British Journal of Ophthalmology最新文献_第6页

Preretinal abnormal tissue before and after pars plana vitrectomy in macula-on rhegmatogenous retinal detachment: a multimodal imaging study 黄斑上孔源性视网膜脱离行玻璃体切除前后视网膜前异常组织的多模态成像研究

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2025-01-03 DOI: 10.1136/bjo-2024-326442

Alberto Quarta, Lisa Toto, Maria Ludovica Ruggeri, Annamaria Porreca, Agbeanda Aharrh-Gnama, Lucio Zeppa, Lorenzo Motta, Matteo Gironi, Marta Di Nicola, Rodolfo Mastropasqua

Purpose To quantitatively explore preretinal abnormal tissue (PAT) in macula-on rhegmatogenous retinal detachment (RRD) before and after surgery. Methods In this case-series study, PAT was detected by en-face optical coherence tomography images with custom slabs in eyes that underwent pars plana vitrectomy and SF6 for macula-on RRD. Main outcome measures were PAT area at baseline, 3-month and 6-month follow-up, and its relative change. Associations between PAT and foveal avascular zone (FAZ) at superficial capillary plexus (SCP), RRD area, retinal tear (RT) area and endolaser area were investigated. Results 36 macula-on eyes RRD were included in the analysis. Significant PAT growth was registered from baseline until 6 months (p<0.001). Baseline PAT area correlated with RT area (r=0.54, p=0.001). Significant correlation between relative change in PAT and relative change in FAZ SCP was found. The multivariable regression model showed a statistically significant association between Endolaser area (cm2) and relative changes in PAT (p=0.004). Conclusions Our study found that despite good retinal reattachment, PAT proliferates over months with vascular changes. Endolaser area has a major influence on PAT growth, without impact on best-corrected visual acuity. Additional knowledge about pathophysiological mechanisms of growth could help understanding which surgical approach may limit PAT extension and future secondary epiretinal membrane. Data are available upon reasonable request. Data and results supporting this study’s findings are available upon reasonable request to the corresponding author. All authors attest that they meet the current ICMJE criteria for authorship.

目的定量探讨黄斑上孔源性视网膜脱离（RRD）手术前后视网膜前异常组织（PAT）的变化。方法在本病例系列研究中，采用自定义平板的正面光学相干断层扫描图像对行玻璃体部切除术和SF6治疗视网膜黄斑病变的眼睛进行PAT检测。主要结局指标为基线时PAT面积、随访3个月、6个月及其相对变化。研究了PAT与浅毛细血管丛（SCP）中央凹无血管区（FAZ）、RRD区、视网膜撕裂区（RT）和内激光区之间的关系。结果36只黄斑眼RRD纳入分析。从基线到6个月，PAT显著增长（p<0.001）。基线PAT面积与RT面积相关（r=0.54, p=0.001）。PAT相对变化与FAZ SCP相对变化之间存在显著相关性。多变量回归模型显示，Endolaser面积（cm2）与PAT的相对变化有统计学意义（p=0.004）。结论：我们的研究发现，尽管视网膜再附着良好，但PAT在数月后会随着血管改变而增殖。激光面积对PAT生长有主要影响，但对最佳矫正视力没有影响。关于生长的病理生理机制的额外知识可以帮助了解哪种手术方法可能限制PAT的扩展和未来的继发性视网膜前膜。如有合理要求，可提供资料。支持本研究结果的数据和结果可根据通讯作者的合理要求提供。所有作者都证明他们符合当前ICMJE的作者标准。

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引用次数: 0

At a glance 一目了然

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2025-01-01 DOI: 10.1136/bjo-2024-326873

Frank Larkin

A national corneal transplant registry analysis of 11,516 endothelial keratoplasty procedures found clear evidence that increasing surgeon experience in that procedure was associated with longer two-year transplant survival. This strongly supports best feasible arrangements for surgeon training and mentoring at the introduction of new procedures. This trial examined the usefulness of short-term 1% topical ciclosporin in cases of acute Stevens-Johnson syndrome (SJS). Additional therapy with 1% ciclosporin was not efficacious over standard therapy in stabilising the ocular surface in cases of acute SJS. Twenty years following an equivalent study, contact lens wear remained the leading risk factor for bacterial keratitis. A majority of Gram-negative bacteria were found, with a marked increase in Moraxella keratitis and a low rate of antibacterial drug resistance. Based on their proposed keratitis grading system, the authors' study provides a reportedly safe, evidence-based management protocol for patients with contact lens associated keratitis (CLAK). This should improve resource allocation and at a time of increasing demand for eye care services by reducing unnecessary patient visits. In a real-world registry, most non-infectious non-anterior uveitis cases were found to require immunosuppression with biologic and/or …

