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Advances in myopia control strategies for children. 儿童近视控制策略的进展。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-28 DOI: 10.1136/bjo-2023-323887
Xiu Juan Zhang, Ebenezer Zaabaar, Amanda Nicole French, Fang Yao Tang, Ka Wai Kam, Clement C Tham, Li Jia Chen, Chi Pui Pang, Jason C Yam

Myopia has long been a global threat to public health. Timely interventions are likely to reduce the risk of vision-threatening complications. There are both established and rapidly evolving therapeutic approaches to slow myopia progression and/or delay its onset. The effective methods for slowing myopia progression include atropine eye-drops, defocus incorporated multiple segments (DIMS) spectacle lenses, spectacle lenses with highly aspherical lenslets target (HALT), diffusion optics technology (DOT) spectacle lenses, red light therapy (RLT), multifocal soft contact lenses and orthokeratology. Among these, 0.05% atropine, HALT lenses, RLT and +3.00 peripheral addition soft contact lenses yield over 60% reduction in myopia progression, whereas DIMS, DOT and MiSight contact lenses demonstrate at least 50% myopia control efficacy. 0.05% atropine demonstrates a more optimal balance of efficacy and safety than 0.01%. The efficacy of 0.01% atropine has not been consistent and requires further validation across diverse ethnicities. Combining atropine 0.01% with orthokeratology or DIMS spectacles yields better outcomes than using these interventions as monotherapies. Increased outdoor time is an effective public health strategy for myopia prevention while recent studies suggest that 0.05% low-concentration atropine and RLT therapy have promising potential as clinical myopia prevention interventions for high-risk groups. Myopia control spectacle lenses, being the least invasive, are safe for long-term use. However, when considering other approaches, it is essential to ensure proper instruction and regular follow-ups to maintain safety and monitor any potential complications. Ultimately, significant advances have been made in myopia control strategies, many of which have shown meaningful clinical outcomes. However, regular use and adequate safety monitoring over extended durations are imperative to foster confidence that can only come from extensive clinical experience.

长期以来,近视一直是威胁公众健康的全球性问题。及时干预有可能降低威胁视力的并发症的风险。目前既有成熟的治疗方法,也有快速发展的治疗方法来减缓近视的发展和/或延缓近视的发生。延缓近视发展的有效方法包括阿托品眼药水、散焦融合多片式(DIMS)眼镜片、高非球面镜片目标(HALT)眼镜片、扩散光学技术(DOT)眼镜片、红光疗法(RLT)、多焦点软性隐形眼镜和角膜矫形术。其中,0.05% 的阿托品、HALT 镜片、RLT 和 +3.00 周边附加软性隐形眼镜可减少 60% 以上的近视度数加深,而 DIMS、DOT 和 MiSight 隐形眼镜的近视控制效果至少为 50%。与 0.01% 的阿托品相比,0.05% 的阿托品能更好地兼顾疗效和安全性。0.01% 阿托品的疗效并不一致,需要在不同种族中进一步验证。将 0.01% 阿托品与角膜矫形术或 DIMS 光学眼镜结合使用,比将这些干预措施作为单一疗法使用效果更好。增加户外活动时间是预防近视的有效公共卫生策略,而最近的研究表明,0.05% 低浓度阿托品和 RLT疗法作为高危人群预防近视的临床干预措施具有广阔的前景。近视控制眼镜片的侵入性最小,可长期安全使用。不过,在考虑其他方法时,必须确保正确的指导和定期的随访,以保持安全性并监测任何潜在的并发症。归根结底,近视控制策略已经取得了重大进展,其中许多都取得了显著的临床效果。然而,只有通过长期定期使用和充分的安全监测,才能增强人们的信心,而这种信心只能来自于丰富的临床经验。
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引用次数: 0
Characteristics of myopic maculopathy in Chinese children and adolescents with high myopia. 中国高度近视儿童和青少年近视性黄斑病变的特征。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-28 DOI: 10.1136/bjo-2023-324430
Feng Jiang, Ou Xiao, Xinxing Guo, Qiuxia Yin, Lixia Luo, Mingguang He, Zhixi Li

Aims: To investigate the characteristics of myopic maculopathy among highly myopic Chinese children and adolescents and explore its associated risk factors.

Methods: Children and adolescents aged 7-17 years with spherical equivalent (SE) ≤ -6.00 dioptres (D) were recruited. Myopic maculopathy was categorised based on the International Meta-Analysis of Pathological Myopia Classification. The extent of diffuse choroidal atrophy (DCA) was classified using Early Treatment Diabetic Retinopathy Study grid (ETDRS). The area of DCA was categorised into three classes relative to optic disk area (DA): A1 (≤1 DA), A2 (1 to ≤5 DA) and A3 (5 to ≤10 DA). Logistic regression was used to identify risk factors associated with myopic maculopathy.

Results: Of the 425 participants aged 13.66±2.67 years, the proportions of tessellated fundus and DCA were 11.76% and 12.24%, and no more severe fundus lesions or 'plus' lesions. The proportion of DCA was 27.03% in children under 11, significantly higher than the 9.12% observed in those aged 11 and older (p<0.001). The percentages of DCA involving the outer, middle and central circles of the ETDRS grid were 42.31%, 55.77% and 1.92%. Myopic maculopathy was significantly associated with younger age (p<0.001), longer axial length (AL; p<0.001) and larger β-zone peripapillary atrophy (β-PPA; p=0.012).

