BACKGROUND/AIMSTo identify sociodemographic and clinical factors associated with best-corrected visual acuity (BCVA) restoration at the visit after lost to follow-up (LTFU) in patients with myopic choroidal neovascularization (mCNV) treated with antivascular endothelial growth factor intravitreal injections (IVI).METHODSA multicentre, retrospective cohort study was conducted in China of mCNV patients receiving injections who were LTFU >6 months. Data were collected from baseline visit, pre-LTFU, initial post-LTFU visit and 6 months post-LTFU, and the final visit. Logistic regression analyses assessed associations between sociodemographic/clinical factors and BCVA restoration.RESULTSThe study included 1155 LTFU patients with mCNV (mean (SD) age: 54 (16) years; 61.6% female), with 66.6% achieving BCVA restoration at the initial post-LTFU visit after LTFU (mean(SD) duration: 315 (154) days. Patients with BCVA restoration were younger (p=0.004), more often from eastern China (p=0.022), and had shorter LTFU duration (p=0.013). Stratification by pre-LTFU BCVA showed that patients with BCVA ≥20/40 had lower restoration odds (OR 0.65, 95% CI 0.44 to 0.96; p=0.032) compared with those with BCVA <20/200. BCVA decline was associated with increased central subfield thickness(CST) (OR 1.52, 95% CI 1.15 to 2.01; p=0.004). Among 223 patients with ≥6 months post-LTFU, those with initial post-LTFU CST >280 µm had higher BCVA restoration odds (OR 1.98, 95% CI 1.02 to 3.92; p=0.046).CONCLUSIONSBetter pre-LTFU BCVA (≥20/40) increased post-LTFU deterioration risk (associated with progressive CST thickening), while elevated post-LTFU CST (>280 µm) predicted higher BCVA restoration odds in patients with sustained follow-up, supporting CST-guided monitoring and early intervention for high-risk groups.
背景/目的：确定与失访（LTFU）后近视脉络膜新生血管（mCNV）患者接受抗血管内皮生长因子玻璃体内注射（IVI）治疗后最佳矫正视力（BCVA）恢复相关的社会人口学和临床因素。方法在中国开展一项多中心、回顾性队列研究，研究对象为接受LTFU注射6个月的mCNV患者。数据收集自基线访问、ltfu前访问、ltfu后初始访问和ltfu后6个月以及最终访问。Logistic回归分析评估了社会人口学/临床因素与BCVA恢复之间的关系。结果本研究纳入1155例LTFU合并mCNV患者(平均（SD）年龄：54（16）岁；61.6%女性)，66.6%的患者在LTFU后首次随访时BCVA恢复（平均（SD）持续时间：315（154）天）。BCVA恢复患者较年轻（p=0.004），多来自中国东部（p=0.022）， LTFU持续时间较短（p=0.013）。ltfu前BCVA分层显示，BCVA≥20/40的患者与BCVA 280µm的患者相比，BCVA恢复几率较低（OR 0.65, 95% CI 0.44 ~ 0.96, p=0.032）， BCVA恢复几率较高（OR 1.98, 95% CI 1.02 ~ 3.92, p=0.046）。结论ltfu前较好的BCVA（≥20/40）增加了ltfu后恶化风险（与CST进行性增厚相关），而ltfu后CST升高（>280µm）预示着持续随访患者BCVA恢复的几率更高，支持CST引导下的监测和高危人群的早期干预。
{"title":"Clinical characteristics and visual recovery in lost-to-follow-up myopic choroidal neovascularization treated with antivascular endothelial growth factor therapy.","authors":"Yupeng Xu,Yinchen Shen,Shu Li,Chuandi Zhou,Xiaorong Li,Xiaolu Yang,Xian Wang,Yong Li,Dawei Sun,Wenfang Zhang,Suyan Li,Han Zhang,Hongbin Lv,Xiang Ma,Honghua Yu,Zongming Song,Tianzi Zhang,Xuhui Yu,Yong Liu,Tongtong Niu,Rongdi Yuan,Zhipeng You,Qing Liu,Yanping Song,Xiaodong Sun,Zhi Zheng,Xun Xu,Kun Liu","doi":"10.1136/bjo-2025-327796","DOIUrl":"https://doi.org/10.1136/bjo-2025-327796","url":null,"abstract":"BACKGROUND/AIMSTo identify sociodemographic and clinical factors associated with best-corrected visual acuity (BCVA) restoration at the visit after lost to follow-up (LTFU) in patients with myopic choroidal neovascularization (mCNV) treated with antivascular endothelial growth factor intravitreal injections (IVI).METHODSA multicentre, retrospective cohort study was conducted in China of mCNV patients receiving injections who were LTFU >6 months. Data were collected from baseline visit, pre-LTFU, initial post-LTFU visit and 6 months post-LTFU, and the final visit. Logistic regression analyses assessed associations between sociodemographic/clinical factors and BCVA restoration.RESULTSThe study included 1155 LTFU patients with mCNV (mean (SD) age: 54 (16) years; 61.6% female), with 66.6% achieving BCVA restoration at the initial post-LTFU visit after LTFU (mean(SD) duration: 315 (154) days. Patients with BCVA restoration were younger (p=0.004), more often from eastern China (p=0.022), and had shorter LTFU duration (p=0.013). Stratification by pre-LTFU BCVA showed that patients with BCVA ≥20/40 had lower restoration odds (OR 0.65, 95% CI 0.44 to 0.96; p=0.032) compared with those with BCVA <20/200. BCVA decline was associated with increased central subfield thickness(CST) (OR 1.52, 95% CI 1.15 to 2.01; p=0.004). Among 223 patients with ≥6 months post-LTFU, those with initial post-LTFU CST >280 µm had higher BCVA restoration odds (OR 1.98, 95% CI 1.02 to 3.92; p=0.046).CONCLUSIONSBetter pre-LTFU BCVA (≥20/40) increased post-LTFU deterioration risk (associated with progressive CST thickening), while elevated post-LTFU CST (>280 µm) predicted higher BCVA restoration odds in patients with sustained follow-up, supporting CST-guided monitoring and early intervention for high-risk groups.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"25 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491642","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}
Mukharram M Bikbov,Gyulli M Kazakbaeva,Ellina M Iakupova,Guzel Bikbova,Leisan I Gilemzianova,Aigul M Nizamutdinova,Songhomitra Panda-Jonas,Anastasia V Insapova,Diana A Timerbulatova,Rakhimova Lilia,Jost B Jonas
