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Short-term effects of sunlight exposure on fundus blood flow perfusion in children: a randomised controlled trial. 日光照射对儿童眼底血流灌注的短期影响:随机对照试验。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2024-325715
Lingyi Zhao, Bo Zhang, Jingjing Wang, Jinliuxing Yang, Linlin Du, Tianxiao Wang, Xun Xu, Xiangui He, Jun Chen

Aim: To evaluate the short-term effects of different sunlight exposure on fundus blood flow perfusion (BFP) after near work.

Methods: In this parallel randomised controlled trial, 81 students aged 7-15 with spherical equivalent refraction between -2.00 and +3.00 diopters were randomly assigned to either a low-illuminance (4k lux) group (N=40) or high-illuminance (10k lux) (N=41). Following 1 hour indoor reading, participants had sunlight exposure matching their group's intensity for 15 minutes. BFPs in the superficial retina, deep retina and choroid were measured at four time points: pre-reading, post-reading, 5th-minute and 15th-minute sunlight exposure.

Results: Within the initial 5 minutes of sunlight exposure, the 10k lux group showed a tendency for decreased BFP, particularly in the choroid (superficial retina: -0.2, 95% CI -0.9 to 0.5; deep retina: -0.1, 95% CI -0.6 to 0.4; choroid: -0.4, 95% CI -0.8 to 0.0), while the 4k lux group exhibited an increase (superficial retina: 0.7, 95% CI 0.1 to 1.3; deep retina: 0.3, 95% CI -0.2 to 0.8; choroid: 0.1, 95% CI -0.2 to 0.5). From 5 to 15 minutes, BFP decreased in both groups. At the 5th-minute mark, the 10k lux group exhibited a greater decrease in choroid (10k -0.4 vs 4k 0.1, p=0.051). No significant difference was observed after 15 minutes of exposure.

Conclusion: Higher illuminance sunlight exposure can restore fundus BFP more rapidly than lower; however, duration remains pivotal. To prevent myopia, continuous sunlight exposure for over 15 minutes is recommended to aid in reinstating the fundus BFP increased by near work.

Trial registration number: NCT05594732.

目的:评估不同日光照射对近距离工作后眼底血流灌注(BFP)的短期影响:在这项平行随机对照试验中,81 名球面等效屈光度在 -2.00 和 +3.00 屈光度之间的 7-15 岁学生被随机分配到低照度(4k 勒克斯)组(40 人)或高照度(10k 勒克斯)组(41 人)。在室内阅读 1 小时后,参与者接受 15 分钟与本组照度相匹配的阳光照射。在阅读前、阅读后、日光照射第 5 分钟和第 15 分钟这四个时间点测量了浅层视网膜、深层视网膜和脉络膜的 BFP:结果:在阳光照射的最初 5 分钟内,10k 勒克斯组的 BFP 呈下降趋势,尤其是脉络膜(浅层视网膜:-0.2,95% CI -0.9 至 0.5;深层视网膜:-0.1,95% CI -0.6 至 0.4;脉络膜:-0.4,95% CI -0.8 至 0.0),而 4k 勒克斯组则显示出增加(视网膜浅层:0.7,95% CI 0.1 至 1.3;视网膜深层:0.3,95% CI -0.2 至 0.8;脉络膜:0.1,95% CI -0.2 至 0.5)。从 5 分钟到 15 分钟,两组的 BFP 都有所下降。在第 5 分钟时,10k 勒克斯组的脉络膜下降幅度更大(10k -0.4 vs 4k 0.1,p=0.051)。照射 15 分钟后未观察到明显差异:结论:较高照度的日光照射比较低照度的日光照射能更快地恢复眼底BFP,但持续时间仍然至关重要。结论:较高照度的日光照射能比较低照度的日光照射更快地恢复眼底BFP,但日光照射时间的长短仍然至关重要。为预防近视,建议连续照射日光15分钟以上,以帮助恢复因近距离工作而增加的眼底BFP:NCT05594732.
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引用次数: 0
Evaluation of adjuvant role of topical cyclosporine 1% in acute Stevens-Johnson syndrome: a randomised control trial. 评估 1%局部环孢素在急性史蒂文斯-约翰逊综合征中的辅助作用:随机对照试验。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-324901
Namrata Sharma, Renu Venugopal, Ritu Nagpal, Priyadarshini K, Kamna Verma, Kaushal K Verma, N R Biswas, Thirumurthy Velpandian, Seema Sen, S N Dwivedi, Radhika Tandon, Jeewan S Titiyal, Rasik Vajpayee

Purpose: To evaluate the role of topical cyclosporine A 1% (CsA) as an adjuvant therapy in patients with acute Stevens-Johnson syndrome (SJS).

Methods: This is a randomised controlled trial in which 44 patients (88 eyes) with acute SJS, presenting within 3 months from the onset of the disease, were enrolled and randomised. Group A (n=44 eyes) patients received treatment with topical CsA 1% along with standard therapy consisting of topical corticosteroids, antibiotics and lubricants. Group B (n=44 eyes) patients received topical saline drops in combination with standard therapy. Various ocular surface parameters were assessed at baseline and the 6-month follow-up.

Results: The mean age of patients (years) was 23.9±15.1 in the CsA group and 26.0±18.7 in the control group (p=0.6840). The mean time from disease onset to presentation (days) was 17.0±14.0 and 12.9±11.3 in CsA and control groups, respectively (p=0.1568). At presentation, the mean grades of severity scores of various parameters were comparable. At 6 months, both groups showed a significant improvement in the mean severity grades of conjunctival hyperaemia (A, p=0.001; B, p=0.0001), mucocutaneous junction involvement (A, p=0.001; B, p=0.0001) and meibomian gland involvement (A, p=0.0471; B, p=0.006). Compared with baseline, the grades of corneal keratinisation (baseline, 0.48±0.7; 6 months, 1.02±0.8; p=0.0015) and neovascularisation (baseline, 1.07±1.2; 6 months, 1.57±1.0; p=0.0412) worsened after 6 months of CsA therapy. Intergroup comparison of grades of various parameters however did not reveal any significant difference at 6 months.

