, Alain M Bron, Catherine P Creuzot-Garcher, Mitchell Lawlor
Objective: To evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.
Methods: A retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational registry. Complete success (CS) was defined as intraocular pressure (IOP) reduction ≥20% from preoperative and an IOP ≤18 mm Hg and ≥6 mm Hg with no secondary procedure at 2 years and without IOP-lowering medications. Qualified success (QS) was defined similarly, allowing the use of IOP-lowering medications.
Results: The Xen 45 gel stent implant was implanted in 646 eyes of 515 patients. Preoperative IOP was 21.4±7.6 (mean±SD) mm Hg on 2.7±1.3 IOP-lowering medication and mean deviation was -10.2±8.4 dB. After 24-month follow-up, IOP was 16.8±7.3 mm Hg (mean reduction of 21.7%) on 1.2±1.4 IOP-lowering medications. CS and QS rates at 24 months were 26% and 48%, respectively. CS and QS were higher in the Xen stand-alone group (33% and 52%, respectively) than in the Xen+cataract group (16% and 42%, respectively). Bleb needling was performed in 28.4% of cases, and 18% underwent a secondary procedure.
Conclusions: The Xen 45 gel stent implant offers acceptable long-term efficacy for the treatment of open-angle glaucoma. However, there is a significant rate of reoperation and needling, and outcomes are less effective if combined with cataract surgery.
{"title":"Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry.","authors":"Louis Arnould, Elise Balsat, Yohei Hashimoto, Andrew White, George Kong, Hamish Dunn, Leo Fan, Pierre-Henry Gabrielle, Alain M Bron, Catherine P Creuzot-Garcher, Mitchell Lawlor","doi":"10.1136/bjo-2023-325077","DOIUrl":"10.1136/bjo-2023-325077","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational registry. Complete success (CS) was defined as intraocular pressure (IOP) reduction ≥20% from preoperative and an IOP ≤18 mm Hg and ≥6 mm Hg with no secondary procedure at 2 years and without IOP-lowering medications. Qualified success (QS) was defined similarly, allowing the use of IOP-lowering medications.</p><p><strong>Results: </strong>The Xen 45 gel stent implant was implanted in 646 eyes of 515 patients. Preoperative IOP was 21.4±7.6 (mean±SD) mm Hg on 2.7±1.3 IOP-lowering medication and mean deviation was -10.2±8.4 dB. After 24-month follow-up, IOP was 16.8±7.3 mm Hg (mean reduction of 21.7%) on 1.2±1.4 IOP-lowering medications. CS and QS rates at 24 months were 26% and 48%, respectively. CS and QS were higher in the Xen stand-alone group (33% and 52%, respectively) than in the Xen+cataract group (16% and 42%, respectively). Bleb needling was performed in 28.4% of cases, and 18% underwent a secondary procedure.</p><p><strong>Conclusions: </strong>The Xen 45 gel stent implant offers acceptable long-term efficacy for the treatment of open-angle glaucoma. However, there is a significant rate of reoperation and needling, and outcomes are less effective if combined with cataract surgery.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1672-1678"},"PeriodicalIF":3.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alejandra Daruich, Maxence Rateaux, Emilie Batté, Nathalie de Vergnes, Sophie Valleix, Matthieu P. Robert, Dominique Bremond Gignac
Aims To report main outcomes and complications following voretigene neparvovec (Luxturna) treatment in paediatric patients. Methods Records of patients under the age of 17 treated by subretinal administration of voretigene neparvovec for confirmed biallelic RPE65 -mediated inherited retinal dystrophy were retrospectively reviewed. Best-corrected visual acuity (BCVA) and data from spectral-domain optical coherence tomography, ultra-wide-field fundus imaging and Goldmann visual field (VF) were analysed at 12 months follow-up. Results 12 eyes of six patients (mean age: 7.8 years) were analysed. No intraoperative complications occurred. BCVA significantly improved at 12-month follow-up (mean LogMAR (logarithm of the minimal angle of resolution) BCVA: 1.0±0.8 at baseline vs 0.6±0.3 at 12 months, p=0.001). Mean central macular thickness and central outer nuclear layer thickness did not change at 12 months follow-up. VF V4e isopter did not show significant changes. Postoperatively complications included: elevated intraocular pressure in two eyes of the same patient, a parafoveal lamellar hole at 3 months post-treatment and atrophy on the injection site observed in all eyes except one, which significantly enlarged during 12 months (p=0.008). Conclusions Most paediatric patients treated by voretigene neparvovec showed a significant increase in visual function at 12 months follow-up. None of the postoperative complications prevented gains in visual function. All data relevant to the study are included in the article or uploaded as supplementary information. NA.