Conclusion: In highly myopic children and adolescents, myopic maculopathy predominantly manifested as DCA (12.24%), with no cases of worse myopic maculopathy or 'plus' lesions. Younger age, longer AL and larger β-PPA were risk factors for myopic maculopathy.

目的:研究中国高度近视儿童和青少年近视性黄斑病变的特征,并探讨其相关风险因素:招募球面等效视力(SE)≤-6.00屈光度(D)的7-17岁儿童和青少年。近视性黄斑病变根据病理性近视国际元分析分类进行分类。弥漫性脉络膜萎缩(DCA)的程度根据早期治疗糖尿病视网膜病变研究网格(ETDRS)进行分类。相对于视盘面积(DA),DCA的面积被分为三个等级:A1(≤1 DA)、A2(1 至 ≤5 DA)和 A3(5 至 ≤10 DA)。采用逻辑回归法确定与近视性黄斑病变相关的风险因素:在年龄为(13.66±2.67)岁的 425 名参与者中,有网状眼底和 DCA 的比例分别为 11.76% 和 12.24%,没有更严重的眼底病变或 "加号 "病变。11 岁以下儿童的 DCA 比例为 27.03%,明显高于 11 岁及以上儿童的 9.12%(p 结论:在高度近视的儿童和青少年中,近视性黄斑病变主要表现为DCA(12.24%),没有更严重的近视性黄斑病变或 "附加 "病变病例。年龄越小、AL越长、β-PPA越大是近视性黄斑病变的风险因素。
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引用次数: 0
Short-term choroidal changes as early indicators for future myopic shift in primary school children: results of a 2-year cohort study. 将短期脉络膜变化作为小学生未来近视转移的早期指标:一项为期两年的队列研究结果。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-28 DOI: 10.1136/bjo-2024-325871
Hao Wu, Mengqi Liu, Yuanyuan Wang, Xiang Li, Weihe Zhou, Haoer Li, Zhu Xie, Pengqi Wang, Tingting Zhang, Wei Qu, Jing Huang, Yunpeng Zhao, Jiefang Wang, Sen Zhang, Jia Qu, Cong Ye, Xiangtian Zhou

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

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

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

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

背景:评估短期脉络膜变化对儿童未来近视度数变化的预测价值:方法:对 289 名小学生的 577 只眼睛进行为期 2 年的前瞻性随访。基线、1 年和 2 年的屈光度数以及基线和 3 个月的光学相干断层扫描脉络膜测量值均用于分析。结果:228 名参与者(455 只眼睛)完成了为期 2 年的随访。在 311 只最初为非近视眼的眼睛中,约有 37.6% 出现了近视度数改变;在 144 只最初为近视眼的眼睛中,约有 73.6% 出现了近视度数改变。值得注意的是,3 个月后,发现有近视转移的初始近视眼的脉络膜厚度(ChT)、管腔面积(LA)、基质面积(SA)和脉络膜总面积(TCA)比没有近视转移的近视眼减少得更多,但在有近视转移和没有近视转移的非近视眼之间,没有观察到任何脉络膜参数的显著差异。多变量分析表明,在近视眼中,ChT、LA、SA 和 TCA 每增加一个百分点,近视度数发生改变的几率就会降低(所有 p 均为 0):短期脉络膜变化可作为儿童未来近视度数改变的早期指标。
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引用次数: 0
Visual outcomes and prognostic factors in ischaemic retinal vasculitis. 缺血性视网膜血管炎的视觉结果和预后因素。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-28 DOI: 10.1136/bjo-2024-325775
Aaron Yap, Helen Kearns, Joanne L Sims, Rachael L Niederer

Purpose: Our aim was to describe the visual outcomes and determine the clinical factors in ischaemic retinal vasculitis (IRV) that were predictive of a poor visual prognosis or infectious aetiology.

Methods: Retrospective cohort study of consecutive presentations of IRV to Auckland District Health Board from 2009 to 2022.

Results: The median age at presentation was 39.2 years and 108 (53.7%) were women. The total median follow-up was 4.8 years. Infectious aetiology was present in 151 eyes (52.1%). Moderate visual loss (20/50 to 20/200) occurred in 20 eyes (6.9%) and severe visual loss (≤20/200) occurred in 41 eyes (14.1%). Median visual acuity was 20/30 (IQR 20/25 to 20/100) on presentation and 20/25 (IQR 20/20 to 20/50) at final follow-up. Retinitis (HR 4.675 p=0.048) and cystoid macular oedema (CME) (HR 7.265 p<0.001) were significantly associated with vision loss. There was concurrent macular ischaemia in 26 eyes (19.4%) and CME in 52 eyes (17.9%). Retinitis was predictive of infectious aetiology (p=0.006) and cotton wool spots for non-infectious aetiology (p<0.001). Retinal haemorrhage (HR 5.580 p=0.001), retinal vein occlusion (HR 5.071 p=0.001) and quadrants of ischaemia (HR 2.222 p=0.025) were significantly associated with vitreous haemorrhage.

Conclusion: In patients with IRV, 21% of affected individuals sustained moderate-to-severe vision loss over 5 years. Ultra-widefield fluorescein angiography can be used to quantify the risk of neovascular complications and guide treatment.

