British Journal of Ophthalmology最新文献

Background: Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual outcomes following this treatment. This study evaluates final visual acuity (VA) in patients with RB treated with IAC, identifying factors contributing to vision loss.

Methods: A retrospective review was conducted at La Paz University Hospital in Madrid, including 71 eyes from 60 patients treated with IAC from 2016 to 2025. Data collected included the International Classification of Retinoblastoma and foveal involvement at diagnosis. VA was assessed using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR). The primary outcome was VA. The secondary outcome was the incidence of choroidal occlusive vasculopathy (COV).

Results: Of the 71 eyes, 24 belonged to patients too immature for VA assessment, and 20 were enucleated due to disease progression. Among the 27 eyes with measurable VA, 7 had a healthy fovea at diagnosis. 23 (85.2%) had a VA≥1.0 logMAR, including 10 (37%) with no light perception. Only four eyes (14.8%) achieved a VA<1.0 logMAR, all with a healthy fovea at diagnosis. Linear regression showed significant association between foveal involvement at diagnosis and reduced final VA. 16 of 71 eyes (22.5%) developed COV, with statistically significant correlation with the number of IAC cycles.

Conclusion: IAC is effective for tumour control and eye preservation but often yields poor visual outcomes in advanced RB due to pre-existing damage and complications like COV. These findings emphasise the importance of counselling families regarding the visual limitations of IAC treatment.

Background: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health.

Methods: We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180).

Results: Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals.

Conclusions: Mpox-related ophthalmic disease can cause substantial-and potentially preventable-visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II-particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.