British Journal of Ophthalmology最新文献

Aims: To explore the clinical application of a novel swept-source anterior segment optical coherence tomography angiography (AS-OCTA) system for imaging corneal neovascularisation (CoNV), assessing limbal vasculature and detecting short-term vascular changes following pharmacologic vasoconstriction.

Methods: This cross-sectional observational study included 20 eyes: 10 with clinically diagnosed CoNV of various aetiologies and 10 healthy controls. Each eye underwent AS-OCTA imaging using the BMizar 400kHz Full-Range Swept-Source OCT system at baseline and after administration of 10% phenylephrine (PE). FlowArea (mm²) was automatically calculated across predefined circular regions of interest (ROIs) encompassing the cornea, limbus and episclera. In corneal and limbal ROIs, en face images were segmented into three depth layers: total (epithelium to endothelium), superficial (epithelium to 150 µm) and deep (150 µm to endothelium).

Results: CoNV eyes exhibited significantly higher total and deep corneal FlowArea compared with controls (p=0.0002 and p=0.0005, respectively). Post PE, a significant reduction in FlowArea was observed in the total and deep corneal layers of CoNV eyes (p=0.006 and p=0.009, respectively), and in the limbal region of both groups, with significant reductions observed in CoNV and controls (p=0.006 and p=0.003, respectively).

Conclusions: This AS-OCTA platform enabled high-resolution, depth-resolved visualization of CoNV and revealed vascular changes following topical vasoconstriction. The extended field of view allowed simultaneous assessment of corneal, limbal and episcleral vasculature within a single scan session, supporting its potential role in both diagnostic evaluation and longitudinal monitoring of anterior segment diseases.

Backgrounds/aims: Any association of secondhand smoke (SHS) with refractive astigmatism (RA) and corneal astigmatism (CA) remains unknown. This study aims to investigate the associations of SHS exposure with RA and CA in schoolchildren.

Methods: We conducted a population-based, cross-sectional study involving 11 545 children aged 6-8 years from the Hong Kong Children Eye Study. SHS exposure was evaluated through questionnaires, quantified by parental smoking. Child astigmatism was defined by cycloplegic autorefraction and keratometry. The associations of SHS exposure with risks and magnitudes of RA and CA were tested using logistic and linear regressions.

Results: 26.47% of children were exposed to SHS (mean age±SD, 7.35±0.88 years; 51.1% boys). SHS exposure was associated with the risk (OR (95% CI), 1.11 (1.00 to 1.23), p=0.04) and magnitude of RA (β (SE), -0.03D (0.01), p=0.046). Exposure to ≥10 cigarettes/day was associated with risk (OR (95% CI), 1.64 (1.23 to 2.17), p<0.001) and magnitude of RA (β (SE), -0.11D (0.05), p=0.01). Exposure to ≥20 cigarettes/day was associated with RA risk (OR (95% CI), 2.18 (1.48 to 3.19), p<0.001), RA magnitude (β (SE), -0.20D (0.06), p=0.001) and CA magnitude (β (SE), 0.17D (0.070, p=0.01). Test for linear trend with SHS quantity was significant for both risk (p=0.004) and magnitude of RA (p=0.03).

Conclusion: SHS exposure increases the risk and severity of child RA dose-dependently. Reduction of smoking in the presence of children or better provision of a smoke-free living environment for children is recommended.

Background: The association between vitamin D deficiency and cataract is debated, with limited longitudinal data on serum 25-hydroxyvitamin D (25(OH)D) levels in cataract development. This study aimed to examine both cross-sectional and longitudinal associations between serum 25(OH)D concentrations and cataract risk.

Methods: The cross-sectional analyses included 442 255 UK Biobank participants with available serum 25(OH)D data. For longitudinal analyses, 427 923 participants without baseline cataract were assessed. Logistic regression models and Cox proportional hazards models were conducted to evaluate the associations between serum 25(OH)D concentrations and cataract risk.

Results: In the cross-sectional analyses, higher serum 25(OH)D quartiles were inversely associated with cataract risk (p for trend <0.001). Longitudinal analyses, with a mean follow-up of 10.8 years, showed significant associations between vitamin D deficiency and increased incident cataract risk (HR 1.11, 95% CI 1.07 to 1.15). Compared with the reference group (50-75 nmol/L), participants with severe vitamin D deficiency (<25 nmol/L) had a 27% (HR 1.27, 95% CI 1.07 to 1.49), 12% (HR 1.12, 95% CI 1.04 to 1.21) and 9% (HR 1.09, 95% CI 1.04 to 1.14) higher risk of developing cataract among individuals below 50, 50-60 and above 60 years, respectively.

Conclusions: The study identified significant cross-sectional and prospective associations between vitamin D deficiency and increased cataract risk, with younger individuals being more susceptible. These findings emphasise the importance of early monitoring and intervention to address vitamin D deficiency and mitigate cataract risk.

Aim: To compare the long-term effectiveness of combined phacoemulsification and Hydrus microstent (phaco-Hydrus) versus iStent inject (phaco-iStent) using microinvasive glaucoma surgery-specific surgical success definitions in a large observational cohort.

Methods: Retrospective study of eyes in the Fight Glaucoma Blindness registry that underwent phaco-Hydrus or phaco-iStent with a minimum of 48 months follow-up. The prespecified primary endpoint was ≥20% intraocular pressure (IOP) decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline at 48 months with no preoperative washout. Propensity score matching of baseline covariates was used to examine outcomes in a subcohort (matched cohort).

Results: 431 eyes (98 phaco-Hydrus: 331 phaco-iStent) were included in the overall cohort and 177 eyes (59 phaco-Hydrus: 118 phaco-iStent) in the matched cohort. There was no significant difference in the rate of surgical success between each group in achieving the primary endpoint at 48 months (adjusted overall cohort, 41.2% vs 43.0% in phaco-Hydrus vs phaco-iStent respectively, p=0.81; matched cohort, 44.1% vs 43.2%, p=0.99). There was no significant difference in degree of IOP reduction, medication reduction and adjusted secondary outcomes between the phaco-Hydrus and phaco-iStent groups in both overall and matched cohorts. The incidence of adverse events and secondary procedures was similar between both groups.

Conclusion: There was no significant difference in surgical success between phaco-Hydrus and phaco-iStent groups at 48 months. Over 40% of eyes maintained the primary success endpoint of ≥20% IOP decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline without the need for secondary glaucoma surgery.