目的:我们的目的是描述缺血性视网膜血管炎(IRV)的视觉结果,并确定可预测不良视觉预后或感染性病因的临床因素:方法:对2009年至2022年奥克兰地区卫生局连续接诊的IRV患者进行回顾性队列研究:中位发病年龄为39.2岁,108人(53.7%)为女性。总随访时间的中位数为 4.8 年。151只眼睛(52.1%)存在感染病因。20只眼睛(6.9%)出现中度视力下降(20/50至20/200),41只眼睛(14.1%)出现重度视力下降(≤20/200)。发病时视力中位数为 20/30(IQR 20/25 至 20/100),最后随访时视力中位数为 20/25(IQR 20/20 至 20/50)。视网膜炎(HR 4.675 p=0.048)和囊样黄斑水肿(CME)(HR 7.265 p=0.048):在IRV患者中,21%的患者在5年内视力中度至重度下降。超宽视野荧光素血管造影可用于量化新生血管并发症的风险并指导治疗。
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引用次数: 0
Comparison of subconjunctival TRIamcinolone acetonide injection and intravitreal dexamethasone (OZurdex) injection for uveitic and postoperative macular oedema: the TRIOZ study. 对比结膜下注射 TRIamcinolone acetonide 和玻璃体内注射地塞米松 (OZurdex) 治疗葡萄膜炎和术后黄斑水肿:TRIOZ 研究。
IF 3.7 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-28 DOI: 10.1136/bjo-2023-325128
Chloé Couret, Pierre-Antoine Quintart, Alexandra Poinas, Marie-Anne Vibet, Marie-Laure Le Lez, Pierre Labalette, Bahram Bodaghi, Marc Labetoulle, Marie-Bénédicte Rougier, Karine Angioi, Christophe Chiquet, Cherif Titah, Laurent Kodjikian, Stephanie Baillif, Catherine Creuzot-Garcher, Marie-Hélène Errera, Michel Weber

Aims: To compare effectiveness of subconjunctival triamcinolone acetonide injections and intravitreal injections of dexamethasone 700 µg implants in reducing central macular thickness (CMT) in uveitic and postoperative macular oedema (ME).

Methods: We conducted an open-label, French multicentre randomised comparative trial with a logarithmic CMT non-inferiority margin set at 0.06. Patients were adults with non-infectious inflammatory ME, without any contraindication to the treatments. They were randomised 1:1 to receive either triamcinolone or dexamethasone. The primary endpoint was the difference in CMT among treated eyes between baseline and 2 months, measured with spectral-domain optical coherence tomography. Secondary outcomes included visual acuity, laser flare, vitreous haze, duration of action, tolerance to injections and adverse events.

Results: Between January 2016 and January 2020, 106 patients were enrolled (54 in the triamcinolone group and 52 in the dexamethasone group). Subconjunctival triamcinolone injections seemed to be non-inferior to intravitreal dexamethasone injections, especially at month 3 (and nearly at month 1). Nevertheless, we could not demonstrate it, with a treatment effect at month 2 of 0.05 (0.01 ; 0.09) (p value=0.001). This was corroborated by post hoc analyses in the postoperative subgroup, for whom the non-inferiority was nearly demonstrated at month 2 with a treatment effect of 0.02 (-0.03 ; 0.08) (p=0.37). There was no significant difference in the occurrence of adverse effects.

Conclusion: We could not demonstrate the non-inferiority of triamcinolone injections at month 2. Nevertheless, they showed some efficacity, particularly in treating postoperative ME, being as safe as dexamethasone injections, without any loss of chance if a therapeutic switch is necessary.