一项对11516例内皮角膜移植术进行的全国角膜移植登记分析发现，有明确证据表明，增加该手术的外科医生经验与较长的两年移植生存期相关。这有力地支持了在引入新手术时对外科医生进行培训和指导的最佳可行安排。本试验探讨了1%短期局部环孢素治疗急性史蒂文斯-约翰逊综合征（SJS）的有效性。在稳定急性SJS病例的眼表方面，1%环孢素的额外治疗并不比标准治疗有效。经过20年的同等研究，隐形眼镜佩戴仍然是细菌性角膜炎的主要危险因素。革兰氏阴性菌居多，角膜炎莫拉菌明显增多，抗菌药物耐药率低。基于他们提出的角膜炎分级系统，作者的研究为隐形眼镜相关性角膜炎（CLAK）患者提供了一种安全的、基于证据的管理方案。这将通过减少不必要的患者就诊，改善资源分配，并在对眼科保健服务需求不断增加的时候。在现实世界的登记中，大多数非感染性非前路葡萄膜炎病例需要免疫抑制与生物和/或…

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引用次数: 0

Genome-wide association study of anterior uveitis 前葡萄膜炎的全基因组关联研究

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-27 DOI: 10.1136/bjo-2024-326037

Fredrika Koskimäki, Oona Ahokas, Risto Kajanne, Krista-Roberta Saviauk, Abdelrahman Elnahas, Anu Reigo, Kadri Reis, Tõnu Esko, Priit Palta, Sanna Leinonen, Johannes Kettunen, Johanna Liinamaa, Minna K Karjalainen, Ville Saarela, Estonian Biobank Research Team Consortium

Background/aims The purpose of this study is to define genetic factors associated with anterior uveitis through genome-wide association study (GWAS). Methods In this GWAS meta-analysis, we combined data from the FinnGen, Estonian Biobank and UK Biobank with a total of 12 205 anterior uveitis cases and 917 145 controls. We performed a phenome-wide association study (PheWAS) to investigate associations across phenotypes and traits. We also evaluated genetic correlations of anterior uveitis. Results We identified six anterior uveitis-associated loci. Genome-wide significant (p<5 × 10−8) associations were identified for the first time at three loci (innate immunity activator ( INAVA) , nucleotide-binding domain, leucine-rich repeat family, pyrin domain containing 3 and nitric oxide synthase 2). We detected associations at three loci previously reported to be associated with uveitis (endoplasmic reticulum aminopeptidase 1 ( ERAP1) , the trinucleotide repeat containing 18 ( TNRC18) and the HLA region) and also replicated associations at two loci previously associated with acute anterior uveitis ( IL23R and HDAC2-AS2 ). In PheWAS, we further detected that lead single nucleotide polymorphisms (SNPs) at three of the anterior uveitis-associated loci ( ERAP1 , INAVA and TNRC18 ) are associated with other immunity-related phenotypes, including ankylosing spondylitis and inflammatory bowel disease. Additionally, we detected a moderate genetic correlation between anterior uveitis and inflammatory bowel disease ( rg =0.39, p=8 × 10−5). Conclusion We identified six anterior uveitis-associated loci, including three novel loci with genome-wide significance. Our findings deepen our understanding of the genetic basis of anterior uveitis and the genetic connections between anterior uveitis and immune-related disorders, providing a foundation for further research and potential therapeutic interventions. Data are available upon reasonable request.

背景/目的本研究的目的是通过全基因组关联研究（GWAS）确定与前葡萄膜炎相关的遗传因素。方法在这项GWAS荟萃分析中，我们将FinnGen、爱沙尼亚生物银行和英国生物银行的数据与总共12205例前葡萄膜炎病例和917145例对照相结合。我们进行了一项全表型关联研究（PheWAS）来研究表型和性状之间的关联。我们还评估了前葡萄膜炎的遗传相关性。结果我们发现了6个与葡萄膜炎相关的位点。我们首次在三个基因座（先天免疫激活因子（INAVA）、核苷酸结合结构域、富含亮氨酸的重复序列家族、含pyrin结构域3和一氧化氮合酶2）上发现了全基因组显著（p<5 × 10−8）的关联。我们在三个先前报道与葡萄膜炎相关的基因座(内质网氨基肽酶1 （ERAP1）、包含18的三核苷酸重复序列（TNRC18）和HLA区域)，也复制了先前与急性葡萄膜炎相关的两个位点（IL23R和HDAC2-AS2）的关联。在PheWAS中，我们进一步检测到三个前葡萄膜炎相关基因座（ERAP1、INAVA和TNRC18）的先导单核苷酸多态性（snp）与其他免疫相关表型相关，包括强直性脊柱炎和炎症性肠病。此外，我们发现前葡萄膜炎和炎症性肠病之间存在中等程度的遗传相关性（rg =0.39, p=8 × 10−5）。结论我们发现了6个前葡萄膜炎相关基因座，其中包括3个具有全基因组意义的新基因座。我们的发现加深了我们对前葡萄膜炎的遗传基础以及前葡萄膜炎与免疫相关疾病之间的遗传联系的理解，为进一步的研究和潜在的治疗干预提供了基础。如有合理要求，可提供资料。

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引用次数: 0

CMV corneal endotheliitis 巨细胞病毒性角膜内皮炎

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-22 DOI: 10.1136/bjo-2024-326866

