British Journal of Ophthalmology最新文献_第7页

Deep learning-based normative database of anterior chamber dimensions for angle closure assessment: the Singapore Chinese Eye Study 基于深度学习的用于闭角评估的前房尺寸规范数据库：新加坡华人眼科研究

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-11-01 DOI: 10.1136/bjo-2024-325602

Zhi-Da Soh, Mingrui Tan, Zann Lee, Marco Yu, Sahil Thakur, Raghavan Lavanya, Monisha Esther Nongpiur, Xinxing Xu, Victor Koh, Tin Aung, Yong Liu, Ching-Yu Cheng

Background/ Aims The lack of context for anterior segment optical coherence tomography (ASOCT) measurements impedes its clinical utility. We established the normative distribution of anterior chamber depth (ACD), area (ACA) and width (ACW) and lens vault (LV), and applied percentile cut-offs to detect primary angle closure disease (PACD; ≥180° posterior trabecular meshwork occluded). Methods We included subjects from the Singapore Chinese Eye Study with ASOCT scans. Eyes with ocular surgery or laser procedures, and ocular trauma were excluded. A deep-learning algorithm was used to obtain Visante ASOCT (Carl Zeiss Meditec, USA) measurements. Normative distribution was established using 80% of eyes with open angles. Multivariable logistic regression was performed on 80% open and 80% angle closure eyes. Diagnostic performance was evaluated using 20% open and 20% angle closure eyes. Results We included 2157 eyes (1853 open angles; 304 angle closure) for analysis. ACD, ACA and ACW decreased with age and were smaller in females, and vice versa for LV (all p<0.022). ACD 20th percentile and LV 85th percentile had a balanced accuracy of 84.4% and 84.2% in detecting PACD, respectively. When combined, ACD 20th and LV 85th percentile had 88.68% sensitivity and 88.85% specificity in detecting PACD as compared with a multivariable regression model (ACA, angle opening distance, LV, iris area) with 88.33% sensitivity and 83.75% specificity. Conclusion Anterior chamber parameters varied with age and gender. The ACD 20th and LV 85th percentile values may be used in silos or in combination to detect PACD in the absence of more sophisticated classification algorithms. Data are available on reasonable request. The data included in this study are not publicly available due to patient privacy and the data are meant for research purposes only. On reasonable request, de-identified data used in this study may be made available for academic purpose by the Singapore Eye Research Institute (SERI), subjected to approval by the local institutional review board. Data request can be sent to the Data Access Committee at SERI via seri@seri.com.sg. Any data that can be shared will be released via a Research Collaboration Agreement (RCA) for non-commercial research purpose.

背景/目的前节光学相干断层扫描（ASOCT）测量结果缺乏背景信息，妨碍了其临床应用。我们建立了前房深度（ACD）、面积（ACA）、宽度（ACW）和晶状体穹窿（LV）的标准分布，并采用百分位数截断法检测原发性闭角疾病（PACD；后小梁网闭塞≥180°）。方法我们纳入了新加坡华人眼科研究的 ASOCT 扫描对象。排除了眼部手术或激光治疗以及眼外伤的眼睛。使用深度学习算法获得 Visante ASOCT（卡尔蔡司医疗技术公司，美国）的测量结果。使用 80% 的开角眼来建立标准分布。对 80% 的开角眼和 80% 的闭角眼进行多变量逻辑回归。使用 20% 的开角眼和 20% 的闭角眼评估诊断性能。结果我们纳入了 2157 只眼睛（1853 只开角；304 只闭角）进行分析。ACD、ACA和ACW随年龄增长而下降，女性的ACD、ACA和ACW更小，反之亦然（均P<0.022）。ACD 第 20 百分位数和 LV 第 85 百分位数检测 PACD 的平衡准确率分别为 84.4% 和 84.2%。与多变量回归模型（ACA、开角距离、LV、虹膜面积）88.33%的灵敏度和83.75%的特异性相比，ACD第20百分位数和LV第85百分位数联合检测PACD的灵敏度为88.68%，特异性为88.85%。结论前房参数随年龄和性别而变化。在没有更复杂的分类算法的情况下，ACD 第 20 个百分位值和 LV 第 85 个百分位值可单独或结合使用来检测 PACD。如有合理要求，可提供相关数据。由于涉及患者隐私，本研究中的数据不对外公开，数据仅供研究使用。经合理请求，新加坡眼科研究所（SERI）可将本研究中使用的去标识化数据提供给学术界使用，但需获得当地机构审查委员会的批准。数据申请可通过 seri@seri.com.sg 发送给新加坡眼科研究所的数据访问委员会。任何可以共享的数据将通过研究合作协议（RCA）发布，用于非商业研究目的。