Conclusions: Adjuvant treatment with topical CsA is not superior to standard therapy, in cases of acute SJS.

目的:评估外用 1%环孢素 A (CsA) 作为急性史蒂文斯-约翰逊综合征(SJS)患者辅助疗法的作用:这是一项随机对照试验,共有44名急性SJS患者(88只眼)入组并接受随机治疗。A组(44只眼睛)患者在接受外用皮质类固醇激素、抗生素和润滑剂等标准疗法的同时,还接受了1% CsA的外用治疗。B 组(44 只眼睛)患者在接受标准疗法的同时,还接受局部生理盐水滴眼液治疗。在基线和 6 个月的随访中对各种眼表参数进行了评估:CsA组患者的平均年龄为(23.9±15.1)岁,对照组为(26.0±18.7)岁(P=0.6840)。CsA组和对照组患者从发病到就诊的平均时间(天)分别为(17.0±14.0)和(12.9±11.3)(P=0.1568)。发病时,两组患者各项指标的平均严重程度评分相当。6 个月时,两组患者结膜高血症(A 组,p=0.001;B 组,p=0.0001)、粘膜皮肤交界处受累(A 组,p=0.001;B 组,p=0.0001)和睑板腺受累(A 组,p=0.0471;B 组,p=0.006)的平均严重程度均有显著改善。与基线相比,角膜角化(基线,0.48±0.7;6 个月,1.02±0.8;p=0.0015)和新生血管(基线,1.07±1.2;6 个月,1.57±1.0;p=0.0412)的等级在 CsA 治疗 6 个月后恶化。然而,6个月后,各种参数的组间等级比较没有发现任何显著差异:结论:在急性SJS病例中,局部CsA辅助治疗并不比标准疗法更有优势。
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引用次数: 0
Handgrip strength and risks of diabetic vascular complications: Evidence from Guangzhou Diabetic Eye Study and UK cohorts. 握力与糖尿病血管并发症的风险:来自广州糖尿病眼研究和英国队列的证据。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-324893
Pingting Zhong, Shaopeng Yang, Riqian Liu, Ziyu Zhu, Yongjie Zhang, Weijing Cheng, Wei Wang

Purpose: The purpose is to investigate the association between handgrip strength (HGS) and the risk of future diabetic complications in multicountry cohorts.

Methods: The association between HGS and diabetic complications was evaluated using cox models among 84 453 patients with pre-diabetes and diabetes from the UK Biobank with a 12-year follow-up. The association between HGS and longitudinal microcirculatory damage rates was assessed among 819 patients with diabetes from the Guangzhou Diabetic Eye Study (GDES) with a 3-year follow-up. Participants were divided into three age groups (<56, 56-65 and ≥65 years), and each group was further subdivided into three HGS tertiles.

Results: A 5 kg reduction in HGS was associated with increased risk for all-cause mortality (women, HR=1.10, 95% CI: 1.05 to 1.14; p<0.001; men, HR=1.13, 95% CI: 1.11 to 1.15; p<0.001). Women and men in the lowest HGS group exhibited 1.6-times and 1.3-1.5-times higher risk of myocardial infarction and stroke compared with the highest HGS group. In men, there was a higher risk of developing end-stage renal disease (HR=1.83, 95% CI: 1.30 to 2.57; p=0.001), while this was not observed in women. Both sexes in the lowest HGS group had a 1.3-times higher risk of diabetic retinopathy compared with the highest HGS group. In the GDES group, individuals with the lowest HGS showed accelerated microcirculatory damage in retina (all p<0.05).

Conclusions: Reduced HGS is significantly associated with a higher risk of diabetic complications and accelerated microvascular damage. HGS could serve as a practical indicator of vascular health in patients with pre-diabetes and diabetes.

目的:在多国队列中研究手握力(HGS)与未来糖尿病并发症风险之间的关系:方法:使用 cox 模型评估了英国生物库中 84 453 名随访 12 年的糖尿病前期和糖尿病患者的 HGS 与糖尿病并发症之间的关系。对广州糖尿病眼病研究(GDES)的 819 名糖尿病患者进行了为期 3 年的随访,评估了 HGS 与纵向微循环损伤率之间的关系。参与者被分为三个年龄组(结果:HGS 降低 5 千克,微循环损伤率降低 5 千克,微循环损伤率降低 5 千克):HGS降低5公斤与全因死亡风险增加有关(女性,HR=1.10,95% CI:1.05至1.14;p结论:HGS降低与全因死亡风险增加显著相关:HGS 降低与糖尿病并发症和微血管加速损伤的风险升高密切相关。HGS可作为糖尿病前期和糖尿病患者血管健康的实用指标。
{"title":"Handgrip strength and risks of diabetic vascular complications: Evidence from Guangzhou Diabetic Eye Study and UK cohorts.","authors":"Pingting Zhong, Shaopeng Yang, Riqian Liu, Ziyu Zhu, Yongjie Zhang, Weijing Cheng, Wei Wang","doi":"10.1136/bjo-2023-324893","DOIUrl":"10.1136/bjo-2023-324893","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose is to investigate the association between handgrip strength (HGS) and the risk of future diabetic complications in multicountry cohorts.</p><p><strong>Methods: </strong>The association between HGS and diabetic complications was evaluated using cox models among 84 453 patients with pre-diabetes and diabetes from the UK Biobank with a 12-year follow-up. The association between HGS and longitudinal microcirculatory damage rates was assessed among 819 patients with diabetes from the Guangzhou Diabetic Eye Study (GDES) with a 3-year follow-up. Participants were divided into three age groups (<56, 56-65 and ≥65 years), and each group was further subdivided into three HGS tertiles.</p><p><strong>Results: </strong>A 5 kg reduction in HGS was associated with increased risk for all-cause mortality (women, HR=1.10, 95% CI: 1.05 to 1.14; p<0.001; men, HR=1.13, 95% CI: 1.11 to 1.15; p<0.001). Women and men in the lowest HGS group exhibited 1.6-times and 1.3-1.5-times higher risk of myocardial infarction and stroke compared with the highest HGS group. In men, there was a higher risk of developing end-stage renal disease (HR=1.83, 95% CI: 1.30 to 2.57; p=0.001), while this was not observed in women. Both sexes in the lowest HGS group had a 1.3-times higher risk of diabetic retinopathy compared with the highest HGS group. In the GDES group, individuals with the lowest HGS showed accelerated microcirculatory damage in retina (all p<0.05).</p><p><strong>Conclusions: </strong>Reduced HGS is significantly associated with a higher risk of diabetic complications and accelerated microvascular damage. HGS could serve as a practical indicator of vascular health in patients with pre-diabetes and diabetes.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"157-164"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179067","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}
引用次数: 0
Reattachment rate with pneumatic retinopexy versus pars plana vitrectomy for single break rhegmatogenous retinal detachment. 气压式视网膜剥离术与玻璃体旁切除术治疗单个破损流变性视网膜脱离的再粘连率。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-324005
Aurora Pecaku, Isabela Martins Melo, Reut Shor, Carolina L M Francisconi, Samara Barbara Marafon, Varun Chaudhary, Roxane Jo Hillier, Rajeev H Muni