{"title":"12-month outcomes after voretigene neparvovec gene therapy in paediatric patients with RPE65-mediated inherited retinal dystrophy","authors":"Alejandra Daruich, Maxence Rateaux, Emilie Batté, Nathalie de Vergnes, Sophie Valleix, Matthieu P. Robert, Dominique Bremond Gignac","doi":"10.1136/bjo-2024-326221","DOIUrl":"https://doi.org/10.1136/bjo-2024-326221","url":null,"abstract":"Aims To report main outcomes and complications following voretigene neparvovec (Luxturna) treatment in paediatric patients. Methods Records of patients under the age of 17 treated by subretinal administration of voretigene neparvovec for confirmed biallelic RPE65 -mediated inherited retinal dystrophy were retrospectively reviewed. Best-corrected visual acuity (BCVA) and data from spectral-domain optical coherence tomography, ultra-wide-field fundus imaging and Goldmann visual field (VF) were analysed at 12 months follow-up. Results 12 eyes of six patients (mean age: 7.8 years) were analysed. No intraoperative complications occurred. BCVA significantly improved at 12-month follow-up (mean LogMAR (logarithm of the minimal angle of resolution) BCVA: 1.0±0.8 at baseline vs 0.6±0.3 at 12 months, p=0.001). Mean central macular thickness and central outer nuclear layer thickness did not change at 12 months follow-up. VF V4e isopter did not show significant changes. Postoperatively complications included: elevated intraocular pressure in two eyes of the same patient, a parafoveal lamellar hole at 3 months post-treatment and atrophy on the injection site observed in all eyes except one, which significantly enlarged during 12 months (p=0.008). Conclusions Most paediatric patients treated by voretigene neparvovec showed a significant increase in visual function at 12 months follow-up. None of the postoperative complications prevented gains in visual function. All data relevant to the study are included in the article or uploaded as supplementary information. NA.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"60 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose This study aimed to identify the various clinical characteristics and ocular imaging features of ocular toxoplasmosis (OT) in HIV patients. Methods Observational retrospective study of 52 eyes of 38 HIV patients with OT. Results 68% of patients were male. 53.8% of eyes had keratic precipitates, anterior chamber cells were seen in 61.5%. 57.69% (n=30) eyes had de novo presentation of retinitis and 42.3% (n=22) of eyes had a retinochoroidal scar at presentation. Bilateral presentation was seen in 37% (n=14). Unifocal retinitis was noted in 38.4% (n=20) and 61.5% of eyes had multifocal (multizonal) retinitis (n=32). The most common multizonal involvement was noted in combined zone 1+2(n=14, 26.9%). The average horizontal and vertical measurements retinitis was 8.35 mm and 7.48 mm, respectively. The average area of retinitis was 66.2 mm2. Localised posterior vitreous detachment was seen in 83% of eyes and posterior hyaloid precipitates were noted in (n=7,39%) of eyes. Retinitis without retinal pigment epithelium elevation occurred in 88.8% of cases, compared with retinitis with retinal pigment epithelium elevation seen in 44.4% of eyes. 50% of eyes had thickened choroid beneath the retinitis lesion. Other unique signs of optical coherence tomography (OCT) noted were angular signs of Henle fibre layer hyper-reflectivity sign (n=1), halo lesions with central hypo (n=3) and choroidal excavation (n=1). Conclusions OT in HIV patients presents with large, bilateral, multifocal retinitis, generally devoid of haemorrhages and can rarely have central clearing. These lesions may present with or without a previous retinochoroidal scar. These lesions have horizontal spread and may not always have thickened choroid on OCT. Data are available on reasonable request.