BACKGROUNDTo assess subfoveal choroidal thickness (SFCT) and its associations in school children in a Russian population.METHODSThe Ural Children Eye Study (UCES), a school-based case-control study, was performed in Ufa/Bashkortostan/Russia from 2019 to 2022 and included 4933 children (mean age: 9.7±2.6 years; range: 6.2-18.8 years). The children underwent a series of ophthalmological and systemic examinations. Optical coherence tomographic (OCT) images of the macula were obtained in a randomly selected subgroup.RESULTSOut of 4933 children primarily participating in the UCES, a randomly selected group of 1462 (29.6%) children underwent OCT. Thicker SFCT (mean: 322±82 µm; median: 317 µm; range: 105-691 µm) was associated (multivariable analysis) with the systemic parameters of older age (beta: 0.15; B: 3.99; 95% CI 0.91, 7.08; p=0.01), taller body height (beta: 0.17; B: 0.78; 95% CI 0.27, 1.29; p=0.003), earlier school start in the morning (beta: -0.07; B: -5.60; 95% CI -9.42, -1.88; p=0.004), lower prevalence of actively resting during studying (beta: -0.06; B: -8.80; 95% CI -15.6, -1.98; p=0.01) and earlier time of going to bed in the evening (beta: -0.07; B: -0.68; 95% CI -1.20, -0.15; p=0.01), and the ocular parameters of shorter axial length (beta: -0.59; B: -46.8; 95% CI -53.0, -40.5; p<0.001), lower corneal refractive power (beta: -0.18; B: -10.3; 95% CI -23.9, -6.81; p<0.001) and deeper anterior chamber depth (beta: 0.12; B: 36.4; 95% CI 17.7, 55.2; p<0.001). It was not significantly associated with sex (p=0.87), body Mass Index (p=0.88) and best-corrected visual acuity (p=0.18). Mean inter-eye SFCT difference (39.3±35.5 µm; median: 30 µm; range: 0.00-259 µm) was related with inter-eye difference in axial length (beta: -0.29; B: -57.1; 95% CI -66.9, -47.4; p<0.001).CONCLUSIONSIn this ethnically mixed school children population from Russia, in contrast to studies on adult individuals, SFCT increased with older age. As in adults, however, at a more marked degree compared with adults, it decreased with longer axial length, by approximately 47 µm for each mm of longer axial length in multivariable analysis.
背景：评估俄罗斯学龄儿童中央凹下脉络膜厚度（SFCT）及其相关性。方法2019 - 2022年在俄罗斯乌法/巴什科尔托斯坦/俄罗斯开展乌拉尔儿童眼科研究（UCES），纳入4933名儿童（平均年龄9.7±2.6岁，范围6.2-18.8岁）。这些儿童接受了一系列眼科和全身检查。在随机选择的亚组中获得黄斑的光学相干断层扫描（OCT）图像。结果在主要参与UCES的4933名儿童中，随机选择1462名（29.6%）儿童接受了oct治疗。（多变量分析）更厚的SFCT（平均值：322±82µm；中位数：317µm；范围：105-691µm）与年龄较大（β: 0.15; B: 3.99; 95% CI 0.91, 7.08; p=0.01）、更高的身高（β: 0.17; B: 0.78; 95% CI 0.27, 1.29; p=0.003）、更早上学(β: -0.07; B: -5.60; 95% CI -9.42, -1.88；p=0.004)，学习期间主动休息的患病率较低（β: -0.06; B: -8.80; 95% CI -15.6, -1.98; p=0.01），晚上睡觉时间较早（β: -0.07; B: -0.68; 95% CI -1.20, -0.15; p=0.01），眼轴长度较短（β: -0.59; B: -46.8; 95% CI -53.0, -40.5; p<0.001），角膜屈光度较低（β: -0.18; B: -10.3; 95% CI -23.9, -6.81; p<0.001），前房深度较深（β: 0.12; B: 36.4; 95% CI - 17.7, 55.2; p<0.001）。与性别（p=0.87）、体重指数（p=0.88）和最佳矫正视力（p=0.18）无显著相关性。平均眼间SFCT差（39.3±35.5µm；中位数：30µm；范围：0.00-259µm）与眼间轴长差相关（β: -0.29; B: -57.1; 95% CI -66.9, -47.4; p<0.001）。结论：在俄罗斯混血学龄儿童人群中，与成人研究相比，SFCT随年龄增长而增加。然而，在成人中，与成人相比，在更明显的程度上，随着轴向长度的增加，它会下降，在多变量分析中，轴向长度每增加mm，它会下降约47µm。
{"title":"Choroidal thickness and associated factors in children: the Ufa Children Eye Study.","authors":"Mukharram M Bikbov,Gyulli M Kazakbaeva,Ellina M Iakupova,Guzel Bikbova,Leisan I Gilemzianova,Aigul M Nizamutdinova,Songhomitra Panda-Jonas,Anastasia V Insapova,Diana A Timerbulatova,Rakhimova Lilia,Jost B Jonas","doi":"10.1136/bjo-2025-328021","DOIUrl":"https://doi.org/10.1136/bjo-2025-328021","url":null,"abstract":"BACKGROUNDTo assess subfoveal choroidal thickness (SFCT) and its associations in school children in a Russian population.METHODSThe Ural Children Eye Study (UCES), a school-based case-control study, was performed in Ufa/Bashkortostan/Russia from 2019 to 2022 and included 4933 children (mean age: 9.7±2.6 years; range: 6.2-18.8 years). The children underwent a series of ophthalmological and systemic examinations. Optical coherence tomographic (OCT) images of the macula were obtained in a randomly selected subgroup.RESULTSOut of 4933 children primarily participating in the UCES, a randomly selected group of 1462 (29.6%) children underwent OCT. Thicker SFCT (mean: 322±82 µm; median: 317 µm; range: 105-691 µm) was associated (multivariable analysis) with the systemic parameters of older age (beta: 0.15; B: 3.99; 95% CI 0.91, 7.08; p=0.01), taller body height (beta: 0.17; B: 0.78; 95% CI 0.27, 1.29; p=0.003), earlier school start in the morning (beta: -0.07; B: -5.60; 95% CI -9.42, -1.88; p=0.004), lower prevalence of actively resting during studying (beta: -0.06; B: -8.80; 95% CI -15.6, -1.98; p=0.01) and earlier time of going to bed in the evening (beta: -0.07; B: -0.68; 95% CI -1.20, -0.15; p=0.01), and the ocular parameters of shorter axial length (beta: -0.59; B: -46.8; 95% CI -53.0, -40.5; p<0.001), lower corneal refractive power (beta: -0.18; B: -10.3; 95% CI -23.9, -6.81; p<0.001) and deeper anterior chamber depth (beta: 0.12; B: 36.4; 95% CI 17.7, 55.2; p<0.001). It was not significantly associated with sex (p=0.87), body Mass Index (p=0.88) and best-corrected visual acuity (p=0.18). Mean inter-eye SFCT difference (39.3±35.5 µm; median: 30 µm; range: 0.00-259 µm) was related with inter-eye difference in axial length (beta: -0.29; B: -57.1; 95% CI -66.9, -47.4; p<0.001).CONCLUSIONSIn this ethnically mixed school children population from Russia, in contrast to studies on adult individuals, SFCT increased with older age. As in adults, however, at a more marked degree compared with adults, it decreased with longer axial length, by approximately 47 µm for each mm of longer axial length in multivariable analysis.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"168 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477552","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}