Aim: To assess the primary reattachment rate (PARR) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomised Trial (PIVOT) criteria with a single break in detached retina.

Methods: A post hoc analysis of two clinical trials. To be included, patients with primary RRD had to meet PIVOT criteria but could have only one break in the detached retina. Patients with additional pathology in the attached retina were included in a secondary analysis. The primary outcome was PARR following PnR versus PPV at 1-year postoperatively.

Results: 162 patients were included. 53% (86/162) underwent PnR and 47% (76/162) had a PPV. 99% (85/86) and 86.8% (66/76) completed the 1-year follow-up visits in the PnR and PPV groups, respectively. PARR was 88.2% (75/85) in the PnR group and 90.9% (60/66) in the PPV group (p=0.6) with a mean postoperative logMAR best-corrected visual acuity of 0.19±0.25 versus 0.34±0.37 (Snellen 20/30 vs 20/44) (p=0.01) each in the PnR and PPV groups, respectively.In an additional analysis of patients who were also allowed to have any pathology in the attached retina, the PARR was 85% (91/107) and 91.6% (66/72) in the PnR and PPV groups, respectively (p=0.18).

Conclusions: PnR and PPV provide similar long-term PARR in a substantial proportion of patients meeting PIVOT criteria with only a single break in the detached retina. Therefore, in patients meeting these specific criteria, PnR is an appropriate first-line therapy as it offers superior functional outcomes without compromising PARR.

目的:评估符合 "气动视网膜剥离术与玻璃体切除术治疗原发性风湿性视网膜脱落结果随机试验"(PIVOT)标准的风湿性视网膜脱落(RRD)患者中,脱落视网膜单一断裂的原发性再附着率(PARR):方法:对两项临床试验进行事后分析。原发性RRD患者必须符合PIVOT标准,但脱落视网膜只能有一处破损,方可纳入试验。附着视网膜有其他病变的患者被纳入二次分析。主要结果是术后1年PnR与PPV的PARR:结果:共纳入 162 例患者。53%(86/162)的患者接受了 PnR,47%(76/162)的患者接受了 PPV。PnR组和PPV组分别有99%(85/86)和86.8%(66/76)的患者完成了为期1年的随访。PnR 组的 PARR 为 88.2%(75/85),PPV 组的 PARR 为 90.9%(60/66)(P=0.6),PnR 组和 PPV 组的术后平均 logMAR 最佳矫正视力分别为 0.19±0.25 对 0.34±0.37(斯奈伦 20/30 对 20/44)(P=0.01)。在对附着视网膜有任何病变的患者进行的额外分析中,PnR 组和 PPV 组的 PARR 分别为 85%(91/107)和 91.6%(66/72)(P=0.18):PnR和PPV可为相当一部分符合PIVOT标准且脱落视网膜仅有一处断裂的患者提供相似的长期PARR。因此,对于符合这些特定标准的患者,PnR 是一种合适的一线治疗方法,因为它能在不影响 PARR 的情况下提供更好的功能性结果。
{"title":"Reattachment rate with pneumatic retinopexy versus pars plana vitrectomy for single break rhegmatogenous retinal detachment.","authors":"Aurora Pecaku, Isabela Martins Melo, Reut Shor, Carolina L M Francisconi, Samara Barbara Marafon, Varun Chaudhary, Roxane Jo Hillier, Rajeev H Muni","doi":"10.1136/bjo-2023-324005","DOIUrl":"10.1136/bjo-2023-324005","url":null,"abstract":"<p><strong>Aim: </strong>To assess the primary reattachment rate (PARR) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomised Trial (PIVOT) criteria with a single break in detached retina.</p><p><strong>Methods: </strong>A post hoc analysis of two clinical trials. To be included, patients with primary RRD had to meet PIVOT criteria but could have only one break in the detached retina. Patients with additional pathology in the attached retina were included in a secondary analysis. The primary outcome was PARR following PnR versus PPV at 1-year postoperatively.</p><p><strong>Results: </strong>162 patients were included. 53% (86/162) underwent PnR and 47% (76/162) had a PPV. 99% (85/86) and 86.8% (66/76) completed the 1-year follow-up visits in the PnR and PPV groups, respectively. PARR was 88.2% (75/85) in the PnR group and 90.9% (60/66) in the PPV group (p=0.6) with a mean postoperative logMAR best-corrected visual acuity of 0.19±0.25 versus 0.34±0.37 (Snellen 20/30 vs 20/44) (p=0.01) each in the PnR and PPV groups, respectively.In an additional analysis of patients who were also allowed to have any pathology in the attached retina, the PARR was 85% (91/107) and 91.6% (66/72) in the PnR and PPV groups, respectively (p=0.18).</p><p><strong>Conclusions: </strong>PnR and PPV provide similar long-term PARR in a substantial proportion of patients meeting PIVOT criteria with only a single break in the detached retina. Therefore, in patients meeting these specific criteria, PnR is an appropriate first-line therapy as it offers superior functional outcomes without compromising PARR.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"113-118"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003680","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}
引用次数: 0
Systemic and ocular outcomes in TB-immunoreactive patients receiving immunomodulatory therapy for non-infectious uveitis: a case-control study. 接受免疫调节疗法治疗非传染性葡萄膜炎的结核病免疫反应患者的全身和眼部预后:一项病例对照研究。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2024-325625
Shravya Choudhary Balla, Mohammed Hasnat Ali, Mudit Tyagi, Soumyava Basu