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引用次数: 0

In vivo lacrimal gland imaging artefact assessment based on swept-source optical coherence tomography for dry eye disease 基于干眼症扫源光学相干断层扫描的活体泪腺成像伪影评估

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-11-01 DOI: 10.1136/bjo-2024-325864

Weijing Cheng, Longyue Li, Juejing Chen, Ziyan Chen, Jing Li, Siyi Liu, Nuan Zhang, Feng Gu, Wenhui Wang, Wei Wang, Boyu Yang, Lingyi Liang

Background This study aimed to characterise imaging artefacts in the lacrimal gland using swept-source optical coherence tomography (SS-OCT) in patients with dry eye disease (DED) and healthy participants and identify risk factors for these artefacts. Methods In total, 151 eyes, including 104 from patients with DED and 47 from non-DED participants, were analysed. Demographic data collection, comprehensive ocular examinations and SS-OCT imaging of the palpebral lobe of the lacrimal gland were performed. Artefacts were classified into distinct categories with different severities. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, gender, best-corrected visual acuity, intraocular pressure (IOP) and the presence of DED with the presence of artefacts. Results Eight artefact types and severity grading were defined by analysing 1208 lacrimal SS-OCT images. The three most prevalent artefacts were defocus (75.83%), cliff (67.47%) and Z-off (58.44%). The presence of artefacts was significantly associated with the presence of DED (OR=9.13; 95% CI, 2.39 to 34.88; p=0.001) and higher IOP (OR=1.34; 95% CI, 1.14 to 1.58; p<0.001). Furthermore, multivariate logistic analyses showed that lower tear film breakup time (OR=0.71; 95% CI, 0.55 to 0.92; p=0.009) and higher meibum quality score (OR=2.86; 95% CI, 1.49 to 5.48; p=0.002) were significantly associated with higher odds for the presence of artefacts. Conclusions DED eyes had more SS-OCT image artefacts than normal eyes. Stringent standardised image quality control should be implemented before further image analysis when using SS-OCT to assess lacrimal gland image. Data are available upon reasonable request.

背景本研究旨在利用扫源光学相干断层扫描（SS-OCT）描述干眼症（DED）患者和健康参与者泪腺成像伪影的特征，并确定这些伪影的风险因素。方法共分析了 151 只眼睛，其中 104 只来自 DED 患者，47 只来自非 DED 患者。研究人员收集了人口统计学数据、进行了全面的眼部检查和泪腺睑叶的 SS-OCT 成像。对不同严重程度的伪影进行了分类。进行了单变量和多变量逻辑回归分析，以评估年龄、性别、最佳矫正视力、眼压（IOP）和是否存在 DED 与是否存在伪影之间的关系。结果通过分析 1208 张泪腺 SS-OCT 图像，确定了八种伪影类型和严重程度分级。最常见的三种伪影是散焦（75.83%）、悬崖（67.47%）和Z-off（58.44%）。伪影的存在与 DED（OR=9.13；95% CI，2.39 至 34.88；p=0.001）和眼压升高（OR=1.34；95% CI，1.14 至 1.58；p<0.001）显著相关。此外，多变量逻辑分析表明，较低的泪膜破裂时间（OR=0.71；95% CI，0.55 至 0.92；p=0.009）和较高的meibum 质量评分（OR=2.86；95% CI，1.49 至 5.48；p=0.002）与较高的伪影出现几率显著相关。结论 DED 眼比正常眼有更多的 SS-OCT 图像伪影。在使用 SS-OCT 评估泪腺图像时，应在进一步图像分析前实施严格的标准化图像质量控制。如有合理要求，可提供相关数据。