Vishal Jhanji

When corneal endotheliitis was first reported by Khodadoust and Attarzadeh in 1982, it was thought to be caused by an autoimmune process.1 The clinical presentation was similar to corneal allograft rejection due to the presence of linear corneal keratic precipitates (KPs). PCR testing in a patient with a similar clinical presentation in Japan led to discovery of the herpes simplex virus.2 Later, Koizumi et al detected cytomegalovirus (CMV) DNA in a case of corneal endotheliitis.3 CMV endotheliitis is a unique entity. The pathogenesis of CMV corneal endotheliitis is unknown. The clinical presentation is characterised by KPs and local corneal oedema eventually leading to corneal endothelial cell damage and bullous keratopathy. The diagnosis is confirmed by the presence of CMV DNA in the anterior chamber. The …

当1982年Khodadoust和Attarzadeh首次报道角膜内皮炎时，它被认为是由自身免疫过程引起的由于线性角膜沉淀（KPs）的存在，其临床表现与角膜异体移植排斥反应相似。在日本对一名具有类似临床表现的患者进行PCR检测后发现了单纯疱疹病毒后来，Koizumi等人在一例角膜内皮炎中检测巨细胞病毒（CMV） DNA巨细胞病毒内皮炎是一个独特的实体。巨细胞病毒角膜内皮炎的发病机制尚不清楚。临床表现以KPs和局部角膜水肿为特征，最终导致角膜内皮细胞损伤和大疱性角膜病变。诊断是证实存在巨细胞病毒DNA在前房。…

引用次数: 0

Predictors of cytomegalovirus corneal endotheliitis postcorneal transplantation 角膜移植后巨细胞病毒角膜内皮炎的预测因素

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-22 DOI: 10.1136/bjo-2024-326055

Mako Watanabe, Koji Kitazawa, Hideki Fukuoka, Koichi Wakimasu, Tsutomu Inatomi, Kengo Yoshii, Noriko Koizumi, Shigeru Kinoshita, Chie Sotozono

Purpose This study was designed to investigate risk factors for the development of cytomegalovirus (CMV) corneal endotheliitis following corneal transplantation. Methods We retrospectively analysed 1225 corneal transplants for bullous keratopathy between 2011 and 2021. 31 cases who were administered the treatment of CMV corneal endotheliitis preoperatively were excluded, and 1194 cases were analysed for risk factors for the development of CMV corneal endotheliitis following corneal transplantation. Results Among 1194 cases, 15 cases (1.26%) occurred CMV corneal endotheliitis after corneal transplantation. Coin-shaped lesion or keratoprecipitates were observed in 100% of cases. Postoperatively, the mean onset of CMV corneal endotheliitis was 9.9±12.2 months, with 12 eyes (80.0%) within the first 12 months. Multivariate analysis adjusted for potential confounding factors revealed a gender (male, OR (8.42, 95% CI: 2.19 to 56.00), the previous history of anterior uveitis (OR: 25.31, 95% CI: 8.22 to 95.19) and the previous history of glaucoma (OR: 6.25, 95% CI: 1.17 to 115.90) were significantly associated with the development of postoperative CMV corneal endotheliitis. The maternal proportion Ryan multiple comparison tests revealed that dual previous history with glaucoma and anterior uveitis significantly enhanced the development of postoperative CMV corneal endotheliitis (p<0.001). Conclusions CMV corneal endotheliitis developed postcorneal transplantation with coin-shaped lesions. Careful postoperative follow-up, especially within the first 12 months after surgery, is necessary for patients with a history of glaucoma or anterior uveitis. Data are available upon reasonable request. The data that support the findings of this study are available from Kyoto Prefectural University of Medicine upon reasonable request.

目的探讨角膜移植术后发生巨细胞病毒（CMV）角膜内皮炎的危险因素。方法回顾性分析2011年至2021年间1225例大疱性角膜病变的角膜移植。排除31例术前接受巨细胞病毒性角膜内皮炎治疗的患者，分析1194例角膜移植术后发生巨细胞病毒性角膜内皮炎的危险因素。结果1194例患者中，角膜移植术后发生巨细胞病毒性角膜内皮炎15例（1.26%）。所有病例均有硬币状病变或角膜沉淀。术后CMV角膜内皮炎的平均发病时间为9.9±12.2个月，前12个月内12只眼（80.0%）。校正潜在混杂因素的多因素分析显示，性别(男性，OR （8.42, 95% CI: 2.19 ~ 56.00）、既往葡萄膜前炎史（OR: 25.31, 95% CI: 8.22 ~ 95.19）和既往青光眼史（OR: 6.25, 95% CI: 1.17 ~ 115.90）与术后CMV角膜内皮炎的发生显著相关。母体比例Ryan多重比较检验显示，青光眼和前葡萄膜炎双重病史显著增加术后CMV角膜内皮炎的发生（p<0.001）。结论巨细胞病毒性角膜内皮炎发生于角膜移植后，病变呈硬币状。对于有青光眼或前葡萄膜炎病史的患者，术后随访十分必要，尤其是术后12个月内。如有合理要求，可提供资料。支持本研究结果的数据可应合理要求从京都立医科大学获得。

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引用次数: 0

Metastatic conjunctival melanoma: a multicentre international study 转移性结膜黑色素瘤：一项多中心国际研究

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-18 DOI: 10.1136/bjo-2024-326043