Background: Tuberculosis (TB)-immunoreactivity, measured in vivo (tuberculin skin test (TST)) or in vitro (interferon gamma release assay (IGRA)), can be found in latent, active or even following clearance of TB infection. In this case-control study, we compared the systemic and ocular outcomes between patients with or without TB-immunoreactivity, who received immunomodulatory therapy (IMT) for non-infectious uveitis.

Methods: We retrospectively reviewed charts of patients with (cases) or without (controls) TB-immunoreactivity (TST±IGRA), who received conventional IMT for ≥6 months, for the treatment of non-infectious uveitis. Patients who received prior or concomitant anti-TB therapy were excluded. Systemic and ocular outcomes were compared between both groups.

Results: 36 cases and 70 controls (gender-matched and age-matched) were included. New-onset pulmonary or extrapulmonary TB developed in one case and none of the controls. Based on this outcome, the absolute risk increase for systemic TB reactivation was noted to be 0.028 (95% CI 0.005 to 0.051) and the number needed to harm was 36. The incidence of persistent or recurrent (worsening ≥2 grades) intraocular inflammation during IMT was comparable between both groups (cases 18/36, controls 35/70, p=1.0). A change in anatomical site of presentation at recurrence was not seen in any case, but in six controls (p=0.15). No new focal chorio-retinal lesions were noted in either group.

Conclusions: Conventional IMT has a very low risk of systemic TB reactivation, and no additional detrimental effect on ocular outcomes, in TB-immunoreactive patients with non-infectious uveitis.

背景:通过体内(结核菌素皮肤试验(TST))或体外(γ干扰素释放试验(IGRA))测定的结核病(TB)免疫反应性,可在潜伏期、活动期甚至在结核感染清除后发现。在这项病例对照研究中,我们比较了因非感染性葡萄膜炎而接受免疫调节疗法(IMT)的患者在有无结核免疫反应之间的全身和眼部结果:我们回顾性地查看了有结核免疫反应(TST±IGRA)或无结核免疫反应(TST±IGRA)患者的病历,这些患者接受了≥6个月的常规IMT治疗,以治疗非感染性葡萄膜炎。不包括之前或同时接受过抗结核治疗的患者。比较两组患者的全身和眼部疗效:结果:共纳入 36 例病例和 70 例对照(性别匹配、年龄匹配)。有 1 例病例出现新发肺结核或肺外结核,对照组病例中无一人出现新发肺结核或肺外结核。根据这一结果,系统性肺结核再活化的绝对风险增加值为 0.028(95% CI 0.005 至 0.051),需要伤害的人数为 36 人。两组患者在IMT期间持续或复发(恶化≥2级)眼内炎症的发生率相当(病例18/36,对照组35/70,P=1.0)。没有任何病例在复发时出现解剖部位的变化,但有 6 例对照组病例出现了这种变化(P=0.15)。两组患者均未发现新的局灶性脉络膜视网膜病变:结论:对于结核免疫反应阳性的非感染性葡萄膜炎患者,传统的 IMT 全身结核再激活的风险很低,对眼部结果也没有额外的不利影响。
{"title":"Systemic and ocular outcomes in TB-immunoreactive patients receiving immunomodulatory therapy for non-infectious uveitis: a case-control study.","authors":"Shravya Choudhary Balla, Mohammed Hasnat Ali, Mudit Tyagi, Soumyava Basu","doi":"10.1136/bjo-2024-325625","DOIUrl":"10.1136/bjo-2024-325625","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB)-immunoreactivity, measured in vivo (tuberculin skin test (TST)) or in vitro (interferon gamma release assay (IGRA)), can be found in latent, active or even following clearance of TB infection. In this case-control study, we compared the systemic and ocular outcomes between patients with or without TB-immunoreactivity, who received immunomodulatory therapy (IMT) for non-infectious uveitis.</p><p><strong>Methods: </strong>We retrospectively reviewed charts of patients with (cases) or without (controls) TB-immunoreactivity (TST±IGRA), who received conventional IMT for ≥6 months, for the treatment of non-infectious uveitis. Patients who received prior or concomitant anti-TB therapy were excluded. Systemic and ocular outcomes were compared between both groups.</p><p><strong>Results: </strong>36 cases and 70 controls (gender-matched and age-matched) were included. New-onset pulmonary or extrapulmonary TB developed in one case and none of the controls. Based on this outcome, the absolute risk increase for systemic TB reactivation was noted to be 0.028 (95% CI 0.005 to 0.051) and the number needed to harm was 36. The incidence of persistent or recurrent (worsening ≥2 grades) intraocular inflammation during IMT was comparable between both groups (cases 18/36, controls 35/70, p=1.0). A change in anatomical site of presentation at recurrence was not seen in any case, but in six controls (p=0.15). No new focal chorio-retinal lesions were noted in either group.</p><p><strong>Conclusions: </strong>Conventional IMT has a very low risk of systemic TB reactivation, and no additional detrimental effect on ocular outcomes, in TB-immunoreactive patients with non-infectious uveitis.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"41-44"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619399","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}
引用次数: 0
Psychological and functional outcomes of horizontal squint surgery in adults with no preoperative diplopia using Quality-of-Life AS-20 questionnaire. 使用生活质量 AS-20 问卷调查术前无复视的成年人接受水平斜视手术的心理和功能效果。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-324719
Nervine El Meshad, Haidy Soliman, Samantha Hunt, Saj Amarakoon, Ahmad Ahmad, Rebecca Ford, Richard Harrad, Vivi Choleva

Background: Corrective squint surgery has a significant psychological impact, affecting both the quality of life and mental health of patients. This study highlights the quantitative and subjective assessment of both the psychological and functional outcomes of squint surgery in adults having horizontal strabismus with no preoperative diplopia using a Quality-Of-Life Adult Strabismus 20 (QOL AS-20) questionnaire.