目的:比较结膜下注射曲安奈德曲安奈德和玻璃体内注射地塞米松 700 µg 植入剂在减少葡萄膜炎和术后黄斑水肿(ME)患者黄斑中心厚度(CMT)方面的效果:我们进行了一项开放标签的法国多中心随机比较试验,CMT 非劣效值对数差定为 0.06。患者均为成人非感染性炎症性 ME 患者,无任何治疗禁忌症。他们按1:1的比例随机接受曲安奈德或地塞米松治疗。主要终点是通过光谱域光学相干断层扫描测量治疗眼在基线和两个月之间的CMT差异。次要结果包括视力、激光耀斑、玻璃体混浊、作用持续时间、对注射的耐受性和不良事件:2016年1月至2020年1月期间,共有106名患者入组(曲安奈德组54人,地塞米松组52人)。结膜下注射曲安奈德似乎不劣于玻璃体内注射地塞米松,尤其是在第 3 个月(几乎在第 1 个月)。然而,我们无法证明这一点,第 2 个月的治疗效果为 0.05 (0.01 ; 0.09) (p 值=0.001)。这一点在术后亚组的事后分析中得到了证实,术后亚组在第 2 个月的治疗效果为 0.02 (-0.03 ; 0.08) (p=0.37) ,几乎证明了非劣效性。不良反应发生率无明显差异:尽管如此,三苯氧胺注射液仍显示出一定的疗效,尤其是在治疗术后 ME 方面,其安全性与地塞米松注射液不相上下,如果需要转换疗法,也不会失去任何机会。
{"title":"Comparison of subconjunctival TRIamcinolone acetonide injection and intravitreal dexamethasone (OZurdex) injection for uveitic and postoperative macular oedema: the TRIOZ study.","authors":"Chloé Couret, Pierre-Antoine Quintart, Alexandra Poinas, Marie-Anne Vibet, Marie-Laure Le Lez, Pierre Labalette, Bahram Bodaghi, Marc Labetoulle, Marie-Bénédicte Rougier, Karine Angioi, Christophe Chiquet, Cherif Titah, Laurent Kodjikian, Stephanie Baillif, Catherine Creuzot-Garcher, Marie-Hélène Errera, Michel Weber","doi":"10.1136/bjo-2023-325128","DOIUrl":"10.1136/bjo-2023-325128","url":null,"abstract":"<p><strong>Aims: </strong>To compare effectiveness of subconjunctival triamcinolone acetonide injections and intravitreal injections of dexamethasone 700 µg implants in reducing central macular thickness (CMT) in uveitic and postoperative macular oedema (ME).</p><p><strong>Methods: </strong>We conducted an open-label, French multicentre randomised comparative trial with a logarithmic CMT non-inferiority margin set at 0.06. Patients were adults with non-infectious inflammatory ME, without any contraindication to the treatments. They were randomised 1:1 to receive either triamcinolone or dexamethasone. The primary endpoint was the difference in CMT among treated eyes between baseline and 2 months, measured with spectral-domain optical coherence tomography. Secondary outcomes included visual acuity, laser flare, vitreous haze, duration of action, tolerance to injections and adverse events.</p><p><strong>Results: </strong>Between January 2016 and January 2020, 106 patients were enrolled (54 in the triamcinolone group and 52 in the dexamethasone group). Subconjunctival triamcinolone injections seemed to be non-inferior to intravitreal dexamethasone injections, especially at month 3 (and nearly at month 1). Nevertheless, we could not demonstrate it, with a treatment effect at month 2 of 0.05 (0.01 ; 0.09) (p value=0.001). This was corroborated by post hoc analyses in the postoperative subgroup, for whom the non-inferiority was nearly demonstrated at month 2 with a treatment effect of 0.02 (-0.03 ; 0.08) (p=0.37). There was no significant difference in the occurrence of adverse effects.</p><p><strong>Conclusion: </strong>We could not demonstrate the non-inferiority of triamcinolone injections at month 2. Nevertheless, they showed some efficacity, particularly in treating postoperative ME, being as safe as dexamethasone injections, without any loss of chance if a therapeutic switch is necessary.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"215-222"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016456","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
Fluid fluctuations assessed with artificial intelligence during the maintenance phase impact anti-vascular endothelial growth factor visual outcomes in a multicentre, routine clinical care national age-related macular degeneration database
IF 4.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-23 DOI: 10.1136/bjo-2024-325615
Ruben Martin-Pinardel, Jordi Izquierdo-Serra, Carolina Bernal-Morales, Sandro De Zanet, Gonzaga Garay-Aramburu, Martin Puzo, Carolina Arruabarrena, Laura Sararols, Maximino Abraldes, Laura Broc, Jose Juan Escobar-Barranco, Marta Figueroa, Miguel Angel Zapata, José M Ruiz-Moreno, Alba Parrado-Carrillo, Aina Moll-Udina, Socorro Alforja, Marc Figueras-Roca, Laia Gómez-Baldó, Carlos Ciller, Stefanos Apostolopoulos, Anastasiia Mishchuk, Ricardo P Casaroli-Marano, Javier Zarranz-Ventura
Aim To evaluate the impact of fluid volume fluctuations quantified with artificial intelligence in optical coherence tomography scans during the maintenance phase and visual outcomes at 12 and 24 months in a real-world, multicentre, national cohort of treatment-naïve neovascular age-related macular degeneration (nAMD) eyes. Methods Demographics, visual acuity (VA) and number of injections were collected using the Fight Retinal Blindness tool. Intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), total fluid (TF) and central subfield thickness (CST) were quantified using the RetinAI Discovery tool. Fluctuations were defined as the SD of within-eye quantified values, and eyes were distributed according to SD quartiles for each biomarker. Results A total of 452 naïve nAMD eyes were