目的 本研究旨在确定 HIV 患者眼弓形虫病（OT）的各种临床特征和眼部影像学特征。方法 对 38 名 OT 患者的 52 只眼睛进行观察性回顾研究。结果 68%的患者为男性。53.8%的眼球有角膜沉淀，61.5%的眼球可见前房细胞。57.69%（30 眼）的患者为新发视网膜炎，42.3%（22 眼）的患者在发病时有视网膜脉络膜瘢痕。双侧发病者占 37%（14 只）。38.4%的眼睛（20 只）患有单灶视网膜炎，61.5%的眼睛（32 只）患有多灶（多区）视网膜炎。最常见的多区受累是1+2区联合受累（14只，26.9%）。视网膜炎的平均水平和垂直测量值分别为 8.35 毫米和 7.48 毫米。视网膜炎的平均面积为 66.2 平方毫米。83%的眼睛出现局部玻璃体后脱离，7,39%的眼睛出现玻璃体后沉淀。88.8%的病例出现视网膜炎，但无视网膜色素上皮细胞增生；44.4%的病例出现视网膜炎，但有视网膜色素上皮细胞增生。50%的眼睛在视网膜炎病变下方有增厚的脉络膜。光学相干断层扫描（OCT）发现的其他独特征象包括：Henle纤维层高反射角征（n=1）、中心低的光晕病变（n=3）和脉络膜挖空（n=1）。结论 HIV 患者的 OT 表现为大面积、双侧、多灶性视网膜炎，一般无出血，很少有中心清亮。这些病变可能伴有或不伴有先前的视网膜脉络膜瘢痕。这些病变呈水平扩散，在 OCT 上不一定会有增厚的脉络膜。如有合理要求，可提供相关数据。
{"title":"Clinical characteristics and optical coherence tomography features of ocular toxoplasmosis inHIV-positive patients: report 1","authors":"Anamika Patel, Merlin Saldanha, Anup Kelagaonkar, Thorani Yediballi, Ilaria Testi, Carlos Pavesio, Avinash Pathengay","doi":"10.1136/bjo-2024-326306","DOIUrl":"https://doi.org/10.1136/bjo-2024-326306","url":null,"abstract":"Purpose This study aimed to identify the various clinical characteristics and ocular imaging features of ocular toxoplasmosis (OT) in HIV patients. Methods Observational retrospective study of 52 eyes of 38 HIV patients with OT. Results 68% of patients were male. 53.8% of eyes had keratic precipitates, anterior chamber cells were seen in 61.5%. 57.69% (n=30) eyes had de novo presentation of retinitis and 42.3% (n=22) of eyes had a retinochoroidal scar at presentation. Bilateral presentation was seen in 37% (n=14). Unifocal retinitis was noted in 38.4% (n=20) and 61.5% of eyes had multifocal (multizonal) retinitis (n=32). The most common multizonal involvement was noted in combined zone 1+2(n=14, 26.9%). The average horizontal and vertical measurements retinitis was 8.35 mm and 7.48 mm, respectively. The average area of retinitis was 66.2 mm2. Localised posterior vitreous detachment was seen in 83% of eyes and posterior hyaloid precipitates were noted in (n=7,39%) of eyes. Retinitis without retinal pigment epithelium elevation occurred in 88.8% of cases, compared with retinitis with retinal pigment epithelium elevation seen in 44.4% of eyes. 50% of eyes had thickened choroid beneath the retinitis lesion. Other unique signs of optical coherence tomography (OCT) noted were angular signs of Henle fibre layer hyper-reflectivity sign (n=1), halo lesions with central hypo (n=3) and choroidal excavation (n=1). Conclusions OT in HIV patients presents with large, bilateral, multifocal retinitis, generally devoid of haemorrhages and can rarely have central clearing. These lesions may present with or without a previous retinochoroidal scar. These lesions have horizontal spread and may not always have thickened choroid on OCT. Data are available on reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims To compare the baseline clinical characteristics and patterns of visual field defects between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) in the Laser in Glaucoma and Ocular Hypertension (LiGHT) China subjects. Methods All patients (n=622) were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. 1105 open-angle glaucoma eyes of 622 patients were classified as NTG (n=559) and HTG eyes (n=546) according to the baseline intraocular pressure (IOP) of 21 mm Hg. The mean deviation (MD), regional MD of the Glaucoma Hemifield Test regions and regional difference values were calculated. Daytime phasing IOP was recorded at 8:00, 10:00, 11:30, 14:30 and 17:00 hour. Multiple regression analyses were conducted for each regional difference. Results Patients with NTG were older, more likely to be female, hypertensive and suffer ischaemic heart disease than patients with HTG (p<0.05 for all comparisons). HTG showed higher mean daytime phasing IOP and higher daytime fluctuations than NTG (p<0.001 for all comparisons). HTG and NTG showed similar MD overall (p=0.665). NTG showed significantly greater hemifield asymmetry than HTG. The two arcuate regional differences in NTG were significantly associated with daytime IOP fluctuations (p<0.01 in both regions). Conclusions In the LiGHT China trial, NTG and HTG showed similar visual field defects severity at enrolment. However, NTG showed more severe hemifield asymmetry compared with HTG, and higher short-time IOP fluctuations might exacerbate this asymmetry in NTG. Data are available upon reasonable request.