Method: The study is a retrospective cohort study on patients with uncomplicated, horizontal squint; with no vertical deviation and was conducted as part of a departmental clinical audit. It also aimed to challenge local clinical commissioning group (CCG) funding restrictions for what they regarded as a 'cosmetic procedure'. The QOL AS-20 questionnaires were completed before and 3 months after surgery and were analysed using the paired Wilcoxon signed rank t-test which showed significant improvement. A Freedom of Information Act request sought information on strabismus surgery funding restrictions from all CCGs to explore variations in perceptions throughout England.

Results: 28 patients were included in the study. The overall success of squint surgery was 67.5%. The median QOL AS-20 questionnaire overall score increased from 28.125 to 88.75 (p value<0.00001), functional subscale from 46.25 to 87.5 (p value<0.00001) and psychological subscale from 15 to 90 (p value<0.00001).

Conclusion: Squint surgery in non-diplopic adults with horizontal squint surgery should be regarded as restorative of normal anatomy from a pathological state rather than a cosmetic procedure.Restrictions to accessing this surgery may increase, especially during post-COVID-19. This patient-focused service evaluation demonstrates the substantial psychosocial benefits of such surgery, as evidenced through quality-of-life assessments.

背景:斜视矫正手术对患者的心理影响很大,会影响患者的生活质量和心理健康。本研究采用生活质量成人斜视 20(QOL AS-20)问卷,对术前无复视的水平斜视成人斜视手术的心理和功能效果进行了定量和主观评估:该研究是一项回顾性队列研究,对象是无并发症、无垂直偏斜的水平斜视患者,是科室临床审计的一部分。该研究还旨在挑战当地临床委托小组(CCG)对其视为 "美容手术 "的资金限制。QOL AS-20 问卷分别在手术前和手术后 3 个月完成,并使用配对 Wilcoxon 签名秩 t 检验进行分析,结果显示改善显著。根据《信息自由法》的要求,研究人员向所有CCG索取了有关斜视手术资金限制的信息,以探究英格兰各地对斜视手术看法的差异。斜视手术的总体成功率为 67.5%。QOL AS-20 问卷总分的中位数从 28.125 分增至 88.75 分(P 值):非二度斜视成人的水平斜视手术应被视为从病理状态恢复正常解剖结构的手术,而非美容手术。这项以患者为中心的服务评估表明,通过生活质量评估,此类手术可带来巨大的心理社会效益。
{"title":"Psychological and functional outcomes of horizontal squint surgery in adults with no preoperative diplopia using Quality-of-Life AS-20 questionnaire.","authors":"Nervine El Meshad, Haidy Soliman, Samantha Hunt, Saj Amarakoon, Ahmad Ahmad, Rebecca Ford, Richard Harrad, Vivi Choleva","doi":"10.1136/bjo-2023-324719","DOIUrl":"10.1136/bjo-2023-324719","url":null,"abstract":"<p><strong>Background: </strong>Corrective squint surgery has a significant psychological impact, affecting both the quality of life and mental health of patients. This study highlights the quantitative and subjective assessment of both the psychological and functional outcomes of squint surgery in adults having horizontal strabismus with no preoperative diplopia using a Quality-Of-Life Adult Strabismus 20 (QOL AS-20) questionnaire.</p><p><strong>Method: </strong>The study is a retrospective cohort study on patients with uncomplicated, horizontal squint; with no vertical deviation and was conducted as part of a departmental clinical audit. It also aimed to challenge local clinical commissioning group (CCG) funding restrictions for what they regarded as a 'cosmetic procedure'. The QOL AS-20 questionnaires were completed before and 3 months after surgery and were analysed using the paired Wilcoxon signed rank t-test which showed significant improvement. A Freedom of Information Act request sought information on strabismus surgery funding restrictions from all CCGs to explore variations in perceptions throughout England.</p><p><strong>Results: </strong>28 patients were included in the study. The overall success of squint surgery was 67.5%. The median QOL AS-20 questionnaire overall score increased from 28.125 to 88.75 (p value<0.00001), functional subscale from 46.25 to 87.5 (p value<0.00001) and psychological subscale from 15 to 90 (p value<0.00001).</p><p><strong>Conclusion: </strong>Squint surgery in non-diplopic adults with horizontal squint surgery should be regarded as restorative of normal anatomy from a pathological state rather than a cosmetic procedure.Restrictions to accessing this surgery may increase, especially during post-COVID-19. This patient-focused service evaluation demonstrates the substantial psychosocial benefits of such surgery, as evidenced through quality-of-life assessments.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"152-156"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603304","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}
引用次数: 0
Predisposing factors, clinical and microbiological insights of bacterial keratitis: analysis of 354 cases from a leading French academic centre. 细菌性角膜炎的诱发因素、临床和微生物学见解:对法国一家顶尖学术中心 354 个病例的分析。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2024-325261
Clara Bertret, Juliette Knoeri, Loic Leveziel, Tristan Bourcier, Françoise Brignole-Baudouin, Lilia Merabet, Nacim Bouheraoua, Vincent Michel Borderie

Aims: To report an epidemiological update of bacterial keratitis (BK) in a tertiary ophthalmology centre over 20 months compared with a previous study on the same timeframe from 1998 to 1999.