included. Eyes with highest (Q4) versus lowest (Q1) fluid fluctuations showed significantly worse VA change (months 3–12) in IRF −3.91 versus 3.50 letters, PED −4.66 versus 3.29, TF −2.07 versus 2.97 and CST −1.85 versus 2.96 (all p<0.05), but not for SRF 0.66 versus 0.93 (p=0.91). Similar VA outcomes were observed at month 24 for PED −8.41 versus 4.98 (p<0.05), TF −7.38 versus 1.89 (p=0.07) and CST −10.58 versus 3.60 (p<0.05). The median number of injections (months 3–24) was significantly higher in Q4 versus Q1 eyes in IRF 9 versus 8, SRF 10 versus 8 and TF 10 versus 8 (all p<0.05). Conclusion This multicentre study reports a negative effect in VA outcomes of fluid volume fluctuations during the maintenance phase in specific fluid compartments, suggesting that anatomical and functional treatment response patterns may be fluid-specific. Data are available in a public, open access repository. Zarranz-Ventura J. (n.d.). Data from: FRB Spain IMAGE nAMD Report 2. Dryad Digital Repository, March 30, 2024. ().
{"title":"Fluid fluctuations assessed with artificial intelligence during the maintenance phase impact anti-vascular endothelial growth factor visual outcomes in a multicentre, routine clinical care national age-related macular degeneration database","authors":"Ruben Martin-Pinardel, Jordi Izquierdo-Serra, Carolina Bernal-Morales, Sandro De Zanet, Gonzaga Garay-Aramburu, Martin Puzo, Carolina Arruabarrena, Laura Sararols, Maximino Abraldes, Laura Broc, Jose Juan Escobar-Barranco, Marta Figueroa, Miguel Angel Zapata, José M Ruiz-Moreno, Alba Parrado-Carrillo, Aina Moll-Udina, Socorro Alforja, Marc Figueras-Roca, Laia Gómez-Baldó, Carlos Ciller, Stefanos Apostolopoulos, Anastasiia Mishchuk, Ricardo P Casaroli-Marano, Javier Zarranz-Ventura","doi":"10.1136/bjo-2024-325615","DOIUrl":"https://doi.org/10.1136/bjo-2024-325615","url":null,"abstract":"Aim To evaluate the impact of fluid volume fluctuations quantified with artificial intelligence in optical coherence tomography scans during the maintenance phase and visual outcomes at 12 and 24 months in a real-world, multicentre, national cohort of treatment-naïve neovascular age-related macular degeneration (nAMD) eyes. Methods Demographics, visual acuity (VA) and number of injections were collected using the Fight Retinal Blindness tool. Intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), total fluid (TF) and central subfield thickness (CST) were quantified using the RetinAI Discovery tool. Fluctuations were defined as the SD of within-eye quantified values, and eyes were distributed according to SD quartiles for each biomarker. Results A total of 452 naïve nAMD eyes were included. Eyes with highest (Q4) versus lowest (Q1) fluid fluctuations showed significantly worse VA change (months 3–12) in IRF −3.91 versus 3.50 letters, PED −4.66 versus 3.29, TF −2.07 versus 2.97 and CST −1.85 versus 2.96 (all p<0.05), but not for SRF 0.66 versus 0.93 (p=0.91). Similar VA outcomes were observed at month 24 for PED −8.41 versus 4.98 (p<0.05), TF −7.38 versus 1.89 (p=0.07) and CST −10.58 versus 3.60 (p<0.05). The median number of injections (months 3–24) was significantly higher in Q4 versus Q1 eyes in IRF 9 versus 8, SRF 10 versus 8 and TF 10 versus 8 (all p<0.05). Conclusion This multicentre study reports a negative effect in VA outcomes of fluid volume fluctuations during the maintenance phase in specific fluid compartments, suggesting that anatomical and functional treatment response patterns may be fluid-specific. Data are available in a public, open access repository. Zarranz-Ventura J. (n.d.). Data from: FRB Spain IMAGE nAMD Report 2. Dryad Digital Repository, March 30, 2024. (<https://doi.org/10.5061/dryad.m905qfv8p>).","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027226","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
Can large language models fully automate or partially assist paper selection in systematic reviews? 大型语言模型能否完全自动化或部分辅助系统评审中的论文选择?
IF 4.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-15 DOI: 10.1136/bjo-2024-326254
Haichao Chen, Zehua Jiang, Xinyu Liu, Can Can Xue, Samantha Min Er Yew, Bin Sheng, Ying-Feng Zheng, Xiaofei Wang, You Wu, Sobha Sivaprasad, Tien Yin Wong, Varun Chaudhary, Yih Chung Tham