Background/aims This study aimed to develop a multimodal artificial intelligence (AI) system that integrates fundus imaging and patient questionnaire data to achieve clinician-level diagnostic accuracy for diagnosing retinal detachment (RD). Methods Ultra-widefield fundus images and comprehensive patient questionnaires were collected from patients with RD and healthy controls at Tsukazaki Hospital. A multimodal model was developed using the Contrastive Language–Image Pretraining framework to classify RD cases, alongside separate image-only and questionnaire-only models for comparison. Per-image and per-subject analyses were conducted to assess model performance. Results The multimodal model outperformed single-modal models in per-image and per-subject assessments. It achieved accuracy, recall and F1 scores of 0.899±0.054, 0.902±0.043 and 0.902±0.048 in the per-image analysis and 0.893±0.071, 0.949±0.044 and 0.873±0.074 in the per-subject analysis, respectively. The AI model’s overall diagnostic accuracy was slightly lower than that of human clinicians; however, it exhibited a higher recall rate, indicating improved detection of true RD cases. Conclusion Integrating fundus imaging with patient questionnaire data significantly improves AI-based RD diagnosis. Future research needs to focus on expanding the dataset and refining the questionnaire design to further improve model performance. Data are available in a public, open-access repository. Data are available in a public, open-access repository. Deidentified ultra-widefield fundus images and paired questionnaire data (CSV) supporting the findings of this study are available in Zenodo[21][1] at (CC BY-NC-ND 4.0). All filenames are randomised and all metadata that could identify participants have been removed. [1]: #ref-21
{"title":"Multimodal artificial intelligence for retinal detachment diagnosis using fundus imaging and patient questionnaires","authors":"Naoyuki Yonemaru, Hitoshi Tabuchi, Hodaka Deguchi, Yuto Omi, Mao Tanabe, Naofumi Ishitobi, Hisashi Maruyama, Yuji Ayatsuka","doi":"10.1136/bjo-2025-327506","DOIUrl":"https://doi.org/10.1136/bjo-2025-327506","url":null,"abstract":"Background/aims This study aimed to develop a multimodal artificial intelligence (AI) system that integrates fundus imaging and patient questionnaire data to achieve clinician-level diagnostic accuracy for diagnosing retinal detachment (RD). Methods Ultra-widefield fundus images and comprehensive patient questionnaires were collected from patients with RD and healthy controls at Tsukazaki Hospital. A multimodal model was developed using the Contrastive Language–Image Pretraining framework to classify RD cases, alongside separate image-only and questionnaire-only models for comparison. Per-image and per-subject analyses were conducted to assess model performance. Results The multimodal model outperformed single-modal models in per-image and per-subject assessments. It achieved accuracy, recall and F1 scores of 0.899±0.054, 0.902±0.043 and 0.902±0.048 in the per-image analysis and 0.893±0.071, 0.949±0.044 and 0.873±0.074 in the per-subject analysis, respectively. The AI model’s overall diagnostic accuracy was slightly lower than that of human clinicians; however, it exhibited a higher recall rate, indicating improved detection of true RD cases. Conclusion Integrating fundus imaging with patient questionnaire data significantly improves AI-based RD diagnosis. Future research needs to focus on expanding the dataset and refining the questionnaire design to further improve model performance. Data are available in a public, open-access repository. Data are available in a public, open-access repository. Deidentified ultra-widefield fundus images and paired questionnaire data (CSV) supporting the findings of this study are available in Zenodo[21][1] at <https://zenodo.org/records/17156390> (CC BY-NC-ND 4.0). All filenames are randomised and all metadata that could identify participants have been removed. [1]: #ref-21","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"38 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145455414","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}
Sang Muk Lee, Soonil Kwon, Min Joung Lee, Bum-Joo Cho, Min Seon Park, Jinsoo Kim, Sung Uk Baek
Background/aims Pseudoexfoliation syndrome (PXS) is associated with increased risk of glaucoma, but the underlying molecular mechanisms remain unclear. This study aimed to compare microRNA (miRNA) expression profiles between PXS with glaucoma (PXSG) and PXS without glaucoma (PXSWG). Methods We enrolled 24 PXS patients undergoing cataract surgery, dividing them into PXSG (n=16) and PXSWG (n=8) groups. miRNA expression in anterior lens capsule tissue was analysed using NanoString nCounter technology. Differentially expressed miRNAs were identified, and functional pathway analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes (KEGG). The correlations between miRNA expression and clinical variables, including glaucoma severity, endothelial cell counts (ECCs) and systemic factors identified in serum blood tests, were also examined. Results Using a panel of 827 