Methods: 354 patients with BK documented by microbiological corneal scraping or resolutive under antibiotics treatment from January 2020 to September 2021 were analysed retrospectively.

Results: One or several risk factors were found in 95.2% of patients: contact lens wear (45.2%), ocular surface disease (25.0%), systemic disease (21.8%), ocular trauma (11.9%) and ocular surgery (8.8%). The positivity rate of corneal scrapings was 82.5%, with 18.2% polybacterial. One hundred seventy-five (59.9%) bacteria were Gram-negative, and 117 (40.1%) were Gram-positive. The most common bacteria were Pseudomonas aeruginosa (32.5%), Moraxella spp (18.1%) and Staphylococcus aureus (8.2%). Final visual acuity (logarithm of the minimum angle of resolution) was associated with age (r=+0.48; p=0.0001), infiltrate size (r=+0.32; p<0.0001), ocular surface disease (r=+0.13; p=0.03), ocular trauma (r=-0.14; p=0.02) and contact lens wear (r=-0.26; p<0.0001). Gram-negative bacteria were responsible for deeper (r=+0.18; p=0.004) and more extensive infiltrates (r=+0.18; p=0.004) in younger patients (r=-0.19; p=0.003). Compared with the previous period, the positivity rate of corneal scrapings and the proportion of Gram-negative bacteria, especially Moraxella spp, increased. All P. aeruginosa and Moraxella spp were sensitive to quinolones, and all S. aureus were sensitive to both quinolones and methicillin.

Conclusion: Contact lens wear remained the leading risk factor. The bacteria distribution was reversed, with a predominance of Gram-negative bacteria and increased Moraxella spp.

目的:报告一家三级眼科中心在20个月内细菌性角膜炎(BK)的最新流行病学情况,并与之前在1998年至1999年期间进行的相同时间段的研究进行比较。方法:对2020年1月至2021年9月期间经微生物学角膜刮片或抗生素治疗下溶解的354例BK患者进行回顾性分析:95.2%的患者存在一种或几种风险因素:佩戴隐形眼镜(45.2%)、眼表疾病(25.0%)、全身性疾病(21.8%)、眼外伤(11.9%)和眼部手术(8.8%)。角膜刮片的阳性率为 82.5%,其中 18.2%为多细菌。175个细菌(59.9%)为革兰氏阴性,117个细菌(40.1%)为革兰氏阳性。最常见的细菌是铜绿假单胞菌(32.5%)、莫拉菌属(18.1%)和金黄色葡萄球菌(8.2%)。最终视力(最小解像角的对数)与年龄(r=+0.48;p=0.0001)、浸润大小(r=+0.32;摩拉菌属增加)和眼球大小有关。所有铜绿假单胞菌和莫拉菌属都对喹诺酮类药物敏感,所有金黄色葡萄球菌都对喹诺酮类药物和甲氧西林敏感:结论:佩戴隐形眼镜仍然是主要的风险因素。细菌分布情况发生了逆转,革兰氏阴性菌占多数,而莫拉菌属有所增加。
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引用次数: 0
Retinotopic cortical mapping in objective functional monitoring of macular therapy. 视网膜异位皮质图在黄斑治疗客观功能监测中的应用
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2021-320723
Markus Ritter, Allan Hummer, Maximilian Pawloff, Anna A Ledolter, David Linhardt, Michael Woletz, Gabor Gyoergy Deak, Stefan Sacu, Robin Ristl, Dariga Ramazanova, Graham E Holder, Christian Windischberger, Ursula Margarethe Schmidt-Erfurth

Background/aims: To determine the suitability of functional MRI (fMRI) as an objective measure of macular function following therapeutic intervention; conventional psychophysical measures rely heavily on patient compliance.

Methods: Twenty patients with neovascular age-related macular degeneration (nAMD) were studied with high-resolution fMRI, visual acuity, reading accuracy and speed, contrast sensitivity (CS) and microperimetry (MP) before and after 3 monthly intravitreal injections of ranibizumab. Population-receptive field retinotopic maps calculated from fMRI data were compared with psychophysical measures and optical coherence tomography.

Results: Best-corrected visual acuity (BCVA) responders (≥5 letters) showed an increase of 29.5% in activated brain area, while non-responders showed a decrease of 0.8%. Radial histograms over eccentricity allowed quantification of the absolute number of significant voxels and thus differences before and after treatment. Responders showed increases in foveal (α<0.5°) activation, while non-responders did not. Absence of intraretinal fluid and preservation of outer retinal layers was associated with higher numbers of active V1 voxels and better BCVA. Higher voxel numbers were associated with improved reading performance and, less marked, with BCVA, CS and MP.

Conclusion: The data show that retinotopic mapping using fMRI can successfully be applied objectively to evaluate the therapeutic response in nAMD patients treated with anti-vascular endothelial growth factor therapy. This demonstrates the ability of retinotopic mapping to provide an objective assessment of functional recovery at a cortical level; the technique can therefore be applied, in other degenerative macular diseases, to the assessment of potential therapeutic interventions such as gene therapy or cell replacement therapy.