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引用次数: 0

At a glance 一览

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-11-01 DOI: 10.1136/bjo-2024-326599

Frank Larkin

In patients with keratoconus, the classification of the severity stage assessed by anterior segment optical coherence tomography was a reliable predictor for success in big bubble formation during deep anterior lamellar keratoplasty. This study adds to existing evidence that unilateral corneal disease or surgical trauma can affect the homeostasis of the contralateral cornea. In this study, significant morphological and quantitative changes were observed in the sub-basal nerve plexus of the cornea in the unoperated eyes of patients after refractive surgery. This was accompanied by changes in dry eye parameters and neuromediators in tear fluid. The health-related quality of life (HRQOL) impairment associated with dry eye symptoms (DES) was greater than that caused by the confounding comorbidities. The most affected HRQOL dimensions varied between patients with different severities of DES. The glued amniotic membrane transplantation …

在角膜炎患者中，前段光学相干断层扫描评估的严重程度分期是预测深前板层角膜成形术中大泡形成成功与否的可靠指标。这项研究补充了现有的证据，即单侧角膜疾病或手术创伤会影响对侧角膜的平衡。在这项研究中，观察到屈光手术后未手术眼的角膜基底下神经丛发生了明显的形态和数量变化。与此同时，干眼症参数和泪液中的神经介质也发生了变化。与干眼症状（DES）相关的健康相关生活质量（HRQOL）损害要大于合并症造成的损害。不同严重程度的干眼症患者受影响最大的健康相关生活质量维度各不相同。胶合羊膜移植 ...

引用次数: 0

Use of immunomodulatory treatment for non-infectious uveitis: an International Ocular Inflammation Society report of real-world practice 使用免疫调节疗法治疗非感染性葡萄膜炎：国际眼部炎症协会真实世界实践报告

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-29 DOI: 10.1136/bjo-2024-326239

Jasmin A Branford, Bahram Bodaghi, Lisia Barros Ferreira, Peter J McCluskey, Jennifer E Thorne, Janet M Matthews, International Study Group for Systemic Immunomodulatory Drug Treatment of Non‐Infectious Uveitis, Justine R Smith

Background Non-infectious uveitis is a diverse group of inflammatory conditions that collectively account for substantial blindness worldwide. Expert guidelines and results of clinical trials guide treatment, but real-world clinical care is impacted by additional factors. In 2023, an international group of uveitis-specialised ophthalmologists formed the International Study Group for Systemic Immunomodulatory Drug Treatment of Non-Infectious Uveitis to report current practice. Methods 221 study group members from 53 countries completed a 30-item questionnaire on their management of non-infectious uveitis including: indications for and investigations prior to initiating systemic immunomodulatory drugs, use of conventional and biological drugs, and follow-up of treated patients. Results Major indications to initiate systemic immunomodulatory drugs were: uveitis not controlled with oral prednis(ol)one (n=208, 94.1%), specific uveitis diagnosis (n=197, 89.1%), and patient intolerance of oral prednis(ol)one (n=186, 84.2%). All members (n=221, 100%) performed pretreatment screens including: blood chemistry (n=217, 98.2%), blood examination (n=207, 93.7%), and Quantiferon assay (n=196, 88.7%). Eight conventional and 14 biological drugs were prescribed: methotrexate was the preferred conventional drug overall (n=126, 57.0%) and for 9 of 11 uveitides, and adalimumab was the preferred biological drug overall (n=216, 97.7%) and for 11 of 11 uveitides. When drugs were combined, methotrexate plus adalimumab was most popular (n=158 of 188 members, 84.0%). Patients with inactive uveitis were typically evaluated and screened for drug toxicity every 6–12 weeks (n=161, 72.9%, and 165, 74.7%, respectively). Conclusion Our report describes practice patterns of a large international group of uveitis specialists treating non-infectious uveitis with systemic immunomodulatory drugs. All data relevant to the study are included in the article or uploaded as supplementary information.