{"title":"Comparison of baseline clinical characteristics and patterns of visual field defects between high-tension and normal-tension glaucoma","authors":"Zidong Chen, Wenxin Yang, Yangfan Yang, Yuzhen Jiang, Yuning Zhang, Xinyi Zhang, Chongxuan Luo, Mingqin Wang, Yanmei Fan, Pingping Liu, Neil Nathwani, Gus Gazzard, Minbin Yu","doi":"10.1136/bjo-2023-324852","DOIUrl":"https://doi.org/10.1136/bjo-2023-324852","url":null,"abstract":"Aims To compare the baseline clinical characteristics and patterns of visual field defects between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) in the Laser in Glaucoma and Ocular Hypertension (LiGHT) China subjects. Methods All patients (n=622) were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. 1105 open-angle glaucoma eyes of 622 patients were classified as NTG (n=559) and HTG eyes (n=546) according to the baseline intraocular pressure (IOP) of 21 mm Hg. The mean deviation (MD), regional MD of the Glaucoma Hemifield Test regions and regional difference values were calculated. Daytime phasing IOP was recorded at 8:00, 10:00, 11:30, 14:30 and 17:00 hour. Multiple regression analyses were conducted for each regional difference. Results Patients with NTG were older, more likely to be female, hypertensive and suffer ischaemic heart disease than patients with HTG (p<0.05 for all comparisons). HTG showed higher mean daytime phasing IOP and higher daytime fluctuations than NTG (p<0.001 for all comparisons). HTG and NTG showed similar MD overall (p=0.665). NTG showed significantly greater hemifield asymmetry than HTG. The two arcuate regional differences in NTG were significantly associated with daytime IOP fluctuations (p<0.01 in both regions). Conclusions In the LiGHT China trial, NTG and HTG showed similar visual field defects severity at enrolment. However, NTG showed more severe hemifield asymmetry compared with HTG, and higher short-time IOP fluctuations might exacerbate this asymmetry in NTG. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"128 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eugene Kim, Magdalena Stec, Noreen Shaikh, Jonathan Huang, Hantamalala Ralay Ranaivo, Rebecca Mets-Halgrimson
Background: Remote learning during the COVID-19 pandemic caused behavioural changes such as increased screen time and decreased outdoor time. This study aimed to investigate myopia progression in children during the COVID-19 pandemic.
Methods: This was a retrospective observational study performed among 2064 patients ages 2-17 with cycloplegic refractions in the months of January 2019-March 2021 at a tertiary children's hospital. Exclusion criteria were a medical history of relevant connective tissue diseases, myopia control treatment, pseudophakia and aphakia.
Results: The overall cohort (n=2064) had a mean spherical equivalent (SE) of 0.12±3.70 D in 2019, -0.07±3.95 D in 2020 and -0.49±3.85 D in 2021. The change in mean SE (0.42 D) from 2020 to 2021 was 2.2 times greater than the change (0.19 D) from 2019 to 2020 at baseline. In the cohort of return patients, there was a significant difference in myopic shift between years (F-ratio=14.4, p<0.00001), and a significant change from 2020 to 2021 (p=0.00008) but not from 2019 to 2020. When observing the prevalence of myopia grouped by age, 8-year-old and 17-year-old patients had the greatest increase compared with baseline. When grouped by refractive error, low myopia children (-0.5 D to -3.00 D) displayed the greatest change in mean SE 2020-2021.
Conclusions: There was a substantial increase in myopia progression for children in the Chicagoland area after the period of COVID-19 changes. The behavioural changes of home confinement and online learning during the pandemic may explain these findings.
{"title":"Refractive changes in children in the Chicago area during the COVID-19 pandemic: a retrospective observational study.","authors":"Eugene Kim, Magdalena Stec, Noreen Shaikh, Jonathan Huang, Hantamalala Ralay Ranaivo, Rebecca Mets-Halgrimson","doi":"10.1136/bjo-2024-325984","DOIUrl":"10.1136/bjo-2024-325984","url":null,"abstract":"<p><strong>Background: </strong>Remote learning during the COVID-19 pandemic caused behavioural changes such as increased screen time and decreased outdoor time. This study aimed to investigate myopia progression in children during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This was a retrospective observational study performed among 2064 patients ages 2-17 with cycloplegic refractions in the months of January 2019-March 2021 at a tertiary children's hospital. Exclusion criteria were a medical history of relevant connective tissue diseases, myopia control treatment, pseudophakia and aphakia.</p><p><strong>Results: </strong>The overall cohort (n=2064) had a mean spherical equivalent (SE) of 0.12±3.70 D in 2019, -0.07±3.95 D in 2020 and -0.49±3.85 D in 2021. The change in mean SE (0.42 D) from 2020 to 2021 was 2.2 times greater than the change (0.19 D) from 2019 to 2020 at baseline. In the cohort of return patients, there was a significant difference in myopic shift between years (F-ratio=14.4, p<0.00001), and a significant change from 2020 to 2021 (p=0.00008) but not from 2019 to 2020. When observing the prevalence of myopia grouped by age, 8-year-old and 17-year-old patients had the greatest increase compared with baseline. When grouped by refractive error, low myopia children (-0.5 D to -3.00 D) displayed the greatest change in mean SE 2020-2021.</p><p><strong>Conclusions: </strong>There was a substantial increase in myopia progression for children in the Chicagoland area after the period of COVID-19 changes. The behavioural changes of home confinement and online learning during the pandemic may explain these findings.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yohei Hashimoto, Adrian Robert Hunt, Jane M Wells, Gayatri Banerjee, Ross Ferrier, Richard Barry, Andrew Field, Justin Game, Claire Yvonne Hooper, Daniel Barthelmes, Mark C Gillies
Background: To compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).