背景/目的确定功能磁共振成像(fMRI)是否适合作为治疗干预后黄斑功能的客观测量方法;传统的心理物理测量方法在很大程度上依赖于患者的依从性:在每月3次玻璃体内注射雷尼珠单抗前后,对20名新生血管性老年黄斑变性(nAMD)患者进行了高分辨率fMRI、视力、阅读准确性和速度、对比敏感度(CS)和微观视力测定(MP)的研究。根据 fMRI 数据计算出的群体感受野视网膜位图与心理物理测量和光学相干断层扫描进行了比较:结果:最佳矫正视力(BCVA)反应者(≥5 个字母)的激活脑区增加了 29.5%,而无反应者减少了 0.8%。通过偏心率径向直方图可以量化显著体素的绝对数量,从而量化治疗前后的差异。有反应者的眼窝(α)有所增加:这些数据表明,利用 fMRI 进行视网膜位点图绘制可以成功地客观评估接受抗血管内皮生长因子治疗的 nAMD 患者的治疗反应。这表明视网膜定位图能够客观评估大脑皮层的功能恢复情况;因此,该技术可应用于其他退行性黄斑疾病,以评估基因疗法或细胞替代疗法等潜在的治疗干预措施。
{"title":"Retinotopic cortical mapping in objective functional monitoring of macular therapy.","authors":"Markus Ritter, Allan Hummer, Maximilian Pawloff, Anna A Ledolter, David Linhardt, Michael Woletz, Gabor Gyoergy Deak, Stefan Sacu, Robin Ristl, Dariga Ramazanova, Graham E Holder, Christian Windischberger, Ursula Margarethe Schmidt-Erfurth","doi":"10.1136/bjo-2021-320723","DOIUrl":"10.1136/bjo-2021-320723","url":null,"abstract":"<p><strong>Background/aims: </strong>To determine the suitability of functional MRI (fMRI) as an objective measure of macular function following therapeutic intervention; conventional psychophysical measures rely heavily on patient compliance.</p><p><strong>Methods: </strong>Twenty patients with neovascular age-related macular degeneration (nAMD) were studied with high-resolution fMRI, visual acuity, reading accuracy and speed, contrast sensitivity (CS) and microperimetry (MP) before and after 3 monthly intravitreal injections of ranibizumab. Population-receptive field retinotopic maps calculated from fMRI data were compared with psychophysical measures and optical coherence tomography.</p><p><strong>Results: </strong>Best-corrected visual acuity (BCVA) responders (≥5 letters) showed an increase of 29.5% in activated brain area, while non-responders showed a decrease of 0.8%. Radial histograms over eccentricity allowed quantification of the absolute number of significant voxels and thus differences before and after treatment. Responders showed increases in foveal (α<0.5°) activation, while non-responders did not. Absence of intraretinal fluid and preservation of outer retinal layers was associated with higher numbers of active V1 voxels and better BCVA. Higher voxel numbers were associated with improved reading performance and, less marked, with BCVA, CS and MP.</p><p><strong>Conclusion: </strong>The data show that retinotopic mapping using fMRI can successfully be applied objectively to evaluate the therapeutic response in nAMD patients treated with anti-vascular endothelial growth factor therapy. This demonstrates the ability of retinotopic mapping to provide an objective assessment of functional recovery at a cortical level; the technique can therefore be applied, in other degenerative macular diseases, to the assessment of potential therapeutic interventions such as gene therapy or cell replacement therapy.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"98-106"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174543","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}
引用次数: 0
Association between metformin use with circumpapillary retinal nerve fibre layer thickness and capillary vessel density in glaucoma. 使用二甲双胍与青光眼视网膜毛细血管神经纤维层厚度和毛细血管密度之间的关系。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-325035
Takashi Nishida, Sasan Moghimi, Gopikasree Gunasegaran, Evan Walker, Jo-Hsuan Wu, Kamran Rahmatnejad, Linda M Zangwill, Sally L Baxter, Robert N Weinreb

Background/aims: To investigate the association between use of metformin and circumpapillary retinal nerve fibre layer (cpRNFL) thickness, as well as whole image capillary density (wiCD), in patients with glaucoma.

Methods: This cross-sectional study included patients with glaucoma suspect or primary open-angle glaucoma (POAG) underwent optical coherence tomography angiography imaging. Use and duration of antidiabetic medications were assessed at the time of imaging. Multivariable linear mixed-effect modelling was used to estimate the effect of diabetes medication on wiCD and cpRNFL while controlling for covariates including age, race, body mass index, diagnosis, 24-2 visual field mean deviation, and intraocular pressure, average signal strength index as well as any variables that showed a p <0.1 in the univariable analysis.

Results: A total of 577 eyes (330 POAG and 247 glaucoma suspect) of 346 patients were included. Sixty-five patients (23%) had diabetes, of whom 55 (78.5%) used metformin, and 17 (26.2%) used insulin. After adjusting for covariates, the association between metformin use and wiCD (1.56 (95% CI 0.40 to 2.71); p=0.008), duration of metformin use and wiCD (0.12 (95% CI 0.02 to 0.22) per 1 year longer; p=0.037), and metformin use and cpRNFL thickness (5.17 (95% CI 1.24 to 9.10) µm; p=0.010) had statistically significant associations in each model.

Conclusions: Metformin use was associated with higher wiCD and thicker cpRNFL. These findings indicate a potential association, underscoring the need for longitudinal studies to determine if metformin plays a role in the retinal conditions of patients with glaucoma.

Trial registration number: NCT00221897.