背景非感染性葡萄膜炎是一类多种多样的炎症，在全球范围内造成了大量失明。专家指南和临床试验结果为治疗提供了指导，但实际临床护理还受到其他因素的影响。2023 年，一个由葡萄膜炎专科眼科医生组成的国际组织成立了 "系统免疫调节药物治疗非感染性葡萄膜炎国际研究小组"，以报告当前的治疗方法。方法来自 53 个国家的 221 名研究小组成员填写了一份 30 个项目的调查问卷，内容涉及他们对非感染性葡萄膜炎的治疗方法，包括：开始使用全身免疫调节药物的适应症和使用前的检查、传统药物和生物药物的使用以及治疗患者的随访。结果开始使用全身免疫调节药物的主要适应症是：经口服泼尼松（OL）一药未控制的葡萄膜炎（208 人，94.1%）、特异性葡萄膜炎诊断（197 人，89.1%）和患者对口服泼尼松（OL）一药不耐受（186 人，84.2%）。所有成员（n=221，100%）都进行了预处理筛查，包括：血液化学（n=217，98.2%）、血液检查（n=207，93.7%）和定量分析（n=196，88.7%）。处方中使用了8种常规药物和14种生物药物：总体而言，甲氨蝶呤是首选的常规药物（n=126，57.0%），11种葡萄胎中有9种使用了甲氨蝶呤；总体而言，阿达木单抗是首选的生物药物（n=216，97.7%），11种葡萄胎中有11种使用了阿达木单抗。联合用药时，甲氨蝶呤加阿达木单抗最受欢迎（188名成员中158名，84.0%）。非活动性葡萄膜炎患者通常每 6-12 周接受一次药物毒性评估和筛查（分别为 161 人，72.9% 和 165 人，74.7%）。结论我们的报告描述了一个大型国际葡萄膜炎专家小组使用全身免疫调节药物治疗非感染性葡萄膜炎的实践模式。与研究相关的所有数据均包含在文章中或作为补充信息上传。

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引用次数: 0

Longitudinal OCTA vessel density loss in macula and optic nerve head in healthy, glaucoma suspect and established glaucoma eyes. 健康眼、疑似青光眼眼和已确诊青光眼眼黄斑和视神经头的纵向 OCTA 血管密度损失。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-28 DOI: 10.1136/bjo-2024-325746

Jo-Hsuan Wu, Sasan Moghimi, Takashi Nishida, Mohsen Adelpour, Alireza Kamalipour, Gopikasree Gunasegaran, Linda M Zangwill, Robert N Weinreb

Background/aims: To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes.

Methods: Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes.

Results: There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:-0.72 to -0.92 %/year) and wiCD (range:-0.28 to -0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R²=0.27 vs 0.16).

Conclusions: In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.

背景/目的方法：纳入随访时间≥2年、接受过4次黄斑/视神经头OCTA成像检查的健康、疑似青光眼（GS）和原发性开角型青光眼（POAG）眼的黄斑和视神经头的纵向光学相干断层血管成像（OCTA）变化。使用联合混合效应模型计算了每个诊断组的黄斑 wiVD（全像血管密度）和 ONH wiCD（全像毛细血管密度）变化率。通过配对比较检查了不同诊断的 wiVD/wiCD 变化率差异。对 POAG 眼睛的基线 24-2 视野（VF）平均偏差（MD）与 wiVD/wiCD 变化率的关系进行了评估：结果：健康组、GS 组和 POAG 组分别有 36、57 和 79 只眼睛（25、38 和 50 名受试者）。所有组的 wiVD（范围：-0.72 至 -0.92%/年）和 wiCD（范围：-0.28 至 -0.66%/年）损失率均与零不同（P2=0.27 vs 0.16）：结论：在青光眼患者中，视网膜上皮的微血管损失早于黄斑。结论：在青光眼患者中，视网膜上部微血管的丧失早于黄斑部。此外，视网膜上部微血管丧失与基线视力的关系比黄斑部微血管丧失稍强。用 OCTA 观察 ONH VD 损失可能有助于监测早期青光眼，这一点应在未来更大规模的研究中得到证实。