miRNAs, 23 upregulated miRNAs in PXSG were identified, miRNA-(miR-)887–3 p and miR-933 exhibiting the highest differential expression. The KEGG highlighted enrichment in pathways related to ageing and signal transduction. Elevated levels of several miRNAs, miR-933 and miR-302a-3p, were linked to worse visual field (VF) and thinner peripapillary retinal nerve fibre layer thickness (pRNFLT). Multivariate regression analysis identified associations of miR-302a-3p with lower ECC, miR-302f with thinner pRNFLT and miR-614 with higher triglyceride levels. Conclusion This study indicates potential differences in miRNA expression between PXSG and PXSWG, with several showing suggestive associations with key clinical parameters. These preliminary findings may provide valuable insights into processes relevant to PXS and glaucoma but require validation in larger, independent cohorts to clarify their biomarker potential. Data are available upon reasonable request. Data supporting the findings of the current study are available from the corresponding author on reasonable request.
{"title":"Comparison of microRNA expression in pseudoexfoliation syndrome with and without glaucoma","authors":"Sang Muk Lee, Soonil Kwon, Min Joung Lee, Bum-Joo Cho, Min Seon Park, Jinsoo Kim, Sung Uk Baek","doi":"10.1136/bjo-2025-327218","DOIUrl":"https://doi.org/10.1136/bjo-2025-327218","url":null,"abstract":"Background/aims Pseudoexfoliation syndrome (PXS) is associated with increased risk of glaucoma, but the underlying molecular mechanisms remain unclear. This study aimed to compare microRNA (miRNA) expression profiles between PXS with glaucoma (PXSG) and PXS without glaucoma (PXSWG). Methods We enrolled 24 PXS patients undergoing cataract surgery, dividing them into PXSG (n=16) and PXSWG (n=8) groups. miRNA expression in anterior lens capsule tissue was analysed using NanoString nCounter technology. Differentially expressed miRNAs were identified, and functional pathway analysis was conducted using the Kyoto Encyclopedia of Genes and Genomes (KEGG). The correlations between miRNA expression and clinical variables, including glaucoma severity, endothelial cell counts (ECCs) and systemic factors identified in serum blood tests, were also examined. Results Using a panel of 827 miRNAs, 23 upregulated miRNAs in PXSG were identified, miRNA-(miR-)887–3 p and miR-933 exhibiting the highest differential expression. The KEGG highlighted enrichment in pathways related to ageing and signal transduction. Elevated levels of several miRNAs, miR-933 and miR-302a-3p, were linked to worse visual field (VF) and thinner peripapillary retinal nerve fibre layer thickness (pRNFLT). Multivariate regression analysis identified associations of miR-302a-3p with lower ECC, miR-302f with thinner pRNFLT and miR-614 with higher triglyceride levels. Conclusion This study indicates potential differences in miRNA expression between PXSG and PXSWG, with several showing suggestive associations with key clinical parameters. These preliminary findings may provide valuable insights into processes relevant to PXS and glaucoma but require validation in larger, independent cohorts to clarify their biomarker potential. Data are available upon reasonable request. Data supporting the findings of the current study are available from the corresponding author on reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"131 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145455511","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}
Background We aimed to monitor changes in tear monocyte chemotactic protein-1 (MCP-1) levels following endonasal dacryocystorhinostomy (endo-DCR) and external dacryocystorhinostomy (ext-DCR). Methods and analysis This study was designed as a prospective, longitudinal study and included 42 eyes in the endo-DCR group and 48 eyes in the ext-DCR group. We monitored changes in tear MCP-1 levels. Tear samples were collected on the day before surgery, the first week, and the first and sixth months after surgery to compare changes in tear MCP-1 levels between and within groups. Surgery time and success rates were also compared. Results The mean MCP-1 levels at baseline, first and sixth months were similar between the groups (p=0.722, p=0.661, p=0.676, respectively). In the first week, it was significantly higher in the ext-DCR group than in the endo-DCR group (p<0.001). In the endo-DCR group, it showed a significant and continuous decrease until the first month (p<0.001), and the decrease stabilised in the sixth month. In the ext-DCR group, the mean MCP-1 level displayed a significant peak increase during the first week, followed by a steady decline until the sixth month (p<0.001). The surgery time was longer in the ext-DCR group (p<0.001) and showed a significant correlation with MCP-1 levels in the first week (Spearman’s rho=0.857, p <0.001). The groups’ subjective and anatomical success rates were similar (p=0.642, p=0.549, respectively). Conclusion Both surgeries demonstrated comparable success rates and decreased tear MCP-1 levels during follow-up. In the first week, the mean MCP-1 level exhibited a significant peak increase in the ext-DCR group. Extended surgical duration is a recognised factor affecting the wound-healing process. Data are available upon reasonable request. All data generated or analysed during this study are included in this published article.