背景/目的研究青光眼患者服用二甲双胍与环毛细血管视网膜神经纤维层(cpRNFL)厚度以及全像毛细血管密度(wiCD)之间的关系:这项横断面研究纳入了接受光学相干断层扫描血管成像的青光眼疑似患者或原发性开角型青光眼(POAG)患者。在成像时评估了抗糖尿病药物的使用情况和持续时间。在控制包括年龄、种族、体重指数、诊断、24-2视野平均偏差、眼压、平均信号强度指数在内的协变量的同时,采用多变量线性混合效应模型来估计糖尿病药物对 wiCD 和 cpRNFL 的影响:共纳入 346 名患者的 577 只眼睛(330 只 POAG 和 247 只青光眼疑似患者)。65名患者(23%)患有糖尿病,其中55人(78.5%)使用二甲双胍,17人(26.2%)使用胰岛素。在对协变量进行调整后,二甲双胍的使用与 wiCD(1.56(95% CI 0.40 至 2.71);p=0.008)、二甲双胍的使用时间与 wiCD(每延长 1 年 0.12(95% CI 0.02 至 0.22);p=0.037)以及二甲双胍的使用与 cpRNFL 厚度(5.17(95% CI 1.24 至 9.10)µm;p=0.010)之间的关联在每个模型中均具有统计学意义:结论:二甲双胍的使用与较高的 wiCD 和较厚的 cpRNFL 相关。结论:二甲双胍与较高的 wiCD 和较厚的 cpRNFL 相关。这些发现表明二甲双胍与青光眼患者的视网膜状况存在潜在关联,强调有必要进行纵向研究,以确定二甲双胍是否对青光眼患者的视网膜状况有影响:NCT00221897.
{"title":"Association between metformin use with circumpapillary retinal nerve fibre layer thickness and capillary vessel density in glaucoma.","authors":"Takashi Nishida, Sasan Moghimi, Gopikasree Gunasegaran, Evan Walker, Jo-Hsuan Wu, Kamran Rahmatnejad, Linda M Zangwill, Sally L Baxter, Robert N Weinreb","doi":"10.1136/bjo-2023-325035","DOIUrl":"10.1136/bjo-2023-325035","url":null,"abstract":"<p><strong>Background/aims: </strong>To investigate the association between use of metformin and circumpapillary retinal nerve fibre layer (cpRNFL) thickness, as well as whole image capillary density (wiCD), in patients with glaucoma.</p><p><strong>Methods: </strong>This cross-sectional study included patients with glaucoma suspect or primary open-angle glaucoma (POAG) underwent optical coherence tomography angiography imaging. Use and duration of antidiabetic medications were assessed at the time of imaging. Multivariable linear mixed-effect modelling was used to estimate the effect of diabetes medication on wiCD and cpRNFL while controlling for covariates including age, race, body mass index, diagnosis, 24-2 visual field mean deviation, and intraocular pressure, average signal strength index as well as any variables that showed a p <0.1 in the univariable analysis.</p><p><strong>Results: </strong>A total of 577 eyes (330 POAG and 247 glaucoma suspect) of 346 patients were included. Sixty-five patients (23%) had diabetes, of whom 55 (78.5%) used metformin, and 17 (26.2%) used insulin. After adjusting for covariates, the association between metformin use and wiCD (1.56 (95% CI 0.40 to 2.71); p=0.008), duration of metformin use and wiCD (0.12 (95% CI 0.02 to 0.22) per 1 year longer; p=0.037), and metformin use and cpRNFL thickness (5.17 (95% CI 1.24 to 9.10) µm; p=0.010) had statistically significant associations in each model.</p><p><strong>Conclusions: </strong>Metformin use was associated with higher wiCD and thicker cpRNFL. These findings indicate a potential association, underscoring the need for longitudinal studies to determine if metformin plays a role in the retinal conditions of patients with glaucoma.</p><p><strong>Trial registration number: </strong>NCT00221897.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"45-51"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261101","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}
引用次数: 0
Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial with microperimetry (PEELING). 视网膜外膜手术中剥离内限界膜的利弊:微透视随机临床试验(PEELING)。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-12-17 DOI: 10.1136/bjo-2023-324990
Jean-Baptiste Ducloyer, Yannick Eude, Christelle Volteau, Olivier Lebreton, Alexandre Bonissent, Paul Fossum, Ramin Tadayoni, Catherine P Creuzot-Garcher, Yannick Le Mer, Julien Perol, June Fortin, Alexandra Jobert, Fanny Billaud, Catherine Ivan, Alexandra Poinas, Michel Weber

Background: After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas.

Methods: The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6.

Results: 213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12.

Conclusion: Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery.

Trial registration: NCT02146144.

背景:特发性视网膜外膜(iERM)摘除后,是否应摘除内缘膜(ILM)尚不清楚。研究目的是评估特发性视网膜外膜摘除术后主动剥离内缘膜是否会诱发显微瘤:PEELING研究是一项全国性随机临床试验。如果没有发生自发的ILM剥离,患者被随机分配到ILM剥离组或无ILM剥离组。在第1个月(M1)、第6个月和第12个月的检查中,对各组患者的显微视力、最佳矫正视力(BCVA)和光学相干断层扫描结果进行比较。结果:共纳入213名患者,其中101人经历了自发性ILM剥离,100人被随机分配到ILM剥离组(51人)或无ILM剥离组(49人)。两组显微瘤数量的差异在M1时显著(ILM剥离组多3.9个显微瘤,(0.8;7.0) p=0.0155),但在M6时不显著(ILM剥离组多2.1个显微瘤,(-0.5;4.7) p=0.1155)。只有在无ILM剥离组,微瘤数量明显减少,平均视网膜灵敏度明显提高。无ILM剥离组有9名患者(19.6%)复发了ERM,而ILM剥离组为0(P=0.0008):其中两人接受了翻修手术。在M12复发或未复发的患者之间,平均BCVA和显微视力没有差异:结论:自发性ILM剥离非常常见。结论:自发性ILM剥离非常常见,积极的ILM剥离可防止ERM解剖复发,但可能诱发视网膜损伤并延迟视力恢复:试验注册:NCT02146144。
{"title":"Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial with microperimetry (PEELING).","authors":"Jean-Baptiste Ducloyer, Yannick Eude, Christelle Volteau, Olivier Lebreton, Alexandre Bonissent, Paul Fossum, Ramin Tadayoni, Catherine P Creuzot-Garcher, Yannick Le Mer, Julien Perol, June Fortin, Alexandra Jobert, Fanny Billaud, Catherine Ivan, Alexandra Poinas, Michel Weber","doi":"10.1136/bjo-2023-324990","DOIUrl":"10.1136/bjo-2023-324990","url":null,"abstract":"<p><strong>Background: </strong>After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas.</p><p><strong>Methods: </strong>The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6.</p><p><strong>Results: </strong>213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12.</p><p><strong>Conclusion: </strong>Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery.</p><p><strong>Trial registration: </strong>NCT02146144.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"119-125"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431413","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}
引用次数: 0
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British Journal of Ophthalmology
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