Background/aims Large language models (LLMs) have substantial potential to enhance the efficiency of academic research. The accuracy and performance of LLMs in a systematic review, a core part of evidence building, has yet to be studied in detail. Methods We introduced two LLM-based approaches of systematic review: an LLM-enabled fully automated approach (LLM-FA) utilising three different GPT-4 plugins (Consensus GPT, Scholar GPT and GPT web browsing modes) and an LLM-facilitated semi-automated approach (LLM-SA) using GPT4’s Application Programming Interface (API). We benchmarked these approaches using three published systematic reviews that reported the prevalence of diabetic retinopathy across different populations (general population, pregnant women and children). Results The three published reviews consisted of 98 papers in total. Across these three reviews, in the LLM-FA approach, Consensus GPT correctly identified 32.7% (32 out of 98) of papers, while Scholar GPT and GPT4’s web browsing modes only identified 19.4% (19 out of 98) and 6.1% (6 out of 98), respectively. On the other hand, the LLM-SA approach not only successfully included 82.7% (81 out of 98) of these papers but also correctly excluded 92.2% of 4497 irrelevant papers. Conclusions Our findings suggest LLMs are not yet capable of autonomously identifying and selecting relevant papers in systematic reviews. However, they hold promise as an assistive tool to improve the efficiency of the paper selection process in systematic reviews. Data are available upon reasonable request. All data and code are available upon request by emailing thamyc@nus.edu.sg.
背景/目的大型语言模型(llm)在提高学术研究效率方面具有巨大的潜力。法学硕士在系统评价中的准确性和表现,作为证据构建的核心部分,还有待详细研究。我们介绍了两种基于llm的系统评价方法:一种是基于llm的全自动方法(LLM-FA),利用三种不同的GPT-4插件(Consensus GPT、Scholar GPT和GPT网页浏览模式),另一种是基于llm的半自动方法(LLM-SA),使用GPT4的应用程序编程接口(API)。我们使用三篇已发表的系统综述来对这些方法进行基准测试,这些综述报道了糖尿病视网膜病变在不同人群(普通人群、孕妇和儿童)中的患病率。结果3篇综述共收录论文98篇。在这三篇综述中,在LLM-FA方法中,Consensus GPT正确识别了32.7%(98篇中的32篇)的论文,而Scholar GPT和GPT4的网页浏览模式分别仅识别了19.4%(98篇中的19篇)和6.1%(98篇中的6篇)。另一方面,LLM-SA方法不仅成功地收录了这些论文中的82.7%(98篇中的81篇),而且正确地排除了4497篇无关论文中的92.2%。我们的研究结果表明,法学硕士还没有能力在系统综述中自主识别和选择相关论文。然而,它们有望作为一种辅助工具来提高系统评价中论文选择过程的效率。如有合理要求,可提供资料。所有数据和代码可通过电子邮件thamyc@nus.edu.sg索取。
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引用次数: 0
Longitudinal corneal hysteresis changes predict structural progression in medically controlled, early-to-moderate, open-angle glaucoma with a history of refractive surgery 纵向角膜滞后变化可预测曾接受屈光手术的药物控制型早期至中度开角型青光眼的结构性进展
IF 4.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-13 DOI: 10.1136/bjo-2024-326405
Jihei Sara Lee, Hyoung Won Bae, Chan Yun Kim, Sang Yeop Lee
Background The present study aims to identify the relationship between longitudinal changes in corneal hysteresis (CH) and progressive retinal nerve fibre layer (RNFL) thinning in a cohort of medically controlled, early-to-moderate open-angle glaucoma (OAG) patients with a history of laser refractive surgery (LRS). Methods A total of 123 consecutive eyes with a diagnosis of medically controlled (peak intraocular pressure (IOP)<18 mm Hg), early-to-moderate OAG with a history of LRS underwent measurements of CH, corneal-compensated intraocular pressure (IOPcc) and RNFL thicknesses every 6 months. Linear models were used to investigate the relationship between CH change and RNFL thickness change over time. Results Of 123 eyes, 30 eyes (24.4%, 42.9±9.3 years, 36.7% males) demonstrated RNFL loss (93 eyes no progression, 44.4±9.6 years, 30.1% males). No statistically significant difference was found in IOP, but significantly greater decrease in CH was noted in the progression group (−2.525% baseline (95% CI −4.974 to −0.076) vs 1.068% baseline (95% CI, −0.322 to 2.458); p=0.013). Relative CH change was greater for more advanced stage of OAG among the progression group. Patients with the greatest relative CH decrease over time was 1.7 times more likely to present RNFL loss (HR 1.705, 95% CI 1.113 to 2.611, p=0.014). Conclusions Longitudinal decrease in CH over time was greater in those showing structural progression than those without progression among medically controlled, early-to-moderate OAG with a history of LRS. Decrease in CH was significantly associated with faster RNFL loss. Larger CH changes indicate a higher risk of OAG progression in those with a history of LRS. Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.
背景 本研究的目的是在一组有激光屈光手术(LRS)史的药物控制的早中度开角型青光眼(OAG)患者中,确定角膜滞后(CH)的纵向变化与渐进性视网膜神经纤维层(RNFL)变薄之间的关系。方法 对诊断为药物控制(峰值眼压 (IOP) <18 mm Hg)、有激光屈光手术史的早期至中度开角型青光眼患者的 123 只连续眼球每 6 个月进行一次 CH、角膜补偿眼压 (IOPcc) 和 RNFL 厚度测量。采用线性模型研究 CH 变化与 RNFL 厚度随时间变化之间的关系。结果 在 123 只眼睛中,30 只眼睛(24.4%,42.9±9.3 岁,36.7% 为男性)出现 RNFL 损失(93 只眼睛无进展,44.4±9.6 岁,30.1% 为男性)。眼压没有统计学意义上的显著差异,但眼压进展组的CH下降幅度明显更大(基线-2.525% (95% CI -4.974 to -0.076) vs 基线1.068% (95% CI, -0.322 to 2.458); p=0.013)。在进展组中,OAG 阶段越晚,CH 相对变化越大。随着时间的推移,CH相对值下降最大的患者出现RNFL缺失的可能性增加了1.7倍(HR 1.705,95% CI 1.113至2.611,p=0.014)。结论 在药物控制的、有 LRS 病史的早期至中度 OAG 患者中,随着时间的推移,CH 的纵向下降幅度大于无结构性进展的患者。CH的下降与RNFL的加速丧失有明显的相关性。较大的CH变化表明,有LRS病史的OAG进展风险较高。如有合理要求,可提供相关数据。数据可向通讯作者索取。