{"title":"Monitoring tear monocyte chemoattractant protein-1 levels after endonasal versus external dacryocystorhinostomy: a prospective, longitudinal study","authors":"Sinem Karabulut, Ercan Saruhan, Müjdat Karabulut, Okan Akmaz","doi":"10.1136/bjo-2025-328030","DOIUrl":"https://doi.org/10.1136/bjo-2025-328030","url":null,"abstract":"Background We aimed to monitor changes in tear monocyte chemotactic protein-1 (MCP-1) levels following endonasal dacryocystorhinostomy (endo-DCR) and external dacryocystorhinostomy (ext-DCR). Methods and analysis This study was designed as a prospective, longitudinal study and included 42 eyes in the endo-DCR group and 48 eyes in the ext-DCR group. We monitored changes in tear MCP-1 levels. Tear samples were collected on the day before surgery, the first week, and the first and sixth months after surgery to compare changes in tear MCP-1 levels between and within groups. Surgery time and success rates were also compared. Results The mean MCP-1 levels at baseline, first and sixth months were similar between the groups (p=0.722, p=0.661, p=0.676, respectively). In the first week, it was significantly higher in the ext-DCR group than in the endo-DCR group (p<0.001). In the endo-DCR group, it showed a significant and continuous decrease until the first month (p<0.001), and the decrease stabilised in the sixth month. In the ext-DCR group, the mean MCP-1 level displayed a significant peak increase during the first week, followed by a steady decline until the sixth month (p<0.001). The surgery time was longer in the ext-DCR group (p<0.001) and showed a significant correlation with MCP-1 levels in the first week (Spearman’s rho=0.857, p <0.001). The groups’ subjective and anatomical success rates were similar (p=0.642, p=0.549, respectively). Conclusion Both surgeries demonstrated comparable success rates and decreased tear MCP-1 levels during follow-up. In the first week, the mean MCP-1 level exhibited a significant peak increase in the ext-DCR group. Extended surgical duration is a recognised factor affecting the wound-healing process. Data are available upon reasonable request. All data generated or analysed during this study are included in this published article.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"19 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447169","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}
Kwanghyun Lee, Esteban Morales, Agustina de Gainza, Joseph Caprioli
Aims To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression. Methods This retrospective longitudinal study included 1742 eyes from 996 glaucoma patients with ≥4 years of follow-up. Structural data from various devices were converted into a Structural Metascore (SMS), and the Visual Field Index (VFI) was used as the functional parameter. Robust linear regression was applied to each eye’s SMS and VFI over time. Eyes were categorised by baseline mean deviation (MD) into preperimetric (MD ≥0 dB), mild (−6 < MD < 0 dB), moderate (−12 ≤ MD ≤ −6 dB) or severe (MD <−12 dB). Progression was defined as a slope <−1% per year for SMS or VFI. Results Mean SMS slopes ranged from −0.1±0.8%/year (preperimetric) to −0.8±0.7%/year (severe) and VFI slopes ranged from −0.2±0.5%/year to −0.9±1.4%/year (p<0.001). Structural and functional slopes were more correlated in earlier stages. Progression classifications were: both structural and functional (6%), structural-only (13%), functional-only (11%) and stable (70%). Functional-only progression was more common in moderate and severe glaucoma, while structural-only progression predominated in earlier stages. The SMS approach achieved 8.9% prediction error compared with 34.1% for single-device methods. Conclusion The 3D trajectory model visualises distinct progression patterns, with structural changes preceding functional decline in earlier stages and functional-only progression dominating in advanced stages. This integrated model enhances visualisation and quantification of disease dynamics, supporting personalised glaucoma management. Data are available upon reasonable request.
{"title":"3D integrated approach to structural and functional monitoring in glaucoma","authors":"Kwanghyun Lee, Esteban Morales, Agustina de Gainza, Joseph Caprioli","doi":"10.1136/bjo-2025-327847","DOIUrl":"https://doi.org/10.1136/bjo-2025-327847","url":null,"abstract":"Aims To introduce a three-dimensional (3D) trajectory model that integrates structural and functional changes over time to improve assessment and prediction of glaucoma progression. Methods This retrospective longitudinal study included 1742 eyes from 996 glaucoma patients with ≥4 years of follow-up. Structural data from various devices were converted into a Structural Metascore (SMS), and the Visual Field Index (VFI) was used as the functional parameter. Robust linear regression was applied to each eye’s SMS and VFI over time. Eyes were categorised by baseline mean deviation (MD) into preperimetric (MD ≥0 dB), mild (−6 < MD < 0 dB), moderate (−12 ≤ MD ≤ −6 dB) or severe (MD <−12 dB). Progression was defined as a slope <−1% per year for SMS or VFI. Results Mean SMS slopes ranged from −0.1±0.8%/year (preperimetric) to −0.8±0.7%/year (severe) and VFI slopes ranged from −0.2±0.5%/year to −0.9±1.4%/year (p<0.001). Structural and functional slopes were more correlated in earlier stages. Progression classifications were: both structural and functional (6%), structural-only (13%), functional-only (11%) and stable (70%). Functional-only progression was more common in moderate and severe glaucoma, while structural-only progression predominated in earlier stages. The SMS approach achieved 8.9% prediction error compared with 34.1% for single-device methods. Conclusion The 3D trajectory model visualises distinct progression patterns, with structural changes preceding functional decline in earlier stages and functional-only progression dominating in advanced stages. This integrated model enhances visualisation and quantification of disease dynamics, supporting personalised glaucoma management. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"122 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145441227","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}