Puneet Jain, Paul T Finger, Maria Filì, Bertil Damato, Sarah E Coupland, Heinrich Heimann, Nihal Kenawy, Niels J Brouwer, Marina Marinkovic, Sjoerd van Duinen, Jean-Pierre Caujolle, Celia Maschi, Stefan Seregard, David E Pelayes, Martin Folgar, Yacoub Yousef, Hatem Krema, Brenda Gallie, Carlos Alberto Calle Vasquez

Background To reveal clinical findings related to metastatic conjunctival melanoma. Methods 10 ophthalmic oncology centres (9 countries and 4 continents) shared data to create a large clinical case series. The main outcome measures were the incidence and cumulative risk of systemic metastasis, study mortality rates and Kaplan-Meier patient mortality after developing conjunctival melanoma metastasis. Results Of 288 patients, 29 developed metastasis. Five had metastasis at presentation, were American Joint Committee on Cancer (AJCC) cT3-category and exhibited tumour-surface ulceration. Four of five (80%) had melanotic tumours with plical and/or caruncular involvement and died within 1 year. One survived 21 months. In contrast, 24 developed metastases during follow-up (mean 4.6±3.2 years). Their primary tumours were cT1 (n=13/24, 54.1%), cT2 (n=6/24, 25%), cT3 (n=2/24, 8.3%) and 3 cTx (12.5%) at presentation. Death had occurred in 17 patients (n=17/24, 71%) by the end of the study. The cumulative risk of systemic metastasis after treatment was 0.4% (95% CI 0.6% to 2.9%) at 1 year, 8.6% (95% CI 5.1% to 14.3%) at 5 years and 22.3% (95% CI 14.5% to 33.5%) at 10 years. Each increase in AJCC cT category was associated with an 89% higher risk for metastasis (HR=1.89, p<0.001). Among all 29 patients who developed metastasis, those who presented with AJCC cT3 disease were at highest risk (p<0.001). Liver and lung (n=13 each) were the most reported metastatic sites. Conclusion Metastatic conjunctival melanoma was found in 10% of conjunctival melanoma patients. Tumour-specific characteristics including AJCC cT3-category, conjunctival location and surface ulceration were associated with metastatic risk. Survival durations were shorter for those presenting with metastasis. All data relevant to the study are included in the article or uploaded as online supplemental information.

目的：揭示转移性结膜黑色素瘤的临床表现。方法10家眼科肿瘤中心（9个国家，4大洲）共享数据，建立大型临床病例系列。主要观察指标为结膜黑色素瘤转移后的系统性转移发生率和累积风险、研究死亡率和Kaplan-Meier患者死亡率。结果288例患者中29例发生转移。5例出现转移，为美国癌症联合委员会（AJCC） ct3型，并表现出肿瘤表面溃疡。5例患者中有4例（80%）患有黑素肿瘤，伴有政治和/或眼窝受累，并在1年内死亡。其中一人存活了21个月。相比之下，24例在随访期间发生转移（平均4.6±3.2年）。原发肿瘤为cT1 （n=13/24, 54.1%）、cT2 （n=6/24, 25%）、cT3 （n=2/24, 8.3%）和3 cTx（12.5%）。研究结束时，17例患者死亡（n=17/24, 71%）。治疗后系统性转移的累积风险在1年为0.4% (95% CI 0.6% - 2.9%)， 5年为8.6% (95% CI 5.1% - 14.3%)， 10年为22.3% （95% CI 14.5% - 33.5%）。AJCC cT类别每增加一次，转移风险增加89% （HR=1.89, p<0.001）。在所有29例发生转移的患者中，出现AJCC cT3疾病的患者风险最高（p<0.001）。肝和肺（各13例）是报告最多的转移部位。结论结膜黑色素瘤患者中有10%存在转移性结膜黑色素瘤。肿瘤特异性特征包括AJCC ct3类型、结膜位置和表面溃疡与转移风险相关。出现转移的患者生存时间较短。所有与研究相关的数据都包含在文章中或作为在线补充信息上传。