{"title":"Longitudinal corneal hysteresis changes predict structural progression in medically controlled, early-to-moderate, open-angle glaucoma with a history of refractive surgery","authors":"Jihei Sara Lee, Hyoung Won Bae, Chan Yun Kim, Sang Yeop Lee","doi":"10.1136/bjo-2024-326405","DOIUrl":"https://doi.org/10.1136/bjo-2024-326405","url":null,"abstract":"Background The present study aims to identify the relationship between longitudinal changes in corneal hysteresis (CH) and progressive retinal nerve fibre layer (RNFL) thinning in a cohort of medically controlled, early-to-moderate open-angle glaucoma (OAG) patients with a history of laser refractive surgery (LRS). Methods A total of 123 consecutive eyes with a diagnosis of medically controlled (peak intraocular pressure (IOP)<18 mm Hg), early-to-moderate OAG with a history of LRS underwent measurements of CH, corneal-compensated intraocular pressure (IOPcc) and RNFL thicknesses every 6 months. Linear models were used to investigate the relationship between CH change and RNFL thickness change over time. Results Of 123 eyes, 30 eyes (24.4%, 42.9±9.3 years, 36.7% males) demonstrated RNFL loss (93 eyes no progression, 44.4±9.6 years, 30.1% males). No statistically significant difference was found in IOP, but significantly greater decrease in CH was noted in the progression group (−2.525% baseline (95% CI −4.974 to −0.076) vs 1.068% baseline (95% CI, −0.322 to 2.458); p=0.013). Relative CH change was greater for more advanced stage of OAG among the progression group. Patients with the greatest relative CH decrease over time was 1.7 times more likely to present RNFL loss (HR 1.705, 95% CI 1.113 to 2.611, p=0.014). Conclusions Longitudinal decrease in CH over time was greater in those showing structural progression than those without progression among medically controlled, early-to-moderate OAG with a history of LRS. Decrease in CH was significantly associated with faster RNFL loss. Larger CH changes indicate a higher risk of OAG progression in those with a history of LRS. Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"17 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974774","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
Low clinical activity score, ‘progressive’ thyroid eye disease: presentations of 1439 patients from a tertiary centre in Hong Kong 低临床活动度评分,“进行性”甲状腺眼病:来自香港某三级医疗中心的1439名患者的表现
IF 4.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-11 DOI: 10.1136/bjo-2024-325346
Kenneth Ka Hei Lai, Fatema Mohamed Ali Abdulla Aljufairi, Jake Uy Sebastian, Kei Hei Lai, Karen Kar Wun Chan, Joyce Kar Yee Chin, Regine Yien Ching Chan, Chi Lai Li, Wilson Wai Kuen Yip, Alvin Lerrmann Young, Clement Chee Yung Tham, Chi Pui Pang, Kelvin Kam Lung Chong
Background To report the presenting clinical, serological and treatment profiles of 1439 patients with thyroid eye disease (TED) from a tertiary centre in Hong Kong. Study populations Consecutive patients with TED presented to the Thyroid Eye Clinic (TEC), the Chinese University of Hong Kong between 2014 and 2023. Methods Prospective cohort and masked review of medical records and orbital images. Results A total of 1439 (70% female, 98% Han Chinese) patients with TED (26% ex/current smoker), presented at 43±5.9 years old, were reviewed. The first TED symptoms to TEC evaluation was 6±3 months. 85% had Graves’ disease and 12% were given radioactive iodine before presentation. 35% of patients had a family history of autoimmune thyroid diseases. Baseline thyroid-stimulating hormone receptor antibody, thyroid-stimulating immunoglobulin and thyroid peroxidase antibody were elevated in 75%, 69% and 57% tested. Euthyroid TED (E-TED) was diagnosed in 6%, associated with asymmetric presentation (p<0.001). The most common signs were exophthalmos (69%), upper eyelid retraction (53%), swelling (36%), conjunctival injection (34%) and lower eyelid retraction (32%). Notably, 547 (38%) presented with moderate-to-severe and 150 (10%) vision-threatening TED, whose clinical activity score (CAS) was just 2.4±1.4 and 2.6±1.5, respectively. Male and TED onset after 40 were associated with higher CAS and NOSPEC (No physical signs or symptoms, Only signs, Soft tissue involvement, Proptosis, Extraocular muscle signs, Corneal involvement, and Sight loss) score (both p<0.05). 471 (33%), 361 (25%), 263 (18%) and 138 (9%) patients received intravenous methylprednisolone, orbital radiotherapy, steroid-sparing immunosuppressants and surgical decompression, respectively. Conclusions Around one-third (34%) of our cohort presented with ‘low-CAS, progressive’, moderate-to-severe or vision-threatening TED, while only one-fifth (18%) were clinically active (CAS≥3). Our results showed the limitations and unmet need of the existing ‘high-CAS only’ approach, especially in managing ‘non-inflammatory’ TED, prevalent in non-Caucasian populations. Data are available upon reasonable request. No data are available. Not applicable.