Alireza Kamalipour, Sasan Moghimi, Pooya Khosravi, Natchada Tansuebchueasai, Andrew Steven Camp, Cristiana Vasile, Mohsen Adelpour, Gopikasree Gunasegaran, Michael Saheb Kashaf, Takashi Nishida, Linda M Zangwill, Alexander K N Lam, Christopher Kai-Shun Leung, Robert N Weinreb
Background/aims To apply retinal nerve fibre layer (RNFL) optical texture analysis (ROTA) to investigate (1) the patterns of RNFL bundle defects, and (2) the frequency of papillomacular and papillofoveal bundle involvement across early, moderate and advanced glaucoma. Methods All eyes underwent 24–2 visual field (VF) testing and optical coherence tomography (OCT) for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular and papillofoveal bundles was determined for each eye. 24–2 VF stimulus projections were mapped onto the corresponding topographic areas of ROTA images. Multilevel logistic regression analysis was applied to evaluate the structure-function association. Results Papillomacular bundle defects were highly prevalent in glaucoma, increasing from 87.7% in early to 95.35% in moderate and 100% in advanced glaucoma. Papillofoveal bundle defects were also common, increasing from 29.7% in early to 36.05% in moderate and 60.98% in advanced glaucoma. Central four 24–2 test locations that projected onto the trajectories of papillomacular or papillofoveal RNFL bundle defects demonstrated significantly increased likelihood of VF sensitivity abnormality (ORs of 22.42 at PDP<5% and 20.26 at TDP<5%, respectively, p<0.001 for both). Conclusion ROTA uncovers a wide spectrum of RNFL bundle defects spanning the entire glaucoma continuum. It also provides visualisation of the preserved RNFL bundles in advanced glaucoma. Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with early, moderate and advanced glaucoma, and, when detected, they significantly increase the likelihood of abnormality in the corresponding central 24–2 test locations. Data are available upon reasonable request.
{"title":"Retinal nerve fibre layer optical texture analysis: retinal nerve fibre bundle defect patterns and the extent of macular involvement across different stages of glaucoma","authors":"Alireza Kamalipour, Sasan Moghimi, Pooya Khosravi, Natchada Tansuebchueasai, Andrew Steven Camp, Cristiana Vasile, Mohsen Adelpour, Gopikasree Gunasegaran, Michael Saheb Kashaf, Takashi Nishida, Linda M Zangwill, Alexander K N Lam, Christopher Kai-Shun Leung, Robert N Weinreb","doi":"10.1136/bjo-2024-326968","DOIUrl":"https://doi.org/10.1136/bjo-2024-326968","url":null,"abstract":"Background/aims To apply retinal nerve fibre layer (RNFL) optical texture analysis (ROTA) to investigate (1) the patterns of RNFL bundle defects, and (2) the frequency of papillomacular and papillofoveal bundle involvement across early, moderate and advanced glaucoma. Methods All eyes underwent 24–2 visual field (VF) testing and optical coherence tomography (OCT) for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular and papillofoveal bundles was determined for each eye. 24–2 VF stimulus projections were mapped onto the corresponding topographic areas of ROTA images. Multilevel logistic regression analysis was applied to evaluate the structure-function association. Results Papillomacular bundle defects were highly prevalent in glaucoma, increasing from 87.7% in early to 95.35% in moderate and 100% in advanced glaucoma. Papillofoveal bundle defects were also common, increasing from 29.7% in early to 36.05% in moderate and 60.98% in advanced glaucoma. Central four 24–2 test locations that projected onto the trajectories of papillomacular or papillofoveal RNFL bundle defects demonstrated significantly increased likelihood of VF sensitivity abnormality (ORs of 22.42 at PDP<5% and 20.26 at TDP<5%, respectively, p<0.001 for both). Conclusion ROTA uncovers a wide spectrum of RNFL bundle defects spanning the entire glaucoma continuum. It also provides visualisation of the preserved RNFL bundles in advanced glaucoma. Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with early, moderate and advanced glaucoma, and, when detected, they significantly increase the likelihood of abnormality in the corresponding central 24–2 test locations. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"228 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145441209","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}
Hanna Richkind,Nicole Jody,Shira L Robbins,Jolene C Rudell,David B Granet
BACKGROUND/AIMSTo examine the angle between the driver's eye and the three mirrors (side and rear-view) across different vehicle models, in order to understand head and gaze adjustments that may be necessary for post-strabismus surgery patients to reduce diplopia while driving.METHODSThe driver's eye angle (DEA) was defined as the horizontal angle between the driver's line of sight when looking straight ahead and the direction of their gaze required to view the centre of a given mirror. Angles were measured using a digital protractor from a single 69 inch (1.75 m) tall driver's eye position to the centre of the three mirrors (left side, right side and rear-view) in each vehicle. Measurements considered seat height and proximity to the steering wheel.RESULTSDEAs were calculated for the seat position deemed most comfortable (CP) by the model driver. For the rear-view mirror, the average CP DEA was 43.5° (range: 35.0°-48.4°). The left side mirror averaged 45.8° (range: 39.3°-52.1°) and the right side mirror 68.9° (range: 63.1°-80.3°). Generally, DEAs were highest with the seat in a forward-high position and lowest when seated further back and lower.CONCLUSIONSPatients with strabismus or postsurgical limitations may experience diplopia when using mirrors that require extreme gaze angles. Clinicians should incorporate driving-related visual demands into postoperative counselling. Encouraging rearward-lowered seating and recommending vehicles with narrower mirror angles may reduce symptoms. In some cases, adaptive devices (wide-angle mirrors, blind spot monitoring) may be necessary for safe and comfortable driving.