{"title":"Metastatic conjunctival melanoma: a multicentre international study","authors":"Puneet Jain, Paul T Finger, Maria Filì, Bertil Damato, Sarah E Coupland, Heinrich Heimann, Nihal Kenawy, Niels J Brouwer, Marina Marinkovic, Sjoerd van Duinen, Jean-Pierre Caujolle, Celia Maschi, Stefan Seregard, David E Pelayes, Martin Folgar, Yacoub Yousef, Hatem Krema, Brenda Gallie, Carlos Alberto Calle Vasquez","doi":"10.1136/bjo-2024-326043","DOIUrl":"https://doi.org/10.1136/bjo-2024-326043","url":null,"abstract":"Background To reveal clinical findings related to metastatic conjunctival melanoma. Methods 10 ophthalmic oncology centres (9 countries and 4 continents) shared data to create a large clinical case series. The main outcome measures were the incidence and cumulative risk of systemic metastasis, study mortality rates and Kaplan-Meier patient mortality after developing conjunctival melanoma metastasis. Results Of 288 patients, 29 developed metastasis. Five had metastasis at presentation, were American Joint Committee on Cancer (AJCC) cT3-category and exhibited tumour-surface ulceration. Four of five (80%) had melanotic tumours with plical and/or caruncular involvement and died within 1 year. One survived 21 months. In contrast, 24 developed metastases during follow-up (mean 4.6±3.2 years). Their primary tumours were cT1 (n=13/24, 54.1%), cT2 (n=6/24, 25%), cT3 (n=2/24, 8.3%) and 3 cTx (12.5%) at presentation. Death had occurred in 17 patients (n=17/24, 71%) by the end of the study. The cumulative risk of systemic metastasis after treatment was 0.4% (95% CI 0.6% to 2.9%) at 1 year, 8.6% (95% CI 5.1% to 14.3%) at 5 years and 22.3% (95% CI 14.5% to 33.5%) at 10 years. Each increase in AJCC cT category was associated with an 89% higher risk for metastasis (HR=1.89, p<0.001). Among all 29 patients who developed metastasis, those who presented with AJCC cT3 disease were at highest risk (p<0.001). Liver and lung (n=13 each) were the most reported metastatic sites. Conclusion Metastatic conjunctival melanoma was found in 10% of conjunctival melanoma patients. Tumour-specific characteristics including AJCC cT3-category, conjunctival location and surface ulceration were associated with metastatic risk. Survival durations were shorter for those presenting with metastasis. All data relevant to the study are included in the article or uploaded as online supplemental information.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"64 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841621","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

Optic nerve sheath enhancement on orbital MRI in giant cell arteritis. 巨细胞动脉炎的视神经鞘增强。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-18 DOI: 10.1136/bjo-2024-326608

Rebka K Ephrem, Suyash Mohan, Ryan Rebello, Rui Liang, Robert Kurtz, Jae W Song, Madhura A Tamhankar, Rennie L Rhee

Background: Differentiating arteritic anterior ischaemic optic neuropathy (A-AION) due to giant cell arteritis (GCA) from non-arteritic anterior ischaemic optic neuropathy (NA-AION) may pose a diagnostic challenge. Our study aimed to assess the use of standard orbital MRI in distinguishing ocular manifestations of GCA from NA-AION.

Methods: This study included 25 consecutive patients (11 GCA, 14 NA-AION) who underwent contrast-enhanced orbital MRIs within 3 months of symptom onset. Two radiologists blinded to clinical data independently evaluated MRIs for the enhancement of the optic nerve sheath (ONS) and other orbital structures.

Results: On orbital MRI, ONS enhancement of at least one eye was more common in patients with GCA than NA-AION (64% vs 14%, p=0.02). ONS enhancement on MRI was seen in patients with typical ophthalmologic exam findings of A-AION as well as in GCA patients with other features of ocular ischaemia (eg, retinal artery occlusion). Among patients with GCA, ONS enhancement was bilateral in six of seven cases even when visual symptoms and signs were unilateral.

Conclusion: Patients with ocular GCA are more likely to have ONS enhancement on MRI compared with NA-AION. ONS enhancement was observed in (i) A-AION and other forms of ocular ischaemia, demonstrating the potential value of MRI in multiple orbital pathologies in GCA, and (ii) both the affected and unaffected eye, suggesting MRI may detect early subclinical ocular disease in GCA. These results highlight the potential value of adding orbital MRI to the diagnostic workup of ocular GCA.

背景：鉴别巨细胞动脉炎（GCA）引起的动脉性前缺血性视神经病变（a - aion）与非动脉性前缺血性视神经病变（NA-AION）可能是一个诊断挑战。我们的研究旨在评估使用标准眼眶MRI来区分GCA和na - ion的眼部表现。方法：本研究纳入了25例连续患者（11例GCA， 14例NA-AION），这些患者在症状出现3个月内接受了对比增强眼窝mri检查。两名不了解临床数据的放射科医生独立评估了视神经鞘（ONS）和其他眶结构增强的mri。结果：在眼眶MRI上，GCA患者至少一只眼的ONS增强比na - ion更常见（64% vs 14%, p=0.02）。具有典型A-AION眼科检查结果的患者以及具有其他眼部缺血特征（如视网膜动脉闭塞）的GCA患者MRI上可见ONS增强。在GCA患者中，即使视觉症状和体征是单侧的，7例中有6例的ONS增强是双侧的。结论：与na - ion相比，眼部GCA患者MRI更容易出现ONS增强。在(i) A-AION和其他形式的眼部缺血中观察到ONS增强，表明MRI在GCA的多种眼窝病变中具有潜在价值，（ii）受影响和未受影响的眼睛都有潜在价值，提示MRI可以检测GCA的早期亚临床眼部疾病。这些结果突出了眼眶MRI在眼部GCA诊断检查中的潜在价值。