报告来自香港某三级医疗中心的1439例甲状腺眼病(TED)患者的临床、血清学和治疗情况。研究人群:2014年至2023年间在香港中文大学甲状腺眼科诊所(TEC)连续就诊的TED患者。方法采用前瞻性队列分析和隐式回顾性分析。结果回顾性分析了年龄为43±5.9岁的1439例TED患者(70%为女性,98%为汉族)(26%为戒烟者/吸烟者)。首次TED症状到TEC评估为6±3个月。85%的患者患有格雷夫斯病,12%的患者就诊前接受过放射性碘治疗。35%的患者有自身免疫性甲状腺疾病家族史。基线促甲状腺激素受体抗体、促甲状腺免疫球蛋白和甲状腺过氧化物酶抗体升高的比例分别为75%、69%和57%。甲状腺功能亢进(E-TED)的诊断率为6%,与不对称表现相关(p<0.001)。最常见的症状是眼球突出(69%)、上睑挛缩(53%)、肿胀(36%)、结膜注射(34%)和下睑挛缩(32%)。值得注意的是,547例(38%)表现为中度至重度TED, 150例(10%)表现为视力威胁TED,其临床活动评分(CAS)分别仅为2.4±1.4和2.6±1.5。男性和40岁以后发病的TED患者CAS和NOSPEC评分较高(无体征或症状,只有体征、软组织受累、眼球突出、眼外肌体征、角膜受累和视力丧失)(均p<0.05)。分别有471例(33%)、361例(25%)、263例(18%)和138例(9%)患者接受了静脉注射甲基强的松龙、眼眶放疗、保留类固醇免疫抑制剂和手术减压。大约三分之一(34%)的患者表现为“低CAS,进行性”,中重度或视力威胁的TED,而只有五分之一(18%)的患者临床活跃(CAS≥3)。我们的研究结果显示了现有的“仅高cas”方法的局限性和未满足的需求,特别是在管理非白种人人群中普遍存在的“非炎症性”TED方面。如有合理要求,可提供资料。无数据。不适用。
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引用次数: 0
Prevalence and risk factors of myopic macular degeneration: the Aier-SERI high myopia adult cohort 近视黄斑变性的患病率及危险因素:Aier-SERI高度近视成人队列
IF 4.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-01-08 DOI: 10.1136/bjo-2024-326116
Li Lian Foo, Yanfeng Jiang, Quan V Hoang, Hla Myint Htoon, Ziqi Hu, Wei Pan, Kai Xiong Cheong, Ecosse Luc Lamoureux, Zhikuan Yang, Weizhong Lan, Seang-Mei Saw
Purpose To assess the prevalence and risk factors of myopic macular degeneration (MMD) in young and middle-aged individuals with high myopia in Changsha, central China. Methods A total of 445 adults with high myopia (worse than or equal to −5.0 D) were examined between 2021 and 2023. Autorefraction and biometry using IOLMaster were conducted, and fundus photos were graded for MMD using Meta-PM criteria. MMD was diagnosed if category 2, 3, 4 or any plus lesion was present. Risk factors such as age, gender, spherical equivalent (SE)/axial length (AL), body mass index, education and residence were analysed via logistic regression. Results Participants had an average age of 42.3±7.3 years. MMD prevalence was 21.8% (71 adults) with a mean SE of −9.5±4.7 D and AL of 27.3±1.9 mm. Significant risk factors included greater myopic SE (OR=1.7 per 1 D decrease) and longer AL (OR=3.6 per 1 mm increase). MMD prevalence rose sharply with myopia worse than −10.00 D and AL >27.00 mm, reaching up to 100% for myopia worse than −14.00 D or AL ≥29.00 mm. Conclusion MMD affects about one in five young to middle-aged adults with high myopia. Those exceeding critical myopia and AL thresholds are at higher risk and should be closely monitored. Further research on interventions to prevent axial elongation is needed, particularly for those with high genetic risk. Data are available upon reasonable request.
目的了解长沙市中青年高度近视人群的近视性黄斑变性(MMD)患病率及其危险因素。方法对2021 ~ 2023年445例成人高度近视(≤- 5.0 D)患者进行检查。使用IOLMaster进行自折射和生物测定,并使用Meta-PM标准对眼底照片进行MMD分级。如果出现2、3、4类或任何附加病变,则诊断为烟雾病。通过logistic回归分析年龄、性别、球形当量(SE)/轴长(AL)、体重指数、文化程度和居住地等危险因素。结果患者平均年龄42.3±7.3岁。烟雾病患病率为21.8%(71名成人),平均SE为- 9.5±4.7 D, AL为27.3±1.9 mm。显著的危险因素包括更大的近视SE (OR=1.7每1 D减少)和更长的AL (OR=3.6每1 mm增加)。当近视≥- 10.00 D和AL≥27.00 mm时,烟雾患病率急剧上升,当近视≥- 14.00 D或AL≥29.00 mm时,烟雾患病率高达100%。结论青壮年至中年高度近视患者中约有1 / 5受烟雾病影响。那些超过严重近视和AL阈值的人有更高的风险,应密切监测。需要进一步研究预防轴向伸长的干预措施,特别是对那些具有高遗传风险的人。如有合理要求,可提供资料。
{"title":"Prevalence and risk factors of myopic macular degeneration: the Aier-SERI high myopia adult cohort","authors":"Li Lian Foo, Yanfeng Jiang, Quan V Hoang, Hla Myint Htoon, Ziqi Hu, Wei Pan, Kai Xiong Cheong, Ecosse Luc Lamoureux, Zhikuan Yang, Weizhong Lan, Seang-Mei Saw","doi":"10.1136/bjo-2024-326116","DOIUrl":"https://doi.org/10.1136/bjo-2024-326116","url":null,"abstract":"Purpose To assess the prevalence and risk factors of myopic macular degeneration (MMD) in young and middle-aged individuals with high myopia in Changsha, central China. Methods A total of 445 adults with high myopia (worse than or equal to −5.0 D) were examined between 2021 and 2023. Autorefraction and biometry using IOLMaster were conducted, and fundus photos were graded for MMD using Meta-PM criteria. MMD was diagnosed if category 2, 3, 4 or any plus lesion was present. Risk factors such as age, gender, spherical equivalent (SE)/axial length (AL), body mass index, education and residence were analysed via logistic regression. Results Participants had an average age of 42.3±7.3 years. MMD prevalence was 21.8% (71 adults) with a mean SE of −9.5±4.7 D and AL of 27.3±1.9 mm. Significant risk factors included greater myopic SE (OR=1.7 per 1 D decrease) and longer AL (OR=3.6 per 1 mm increase). MMD prevalence rose sharply with myopia worse than −10.00 D and AL >27.00 mm, reaching up to 100% for myopia worse than −14.00 D or AL ≥29.00 mm. Conclusion MMD affects about one in five young to middle-aged adults with high myopia. Those exceeding critical myopia and AL thresholds are at higher risk and should be closely monitored. Further research on interventions to prevent axial elongation is needed, particularly for those with high genetic risk. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"12 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936682","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
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British Journal of Ophthalmology
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