{"title":"But doctor, will I be able to drive? Car mirror placement design and viewing angles required for safe binocular vision for drivers.","authors":"Hanna Richkind,Nicole Jody,Shira L Robbins,Jolene C Rudell,David B Granet","doi":"10.1136/bjo-2025-327186","DOIUrl":"https://doi.org/10.1136/bjo-2025-327186","url":null,"abstract":"BACKGROUND/AIMSTo examine the angle between the driver's eye and the three mirrors (side and rear-view) across different vehicle models, in order to understand head and gaze adjustments that may be necessary for post-strabismus surgery patients to reduce diplopia while driving.METHODSThe driver's eye angle (DEA) was defined as the horizontal angle between the driver's line of sight when looking straight ahead and the direction of their gaze required to view the centre of a given mirror. Angles were measured using a digital protractor from a single 69 inch (1.75 m) tall driver's eye position to the centre of the three mirrors (left side, right side and rear-view) in each vehicle. Measurements considered seat height and proximity to the steering wheel.RESULTSDEAs were calculated for the seat position deemed most comfortable (CP) by the model driver. For the rear-view mirror, the average CP DEA was 43.5° (range: 35.0°-48.4°). The left side mirror averaged 45.8° (range: 39.3°-52.1°) and the right side mirror 68.9° (range: 63.1°-80.3°). Generally, DEAs were highest with the seat in a forward-high position and lowest when seated further back and lower.CONCLUSIONSPatients with strabismus or postsurgical limitations may experience diplopia when using mirrors that require extreme gaze angles. Clinicians should incorporate driving-related visual demands into postoperative counselling. Encouraging rearward-lowered seating and recommending vehicles with narrower mirror angles may reduce symptoms. In some cases, adaptive devices (wide-angle mirrors, blind spot monitoring) may be necessary for safe and comfortable driving.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"21 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433889","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}
Ahnul Ha,Young Kook Kim,Chang Kyu Lee,Pete A Williams,James E Morgan,Young In Shin,Eunsol Kim,Myungjin Kim,Seungsoo Rho
BACKGROUND/AIMSThe neuroprotective effect of nicotinamide (NAM) supplementation has been demonstrated in both animal models and clinical trials. We conducted a trial to assess whether oral NAM improves retinal function in normal-tension glaucoma (NTG) participants receiving intraocular pressure (IOP)-lowering therapy.METHODSFifty-three NTG participants (untreated IOP ≤18 mm Hg) were enrolled in a double-masked, placebo-controlled crossover randomised clinical trial. Participants were randomly assigned to receive either oral placebo or NAM, followed by crossover without a washout period. Each treatment was administered for 12 weeks (NAM/placebo 1 g/day for 6 weeks, then 2 g/day for the subsequent 6 weeks). Retinal function was evaluated using full-field electroretinography and visual field testing.RESULTSAfter 12 weeks, the amplitude changes of the photopic negative response in peak-to-trough (PhNRPT) and the B-wave were significantly greater in the NAM group (3.121±3.968 and 2.112±3.220 μV, respectively) compared with the placebo group (0.996±4.190 and 0.305±3.279 μV, respectively; p=0.045 and p=0.032). PhNRPT improved beyond twice the 95% coefficient of variation in 29.0% of the NAM group and 19.3% of the placebo group. No significant intergroup differences were observed in changes in mean deviation, pattern SD or visual field index after 12 weeks.CONCLUSIONOral NAM supplementation in NTG participants induced functional improvement, as measured by PhNRPT and B-wave amplitude. Given that NTG is characterised by lower IOP, which may show a weaker correlation with electrophysiological activity and a slower progression rate compared with high-tension glaucoma, further long-term studies are needed to clarify the effects of NAM in this population.TRIAL REGISTRATION NUMBERNCT06078605.
背景/目的补充烟酰胺（NAM）的神经保护作用已在动物模型和临床试验中得到证实。我们进行了一项试验，以评估口服NAM是否能改善接受降低眼压治疗的正常眼压青光眼（NTG）患者的视网膜功能。方法53例NTG患者（未治疗IOP≤18 mm Hg）纳入双盲、安慰剂对照交叉随机临床试验。参与者被随机分配接受口服安慰剂或NAM，随后进行无洗脱期的交叉试验。每次治疗持续12周（NAM/安慰剂1 g/天，连续6周，然后2 g/天，连续6周）。采用全视野视网膜电图和视野测试评估视网膜功能。结果12周后，NAM组的峰谷光负反应（PhNRPT）和b波振幅变化（分别为3.121±3.968和2.112±3.220 μV）显著高于安慰剂组（分别为0.996±4.190和0.305±3.279 μV, p=0.045和p=0.032）。PhNRPT改善了29.0%的NAM组和19.3%的安慰剂组95%变异系数的两倍以上。12周后各组平均偏差、模式SD、视野指数变化无显著差异。结论：通过PhNRPT和b波振幅测量，口服NAM补充剂可促进NTG参与者的功能改善。鉴于NTG的特点是较低的IOP，与高张力性青光眼相比，其与电生理活动的相关性较弱，进展速度较慢，因此需要进一步的长期研究来阐明NAM对这一人群的影响。试验注册号：06078605。