{"title":"Optic nerve sheath enhancement on orbital MRI in giant cell arteritis.","authors":"Rebka K Ephrem, Suyash Mohan, Ryan Rebello, Rui Liang, Robert Kurtz, Jae W Song, Madhura A Tamhankar, Rennie L Rhee","doi":"10.1136/bjo-2024-326608","DOIUrl":"10.1136/bjo-2024-326608","url":null,"abstract":"Background: Differentiating arteritic anterior ischaemic optic neuropathy (A-AION) due to giant cell arteritis (GCA) from non-arteritic anterior ischaemic optic neuropathy (NA-AION) may pose a diagnostic challenge. Our study aimed to assess the use of standard orbital MRI in distinguishing ocular manifestations of GCA from NA-AION.Methods: This study included 25 consecutive patients (11 GCA, 14 NA-AION) who underwent contrast-enhanced orbital MRIs within 3 months of symptom onset. Two radiologists blinded to clinical data independently evaluated MRIs for the enhancement of the optic nerve sheath (ONS) and other orbital structures.Results: On orbital MRI, ONS enhancement of at least one eye was more common in patients with GCA than NA-AION (64% vs 14%, p=0.02). ONS enhancement on MRI was seen in patients with typical ophthalmologic exam findings of A-AION as well as in GCA patients with other features of ocular ischaemia (eg, retinal artery occlusion). Among patients with GCA, ONS enhancement was bilateral in six of seven cases even when visual symptoms and signs were unilateral.Conclusion: Patients with ocular GCA are more likely to have ONS enhancement on MRI compared with NA-AION. ONS enhancement was observed in (i) A-AION and other forms of ocular ischaemia, demonstrating the potential value of MRI in multiple orbital pathologies in GCA, and (ii) both the affected and unaffected eye, suggesting MRI may detect early subclinical ocular disease in GCA. These results highlight the potential value of adding orbital MRI to the diagnostic workup of ocular GCA.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852989","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

Prognosis for patients with metastatic conjunctival melanoma 转移性结膜黑色素瘤患者的预后

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-18 DOI: 10.1136/bjo-2024-326271

Bita Esmaeli

Conjunctival melanoma is a rare ocular cancer, and despite recent advances in the early detection of metastasis and the availability of new drugs such as immune checkpoint inhibitors and Braf-directed targeted therapy that have demonstrated efficacy for the treatment of metastatic conjunctival melanoma,1 it remains a significant cause of morbidity and mortality worldwide. Jain et al report on 29 patients with metastatic conjunctival melanoma.2 These 29 patients represent about 10% of the 288 patients with conjunctival melanoma included in this retrospective review based on data pooled from 10 international centres from a wide geographic area of the world. ‘Metastasis’ is defined as ‘M1’ per the American Joint Commission on Cancer (AJCC) definition and as such only addresses distant (hematogenous) metastasis. In other words, the stated primary objective of the report is to focus on patients who developed hematogenous distant metastasis although the authors provide some information regarding nodal metastasis in the same group of patients. Among the 29 patients with systemic metastasis, five (17%) were found at the time of the initial presentation, while 24 (83%) were …

结膜黑色素瘤是一种罕见的眼部癌症，尽管近来在早期发现转移方面取得了进展，免疫检查点抑制剂和布拉夫定向靶向疗法等新药也已证明对治疗转移性结膜黑色素瘤具有疗效，1 但它仍然是全球发病率和死亡率的一个重要原因。Jain 等人报告了 29 例转移性结膜黑色素瘤患者的情况。2 这 29 例患者约占这项回顾性研究中 288 例结膜黑色素瘤患者的 10%，而这项研究是根据来自全球广泛地区的 10 个国际中心的数据汇集而成的。根据美国癌症联合委员会（AJCC）的定义，"转移 "被定义为 "M1"，因此只涉及远处（血源性）转移。换句话说，虽然作者提供了同组患者结节转移的一些信息，但报告的主要目标是关注发生血源性远处转移的患者。在 29 例全身转移的患者中，有 5 例（17%）是在初次发病时发现的，而 24 例（83%）是在...

引用次数: 0

Prognostic value of macular neovascularisation characteristics for photoreceptor integrity in nAMD: a prospective observational study. 黄斑新生血管特征对光感受器完整性的预后价值：一项前瞻性观察研究。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-18 DOI: 10.1136/bjo-2024-326319

Jiaxin Pu, Xuenan Zhuang, Miaoling Li, Xinlei Hao, Guiqin He, Yongyue Su, Yuhong Gan, Xiongze Zhang, Yuying Ji, Lan Mi, Yining Zhang, Ruijun Yang, Xuelin Chen, Feng Wen

Purpose: To explore the relationship between characteristics of macular neovascularisation (MNV) and photoreceptor integrity in patients with neovascular age-related macular degeneration (nAMD).

Methods: This prospective study enrolled treatment-naïve nAMD eyes and conducted a 3-month follow-up. 16 quantitative MNV features were evaluated using optical coherence tomography angiography, and the impaired areas of ellipsoid zone (EZ), external limiting membrane (ELM) and outer nuclear layer (ONL) were obtained using optical coherence tomography. Correlation and regression analyses assessed the relationships between MNV features and photoreceptor integrity.