Methods: This prospectively designed database study included treatment-naïve eyes with nAMD starting vascular endothelial growth factor inhibitors between July 2018 and April 2023 in Australia. Ophthalmologists were classified into high outliers, non-outliers and low outliers with a funnel plot of the adjusted mean 12-month VA change. The number of injections, last injection interval and proportion of visits where choroidal neovascularisation was active were compared between the groups.
Results: 38 ophthalmologists who treated a total of 1266 eyes (male, 35%; mean age, 81 years old) were classified into 1 high outlier, 34 non-outliers and 3 low outliers (mean VA change, 7.5, 5.1 and 2.5 letters, respectively). The high outlier gave significantly more injections than the non-outliers (mean, 8.6 vs 7.7; p<0.001), while the low outliers administered significantly fewer injections than the non-outliers (mean, 7.1 vs 7.7; p=0.009). The last injection interval was shortest in the high outlier's eyes (9.4 weeks), followed by non-outliers' (10.8 weeks; p=0.04 (vs high outlier's)) and low outliers' (11.8 weeks; p=0.22 (vs non-outliers')). The low outliers' patients had more visits with intraretinal fluid (59%) than non-outliers' (29%; p<0.001) and high outlier's patients (31%; p<0.001).
Conclusion: The low outliers' eyes had fewer injections, a longer treatment interval and more visits with intraretinal fluid. Building a system through which low outliers are anonymously notified of their performance would help improve general quality of care.
背景：比较根据新生血管性年龄相关性黄斑变性（nAMD）患者12个月平均视力（VA）结果将个体眼科医生归为离群值或非离群值的情况：这项前瞻性设计的数据库研究纳入了澳大利亚在2018年7月至2023年4月期间开始使用血管内皮生长因子抑制剂的nAMD患者。根据调整后的 12 个月平均 VA 变化的漏斗图，将眼科医生分为高离群值、非离群值和低离群值。比较了各组的注射次数、最后一次注射间隔和脉络膜新生血管活跃的就诊比例：38名眼科医生共治疗了1266只眼睛（男性，35%；平均年龄81岁），并将其分为1个高度离群组、34个非离群组和3个低度离群组（平均视力变化分别为7.5、5.1和2.5个字母）。高度离群者的注射次数明显多于非离群者（平均为 8.6 次对 7.7 次；p 结论：低度离群者的眼睛视力变化较小：低离群者的眼睛注射次数较少，治疗间隔时间较长，视网膜内积液就诊次数较多。建立一个系统，通过该系统匿名通报低异常值者的表现，将有助于提高总体护理质量。
{"title":"Outlier ophthalmologists in the treatment of neovascular age-related macular degeneration with intravitreal therapy.","authors":"Yohei Hashimoto, Adrian Robert Hunt, Jane M Wells, Gayatri Banerjee, Ross Ferrier, Richard Barry, Andrew Field, Justin Game, Claire Yvonne Hooper, Daniel Barthelmes, Mark C Gillies","doi":"10.1136/bjo-2024-326024","DOIUrl":"https://doi.org/10.1136/bjo-2024-326024","url":null,"abstract":"<p><strong>Background: </strong>To compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).</p><p><strong>Methods: </strong>This prospectively designed database study included treatment-naïve eyes with nAMD starting vascular endothelial growth factor inhibitors between July 2018 and April 2023 in Australia. Ophthalmologists were classified into high outliers, non-outliers and low outliers with a funnel plot of the adjusted mean 12-month VA change. The number of injections, last injection interval and proportion of visits where choroidal neovascularisation was active were compared between the groups.</p><p><strong>Results: </strong>38 ophthalmologists who treated a total of 1266 eyes (male, 35%; mean age, 81 years old) were classified into 1 high outlier, 34 non-outliers and 3 low outliers (mean VA change, 7.5, 5.1 and 2.5 letters, respectively). The high outlier gave significantly more injections than the non-outliers (mean, 8.6 vs 7.7; p<0.001), while the low outliers administered significantly fewer injections than the non-outliers (mean, 7.1 vs 7.7; p=0.009). The last injection interval was shortest in the high outlier's eyes (9.4 weeks), followed by non-outliers' (10.8 weeks; p=0.04 (vs high outlier's)) and low outliers' (11.8 weeks; p=0.22 (vs non-outliers')). The low outliers' patients had more visits with intraretinal fluid (59%) than non-outliers' (29%; p<0.001) and high outlier's patients (31%; p<0.001).</p><p><strong>Conclusion: </strong>The low outliers' eyes had fewer injections, a longer treatment interval and more visits with intraretinal fluid. Building a system through which low outliers are anonymously notified of their performance would help improve general quality of care.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eun Jung Lee, Do Young Park, Jong Chul Han, Changwon Kee
Background/aims: To identify whether an intact retinal nerve fibre layer (RNFL) thickness profile could determine the location of the earliest RNFL defect in glaucoma.