{"title":"Effects of nicotinamide supplementation in normal-tension glaucoma: a crossover placebo-controlled randomised clinical trial.","authors":"Ahnul Ha,Young Kook Kim,Chang Kyu Lee,Pete A Williams,James E Morgan,Young In Shin,Eunsol Kim,Myungjin Kim,Seungsoo Rho","doi":"10.1136/bjo-2025-328096","DOIUrl":"https://doi.org/10.1136/bjo-2025-328096","url":null,"abstract":"BACKGROUND/AIMSThe neuroprotective effect of nicotinamide (NAM) supplementation has been demonstrated in both animal models and clinical trials. We conducted a trial to assess whether oral NAM improves retinal function in normal-tension glaucoma (NTG) participants receiving intraocular pressure (IOP)-lowering therapy.METHODSFifty-three NTG participants (untreated IOP ≤18 mm Hg) were enrolled in a double-masked, placebo-controlled crossover randomised clinical trial. Participants were randomly assigned to receive either oral placebo or NAM, followed by crossover without a washout period. Each treatment was administered for 12 weeks (NAM/placebo 1 g/day for 6 weeks, then 2 g/day for the subsequent 6 weeks). Retinal function was evaluated using full-field electroretinography and visual field testing.RESULTSAfter 12 weeks, the amplitude changes of the photopic negative response in peak-to-trough (PhNRPT) and the B-wave were significantly greater in the NAM group (3.121±3.968 and 2.112±3.220 μV, respectively) compared with the placebo group (0.996±4.190 and 0.305±3.279 μV, respectively; p=0.045 and p=0.032). PhNRPT improved beyond twice the 95% coefficient of variation in 29.0% of the NAM group and 19.3% of the placebo group. No significant intergroup differences were observed in changes in mean deviation, pattern SD or visual field index after 12 weeks.CONCLUSIONOral NAM supplementation in NTG participants induced functional improvement, as measured by PhNRPT and B-wave amplitude. Given that NTG is characterised by lower IOP, which may show a weaker correlation with electrophysiological activity and a slower progression rate compared with high-tension glaucoma, further long-term studies are needed to clarify the effects of NAM in this population.TRIAL REGISTRATION NUMBERNCT06078605.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403793","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}
BACKGROUND/AIMClinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children.METHODSFive databases were searched for randomised controlled trials (RCTs) including children ≤16 years with myopia who received atropine treatment. 34 RCTs with ≥12 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity.RESULTSCompared with controls, atropine significantly reduced myopia progression across all concentrations: <0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)/year; AL: -0.20 (95% CI -0.24 to -0.16) mm/year), 0.1% to <0.5% (0.81 (95% CI 0.50 to 1.13) D/year) and ≥0.5% (1.06 (95% CI 0.88 to 1.24) D/year; -0.36 (95% CI -0.40 to -0.33) mm/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D/year; -0.26 (95% CI -0.31 to -0.20) mm/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D/year; -0.13 (95% CI -0.21 to -0.05) mm/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D/year; -0.11 (95% CI -0.16 to -0.05) mm/year).CONCLUSIONAtropine slows myopia progression in a dose-dependent manner in studies with 1-5 years. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies.PROSPERO REGISTRATION NUMBERCRD42023454104.
亚洲和非亚洲儿童控制近视的最佳阿托品浓度、治疗时间和潜在疗效差异仍存在临床不确定性。本系统综述和荟萃分析评估了不同浓度阿托品控制近视的疗效，比较了东亚、南亚和欧洲白人儿童的结果。方法检索5个数据库，纳入≤16岁近视儿童接受阿托品治疗的随机对照试验（rct）。纳入随访≥12个月的34项rct。球等效折射（SER）进展和轴向长度（AL）延伸的加权平均差异（WMD）根据阿托品浓度和种族进行汇总。结果与对照组相比，阿托品在所有浓度下均显著降低了近视进展：<0.1% (SER WMD: 0.44 （95% CI 0.35 ~ 0.52）屈光度(D)/年；AL: -0.20 (95% CI -0.24至-0.16)mm/年)，0.1%至<0.5% （0.81 (95% CI 0.50至1.13)D/年）和≥0.5% (1.06 (95% CI 0.88至1.24)D/年；-0.36 (95% CI -0.40至-0.33)mm/年)。所有浓度对SER和AL进展的综合影响在东亚地区更大(0.63 (95% CI 0.50至0.76)D/年；-0.26 (95% CI -0.31至-0.20)mm/年)比南亚(0.40 (95% CI 0.11至0.70)D/年；-0.13 (95% CI -0.21至-0.05)mm/年)或白种欧洲人(0.18 (95% CI 0.11至0.25)D/年；-0.11 (95% CI -0.16至-0.05)mm/年)。结论在1-5年的研究中，阿托品以剂量依赖的方式减缓近视进展。亚洲儿童，特别是东亚儿童的效果更好，他们也表现出更大的光性瞳孔扩张。这些发现支持阿托品在近视控制中的作用，并强调在处方和定制治疗策略时考虑种族特异性的重要性。普洛斯彼罗注册号crd42023454104。
{"title":"Ethnic and dose-dependent differences in atropine efficacy for myopia control: a systematic review and meta-analysis.","authors":"Sayantan Biswas,Carla Lanca,Daisy Kynman-Sprinks,Andrzej Grzybowski","doi":"10.1136/bjo-2025-328518","DOIUrl":"https://doi.org/10.1136/bjo-2025-328518","url":null,"abstract":"BACKGROUND/AIMClinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children.METHODSFive databases were searched for randomised controlled trials (RCTs) including children ≤16 years with myopia who received atropine treatment. 34 RCTs with ≥12 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity.RESULTSCompared with controls, atropine significantly reduced myopia progression across all concentrations: <0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)/year; AL: -0.20 (95% CI -0.24 to -0.16) mm/year), 0.1% to <0.5% (0.81 (95% CI 0.50 to 1.13) D/year) and ≥0.5% (1.06 (95% CI 0.88 to 1.24) D/year; -0.36 (95% CI -0.40 to -0.33) mm/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D/year; -0.26 (95% CI -0.31 to -0.20) mm/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D/year; -0.13 (95% CI -0.21 to -0.05) mm/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D/year; -0.11 (95% CI -0.16 to -0.05) mm/year).CONCLUSIONAtropine slows myopia progression in a dose-dependent manner in studies with 1-5 years. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies.PROSPERO REGISTRATION NUMBERCRD42023454104.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"48 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403776","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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