Results: 110 nAMD eyes from 110 patients (73.64% men) were included. Baseline MNV characteristics, including MNV perimeter, maxFeret, minFeret, vessel area, total vessel length, total number of junctions and endpoints, and mean E lacunarity, were positively correlated with photoreceptor damage areas (r ranging from 0.227 to 0.558, p<0.05 for all). Meanwhile, vessel density negatively correlated with photoreceptor damage (r=-0.468 for EZ, -0.394 for ELM and -0.538 for ONL, all p<0.05). After the loading phase, the EZ prognosis was independently associated with baseline MNV minFeret (Std β=0.362, p=0.011) and mean E lacunarity (Std β=0.130, p=0.041). The prognosis for ELM was independently linked to baseline MNV minFeret (Std β=0.373, p=0.014), while no significant factors were found to influence ONL prognosis (p>0.05 for all).

Conclusion: A strong correlation was observed between MNV features and photoreceptor integrity, with larger and more complex vascular networks associated with greater photoreceptor damage.

目的：探讨新生血管性年龄相关性黄斑变性（nAMD）患者黄斑新生血管化（MNV）特征与光感受器完整性的关系。方法：本前瞻性研究纳入treatment-naïve nAMD眼，并进行3个月的随访。采用光学相干断层成像血管造影对16个定量MNV特征进行评价，并利用光学相干断层成像获得椭球区（EZ）、外限制膜（ELM）和外核层（ONL）受损区域。相关和回归分析评估了MNV特征与光感受器完整性之间的关系。结果：纳入110例患者110只nAMD眼，男性占73.64%。基线MNV特征，包括MNV周长、maxFeret、minFeret、血管面积、血管总长度、连接和端点总数、平均E间隙，与光感受器损伤面积呈正相关（r范围为0.227 ~ 0.558，均p0.05）。结论：观察到MNV特征与光感受器完整性之间存在很强的相关性，更大更复杂的血管网络与更大的光感受器损伤相关。

{"title":"Prognostic value of macular neovascularisation characteristics for photoreceptor integrity in nAMD: a prospective observational study.","authors":"Jiaxin Pu, Xuenan Zhuang, Miaoling Li, Xinlei Hao, Guiqin He, Yongyue Su, Yuhong Gan, Xiongze Zhang, Yuying Ji, Lan Mi, Yining Zhang, Ruijun Yang, Xuelin Chen, Feng Wen","doi":"10.1136/bjo-2024-326319","DOIUrl":"10.1136/bjo-2024-326319","url":null,"abstract":"Purpose: To explore the relationship between characteristics of macular neovascularisation (MNV) and photoreceptor integrity in patients with neovascular age-related macular degeneration (nAMD).Methods: This prospective study enrolled treatment-naïve nAMD eyes and conducted a 3-month follow-up. 16 quantitative MNV features were evaluated using optical coherence tomography angiography, and the impaired areas of ellipsoid zone (EZ), external limiting membrane (ELM) and outer nuclear layer (ONL) were obtained using optical coherence tomography. Correlation and regression analyses assessed the relationships between MNV features and photoreceptor integrity.Results: 110 nAMD eyes from 110 patients (73.64% men) were included. Baseline MNV characteristics, including MNV perimeter, maxFeret, minFeret, vessel area, total vessel length, total number of junctions and endpoints, and mean E lacunarity, were positively correlated with photoreceptor damage areas (r ranging from 0.227 to 0.558, p<0.05 for all). Meanwhile, vessel density negatively correlated with photoreceptor damage (r=-0.468 for EZ, -0.394 for ELM and -0.538 for ONL, all p<0.05). After the loading phase, the EZ prognosis was independently associated with baseline MNV minFeret (Std β=0.362, p=0.011) and mean E lacunarity (Std β=0.130, p=0.041). The prognosis for ELM was independently linked to baseline MNV minFeret (Std β=0.373, p=0.014), while no significant factors were found to influence ONL prognosis (p>0.05 for all).Conclusion: A strong correlation was observed between MNV features and photoreceptor integrity, with larger and more complex vascular networks associated with greater photoreceptor damage.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852990","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

Methotrexate versus conventional disease-modifying antirheumatic drugs in the treatment of non-anterior sarcoidosis-associated uveitis. 在治疗非前部肉样瘤病相关葡萄膜炎时，甲氨蝶呤与传统的改变病情抗风湿药物的比较。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-12-17 DOI: 10.1136/bjo-2024-325163

Mathilde Leclercq, Pascal Sève, Lucie Biard, Mathieu Vautier, Georgina Maalouf, Gaëlle Leroux, Fanny Domont, Adélaïde Toutée, Christine Fardeau, Thomas Sales de Gauzy, Sara Touhami, Laurent Kodjikian, Patrice Cacoub, Bahram Bodaghi, David Saadoun, Anne-Claire Desbois

Aims: To compare the safety and efficacy of methotrexate (MTX), mycophenolate mofetil (MMF) and azathioprine (AZA) in non-anterior sarcoidosis-associated uveitis.

Methods: Retrospective study including non-anterior sarcoidosis-associated uveitis according to the revised International Workshop on Ocular Sarcoidosis criteria. The primary outcome was defined as the median time to relapse or occurrence of serious adverse events leading to treatment discontinuation.