Methods: Retrospective longitudinal cohort study of patients with initial unilateral glaucoma who eventually developed new glaucoma in the fellow eye. Guided progression analysis (GPA) of serial optical coherence tomography (OCT) examinations was used to identify the angular locations of the earliest RNFL defect, peak and temporal edge of the baseline RNFL profile and major vessels based on the peripapillary OCT scan circle.
Results: We identified 112 new RNFL defects in 109 fellow eyes of 109 consecutive patients. The locations of new defects were superotemporal (22 eyes), inferotemporal (87 eyes) and papillomacular bundle (3 eyes), respectively. Overall, the midpoint location of the earliest RNFL defect strongly coincided with the RNFL peak (p<0.001). Specifically, the location was mildly (4.3±12.0°) temporal to, rather than at the peak thickness, particularly in eyes with a focal thinning pattern of arcuate bundles (7.8±10.8°). The close topographical relationship was consistent regardless of the interindividual variability in the RNFL profile and vessels, as well as hemispheric locations, and after adjusting for potential factors including age, refractive error, baseline intraocular pressure, tilt ratio, tilt axis and glaucoma diagnosis.
Conclusion: The location of the earliest RNFL defect in glaucoma showed a close relationship with the intact RNFL profile within the same eye, regardless of variations in RNFL, hemispheric location and vessel distribution. In addition, the earliest defect was located mildly temporal to, rather than at, the peak RNFL thickness. The baseline RNFL profile may have a significant role in the regional vulnerability of glaucoma.
{"title":"Earliest location of glaucomatous retinal nerve fibre layer damage is determined by intact baseline RNFL thickness profile.","authors":"Eun Jung Lee, Do Young Park, Jong Chul Han, Changwon Kee","doi":"10.1136/bjo-2024-325630","DOIUrl":"https://doi.org/10.1136/bjo-2024-325630","url":null,"abstract":"<p><strong>Background/aims: </strong>To identify whether an intact retinal nerve fibre layer (RNFL) thickness profile could determine the location of the earliest RNFL defect in glaucoma.</p><p><strong>Methods: </strong>Retrospective longitudinal cohort study of patients with initial unilateral glaucoma who eventually developed new glaucoma in the fellow eye. Guided progression analysis (GPA) of serial optical coherence tomography (OCT) examinations was used to identify the angular locations of the earliest RNFL defect, peak and temporal edge of the baseline RNFL profile and major vessels based on the peripapillary OCT scan circle.</p><p><strong>Results: </strong>We identified 112 new RNFL defects in 109 fellow eyes of 109 consecutive patients. The locations of new defects were superotemporal (22 eyes), inferotemporal (87 eyes) and papillomacular bundle (3 eyes), respectively. Overall, the midpoint location of the earliest RNFL defect strongly coincided with the RNFL peak (p<0.001). Specifically, the location was mildly (4.3±12.0°) temporal to, rather than at the peak thickness, particularly in eyes with a focal thinning pattern of arcuate bundles (7.8±10.8°). The close topographical relationship was consistent regardless of the interindividual variability in the RNFL profile and vessels, as well as hemispheric locations, and after adjusting for potential factors including age, refractive error, baseline intraocular pressure, tilt ratio, tilt axis and glaucoma diagnosis.</p><p><strong>Conclusion: </strong>The location of the earliest RNFL defect in glaucoma showed a close relationship with the intact RNFL profile within the same eye, regardless of variations in RNFL, hemispheric location and vessel distribution. In addition, the earliest defect was located mildly temporal to, rather than at, the peak RNFL thickness. The baseline RNFL profile may have a significant role in the regional vulnerability of glaucoma.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward Barayev, Michael Shapiro, Eran Greenbaum, Yuval Ran, Assaf Gershoni, Gad Dotan