Results: 58 patients with non-anterior sarcoidosis-associated uveitis (MTX (n=33), MMF (n=16) and AZA (n=9)) were included. The time to treatment failure (ie, primary outcome) after adjustment for corticosteroids dose and the presence of vasculitis was significantly higher with MTX (median time of 34.5 months with MTX (IQR: 11.8 -not reached) vs 8.4 months (3.1-22.9) with MMF and 16.8 months (8.0-90.1) with AZA (p=0.020)). The risk of relapse at 12 months was more than twice lower in MTX as compared with MMF (p=0.046). Low visual acuity at the last visit was significantly lower with MTX (4% vs 9% in MMF vs 57% in AZA group (p=0.008)). Regarding all 75 lines of treatment (MTX (n=39), MMF (n=24) and AZA (n=12)), MTX was more effective than MMF and AZA to obtain treatment response at 3 months (OR 10.85; 95% CI 1.13 to 104.6; p=0.039). Significant corticosteroid-sparing effect at 12 months (p=0.035) was only observed under MTX. Serious adverse events were observed in 6/39 (15%), 5/24 (21%) and 2/12 (17%) with MTX, MMF and AZA, respectively.

Conclusion: In non-anterior sarcoidosis-associated uveitis, MTX seems to be more efficient compared with AZA and MMF and with an acceptable safety profile.

目的：比较甲氨蝶呤（MTX）、霉酚酸酯（MMF）和硫唑嘌呤（AZA）治疗非前部肉样瘤病相关葡萄膜炎的安全性和有效性：回顾性研究：根据眼肉样瘤病国际研讨会修订的标准，包括非前部肉样瘤病相关性葡萄膜炎。主要结果定义为复发或发生严重不良事件导致治疗中止的中位时间：共纳入58名非前部肉样瘤病相关葡萄膜炎患者（MTX（33人）、MMF（16人）和AZA（9人））。在对皮质类固醇剂量和是否存在血管炎进行调整后，MTX的治疗失败时间（即主要结果）明显更长（MTX的中位时间为34.5个月（IQR：11.8-未达到），MMF为8.4个月（3.1-22.9），AZA为16.8个月（8.0-90.1）（P=0.020））。与 MMF 相比，MTX 在 12 个月时的复发风险要低两倍多（p=0.046）。在最后一次就诊时，MTX的低视力明显降低（MMF组为4%，AZA组为9%，MMF组为57%（P=0.008））。在所有75种治疗方案（MTX（39例）、MMF（24例）和AZA（12例））中，MTX比MMF和AZA更能在3个月后获得治疗反应（OR 10.85；95% CI 1.13至104.6；P=0.039）。在12个月时，只有MTX能显著节省皮质类固醇（p=0.035）。使用MTX、MMF和AZA时，分别有6/39（15%）、5/24（21%）和2/12（17%）人出现严重不良事件：结论：对于非前部肉样瘤病相关性葡萄膜炎，MTX似乎比AZA和MMF更有效，且安全性可接受。

{"title":"Methotrexate versus conventional disease-modifying antirheumatic drugs in the treatment of non-anterior sarcoidosis-associated uveitis.","authors":"Mathilde Leclercq, Pascal Sève, Lucie Biard, Mathieu Vautier, Georgina Maalouf, Gaëlle Leroux, Fanny Domont, Adélaïde Toutée, Christine Fardeau, Thomas Sales de Gauzy, Sara Touhami, Laurent Kodjikian, Patrice Cacoub, Bahram Bodaghi, David Saadoun, Anne-Claire Desbois","doi":"10.1136/bjo-2024-325163","DOIUrl":"10.1136/bjo-2024-325163","url":null,"abstract":"Aims: To compare the safety and efficacy of methotrexate (MTX), mycophenolate mofetil (MMF) and azathioprine (AZA) in non-anterior sarcoidosis-associated uveitis.Methods: Retrospective study including non-anterior sarcoidosis-associated uveitis according to the revised International Workshop on Ocular Sarcoidosis criteria. The primary outcome was defined as the median time to relapse or occurrence of serious adverse events leading to treatment discontinuation.Results: 58 patients with non-anterior sarcoidosis-associated uveitis (MTX (n=33), MMF (n=16) and AZA (n=9)) were included. The time to treatment failure (ie, primary outcome) after adjustment for corticosteroids dose and the presence of vasculitis was significantly higher with MTX (median time of 34.5 months with MTX (IQR: 11.8 -not reached) vs 8.4 months (3.1-22.9) with MMF and 16.8 months (8.0-90.1) with AZA (p=0.020)). The risk of relapse at 12 months was more than twice lower in MTX as compared with MMF (p=0.046). Low visual acuity at the last visit was significantly lower with MTX (4% vs 9% in MMF vs 57% in AZA group (p=0.008)). Regarding all 75 lines of treatment (MTX (n=39), MMF (n=24) and AZA (n=12)), MTX was more effective than MMF and AZA to obtain treatment response at 3 months (OR 10.85; 95% CI 1.13 to 104.6; p=0.039). Significant corticosteroid-sparing effect at 12 months (p=0.035) was only observed under MTX. Serious adverse events were observed in 6/39 (15%), 5/24 (21%) and 2/12 (17%) with MTX, MMF and AZA, respectively.Conclusion: In non-anterior sarcoidosis-associated uveitis, MTX seems to be more efficient compared with AZA and MMF and with an acceptable safety profile.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"34-40"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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