Aims To examine the association between colour vision deficiency (CVD) and other ophthalmic disorders including amblyopia, strabismus and ametropia in a large population study. Methods The retrospective, cross-sectional study included 916 388 Israeli army male recruits who had their premilitary medical assessment at the age of 16–18 years from 2000 to 2020, analysing the prevalence of ophthalmic disorders including amblyopia, strabismus and ametropia in army recruits with CVD compared with all other recruits with normal colour vision. Demographic and socioeconomic data were also collected. Results The prevalence of amblyopia (1.28% vs 0.71%, p<0.001), strabismus (1.09% vs 0.83%, p<0.001) and ametropia (moderate—less than 6.00 diopters, 35.05% vs 30.50%, p<0.001 and high—higher than 6.00 diopters, 3.18% vs 2.30%, p<0.001) were all higher among 28 001 (3.06%) army recruits with CVD compared with all other individuals with normal colour vision. CVD was more common in individuals with a higher socioeconomic status (high 3.15% vs low 2.93%, p<0.001) and varied according to recruits’ origin. It was most frequent in individuals whose mother was born in the former Soviet Union (4.98%) compared with other European countries (3.89%), North America (3.28%), Asia (2.78%) and Ethiopia (1.63%). Conclusion CVD is associated with an increased frequency of amblyopia, strabismus and ametropia, which can all impart vision difficulties besides colour vision impairment alone. Data are available upon reasonable request.
{"title":"Colour vision deficiency is associated with increased prevalence of amblyopia, strabismus and ametropia: a large population study","authors":"Edward Barayev, Michael Shapiro, Eran Greenbaum, Yuval Ran, Assaf Gershoni, Gad Dotan","doi":"10.1136/bjo-2023-324564","DOIUrl":"https://doi.org/10.1136/bjo-2023-324564","url":null,"abstract":"Aims To examine the association between colour vision deficiency (CVD) and other ophthalmic disorders including amblyopia, strabismus and ametropia in a large population study. Methods The retrospective, cross-sectional study included 916 388 Israeli army male recruits who had their premilitary medical assessment at the age of 16–18 years from 2000 to 2020, analysing the prevalence of ophthalmic disorders including amblyopia, strabismus and ametropia in army recruits with CVD compared with all other recruits with normal colour vision. Demographic and socioeconomic data were also collected. Results The prevalence of amblyopia (1.28% vs 0.71%, p<0.001), strabismus (1.09% vs 0.83%, p<0.001) and ametropia (moderate—less than 6.00 diopters, 35.05% vs 30.50%, p<0.001 and high—higher than 6.00 diopters, 3.18% vs 2.30%, p<0.001) were all higher among 28 001 (3.06%) army recruits with CVD compared with all other individuals with normal colour vision. CVD was more common in individuals with a higher socioeconomic status (high 3.15% vs low 2.93%, p<0.001) and varied according to recruits’ origin. It was most frequent in individuals whose mother was born in the former Soviet Union (4.98%) compared with other European countries (3.89%), North America (3.28%), Asia (2.78%) and Ethiopia (1.63%). Conclusion CVD is associated with an increased frequency of amblyopia, strabismus and ametropia, which can all impart vision difficulties besides colour vision impairment alone. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"4 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/aims Intravitreal injection (IVT) of anti-vascular endothelial growth factor agents is the standard of care for several retinal diseases but can cause intraocular pressure (IOP) elevations. This study investigates short-term postinjection IOP changes following aflibercept 8 mg and faricimab, compared with aflibercept 2 mg. Methods This observational, prospective study included 90 patients with age-related macular degeneration or diabetic macular oedema, divided into three groups, receiving aflibercept 2 mg, aflibercept 8 mg or faricimab. IOP was measured using an iCare IC200-tonometer preinjection (T0) and at 30 s (T1), 5 min (T2) and 15 min (T3) postinjection. Primary outcomes included IOP changes at the four time points within and between treatment groups. The incidence of transient visual loss requiring paracentesis was recorded. Results All groups experienced a significant IOP increase at T1, with mean IOP increase being 41.47±12.95 mm Hg for aflibercept 2 mg, 43.46±8.97 mm Hg for aflibercept 8 mg and 32.19±11.06 mm Hg for faricimab. By T2, IOP differences were not significant, and by T3, mean IOP returned within normal limits across all groups. Faricimab showed a smaller initial IOP spike than both aflibercept formulations, but this difference was not statistically significant at T2 and T3. Conclusion Transient IOP spikes are observed post-IVT of aflibercept 8 mg and faricimab, with similar trends to aflibercept 2 mg. The initial IOP elevation normalised within 15 min. Faricimab had a lower initial spike, but overall IOP profiles were comparable across different agents. Data are available on reasonable request.
{"title":"Short-term intraocular pressure changes after intravitreal aflibercept 2 mg, aflibercept 8 mg and faricimab: a prospective, comparative study","authors":"Arianna Paris, Giulio Volpe, Kathrin Perruchoud-Ader, Alex Casanova, Moreno Menghini, Gabriela Grimaldi","doi":"10.1136/bjo-2024-326053","DOIUrl":"https://doi.org/10.1136/bjo-2024-326053","url":null,"abstract":"Background/aims Intravitreal injection (IVT) of anti-vascular endothelial growth factor agents is the standard of care for several retinal diseases but can cause intraocular pressure (IOP) elevations. This study investigates short-term postinjection IOP changes following aflibercept 8 mg and faricimab, compared with aflibercept 2 mg. Methods This observational, prospective study included 90 patients with age-related macular degeneration or diabetic macular oedema, divided into three groups, receiving aflibercept 2 mg, aflibercept 8 mg or faricimab. IOP was measured using an iCare IC200-tonometer preinjection (T0) and at 30 s (T1), 5 min (T2) and 15 min (T3) postinjection. Primary outcomes included IOP changes at the four time points within and between treatment groups. The incidence of transient visual loss requiring paracentesis was recorded. Results All groups experienced a significant IOP increase at T1, with mean IOP increase being 41.47±12.95 mm Hg for aflibercept 2 mg, 43.46±8.97 mm Hg for aflibercept 8 mg and 32.19±11.06 mm Hg for faricimab. By T2, IOP differences were not significant, and by T3, mean IOP returned within normal limits across all groups. Faricimab showed a smaller initial IOP spike than both aflibercept formulations, but this difference was not statistically significant at T2 and T3. Conclusion Transient IOP spikes are observed post-IVT of aflibercept 8 mg and faricimab, with similar trends to aflibercept 2 mg. The initial IOP elevation normalised within 15 min. Faricimab had a lower initial spike, but overall IOP profiles were comparable across different agents. Data are available on reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"2 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intracellular dark endothelial spots (IDESs) on specular microscopy developed in 78/122 patients (63.9%) after Descemet stripping automated endothelial keratoplasty (DSAEK). Endothelial cell density (ECD) after DSAEK was significantly smaller in eyes with IDES when compared with those without at all time points (p<0.001) despite no significant difference in graft ECD (p=0.43), resulting in an increased rate of endothelial failure (p=0.044). The presence of glaucoma (OR=2.22, p=0.027), iris damage (OR=2.85, p=0.004) and non-Fuchs status (OR=2.37, p=0.018) were identified as risk factors for IDES development. Preoperative total protein level in aqueous humour was significantly higher in eye with endothelial failure than those without (p=0.0057). The data that support the findings of this study are available on request from the corresponding author (TY). The data are not publicly available due to them containing information that could compromise research participant privacy/consent.
{"title":"Intracellular dark spots are associated with endothelial cell loss after Descemet’s stripping automated endothelial keratoplasty","authors":"Yurina Mori-Ogiwara, Yukari Yagi-Yaguchi, Osama Ibrahim, Kazunari Higa, Hirotsugu Kasamatsu, Takahiro Kanda, Daisuke Tomida, Yoshinori Oie, Takahiko Hayashi, Jun Shimazaki, Takefumi Yamaguchi","doi":"10.1136/bjo-2024-325702","DOIUrl":"https://doi.org/10.1136/bjo-2024-325702","url":null,"abstract":"Intracellular dark endothelial spots (IDESs) on specular microscopy developed in 78/122 patients (63.9%) after Descemet stripping automated endothelial keratoplasty (DSAEK). Endothelial cell density (ECD) after DSAEK was significantly smaller in eyes with IDES when compared with those without at all time points (p<0.001) despite no significant difference in graft ECD (p=0.43), resulting in an increased rate of endothelial failure (p=0.044). The presence of glaucoma (OR=2.22, p=0.027), iris damage (OR=2.85, p=0.004) and non-Fuchs status (OR=2.37, p=0.018) were identified as risk factors for IDES development. Preoperative total protein level in aqueous humour was significantly higher in eye with endothelial failure than those without (p=0.0057). The data that support the findings of this study are available on request from the corresponding author (TY). The data are not publicly available due to them containing information that could compromise research participant privacy/consent.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"69 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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