{"title":"Longitudinal OCTA vessel density loss in macula and optic nerve head in healthy, glaucoma suspect and established glaucoma eyes.","authors":"Jo-Hsuan Wu, Sasan Moghimi, Takashi Nishida, Mohsen Adelpour, Alireza Kamalipour, Gopikasree Gunasegaran, Linda M Zangwill, Robert N Weinreb","doi":"10.1136/bjo-2024-325746","DOIUrl":"https://doi.org/10.1136/bjo-2024-325746","url":null,"abstract":"Background/aims: To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes.Methods: Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes.Results: There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:-0.72 to -0.92 %/year) and wiCD (range:-0.28 to -0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R2=0.27 vs 0.16).Conclusions: In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521058","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

Influence of surgeon learning on outcomes in new ophthalmic procedures: quantified nationwide evidence in endothelial corneal transplantation 外科医生的学习对眼科新手术结果的影响：全国范围内角膜内皮移植手术的量化证据

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-26 DOI: 10.1136/bjo-2024-325366

Shaminie Shanmugaranjan, Cathy Hopkinson, Lewis Downward, Daniel F P Larkin

Aims To investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes. Methods A prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial corneal dystrophy or pseudophakic bullous keratopathy undergoing a first EK procedure in that eye between 2005 and 2020. EK procedures were either Descemet Stripping Endothelial Keratoplasty (DSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK). Primary outcome was transplant survival at 2 years. Secondary outcomes at 1-year post-transplant were (1) best-corrected visual acuity, (2) requirement for repeat air injection procedures to treat graft detachment and (3) iatrogenic primary graft failure. Results Following analysis of 11 516 EK transplants, significant impact of surgeon learning was indicated by (1) the influence of surgeon prior experience in that EK technique, (2) the influence of surgeon prior experience in postoperative management and (3) the time interval from introduction of that EK technique in the United Kingdom to time of surgery. EK grafts reported to have failed within the first 6 months were a significant proportion of all transplant failures. Conclusions Influence of surgeon learning and inexperience in EK of clinical and statistical significance can be quantified and diminishes over time. Equivalent analyses may be feasible for novel procedures in other ophthalmology specialties and surgical training. Training programmes and nationwide advisory networks may be helpful in reducing the duration and impact of surgeon learning curves. Data are available upon reasonable request.

目的研究外科医生的学习对内皮角膜移植术（EK）疗效的影响。方法对 2005 年至 2020 年期间首次接受 EK 手术的 21 岁以上福氏内皮角膜营养不良症或假性角膜牛皮癣患者的 EK 移植进行全国性前瞻性登记研究。角膜内皮移植手术包括德斯米剥离内皮角膜成形术（DSEK）或德斯米膜内皮角膜成形术（DMEK）。主要结果是移植后 2 年的存活率。移植后 1 年的次要结果是：(1) 最佳矫正视力；(2) 为治疗移植物脱落而重复注射空气的需求；(3) 原发性移植物失败。结果对 11 516 例 EK 移植手术进行分析后发现，外科医生的学习对以下几个方面有显著影响：(1) 外科医生之前在该 EK 技术方面的经验的影响；(2) 外科医生之前在术后管理方面的经验的影响；(3) 从该 EK 技术在英国引入到手术时间的时间间隔。据报告，在最初 6 个月内失败的 EK 移植占所有移植失败的很大一部分。结论外科医生在 EK 方面的学习和经验不足对临床和统计意义的影响是可以量化的，并且会随着时间的推移而减弱。对于其他眼科专业的新型手术和手术培训，也可以进行类似的分析。培训计划和全国性咨询网络可能有助于缩短外科医生学习曲线的持续时间并减少其影响。如有合理要求，可提供相关数据。

{"title":"Influence of surgeon learning on outcomes in new ophthalmic procedures: quantified nationwide evidence in endothelial corneal transplantation","authors":"Shaminie Shanmugaranjan, Cathy Hopkinson, Lewis Downward, Daniel F P Larkin","doi":"10.1136/bjo-2024-325366","DOIUrl":"https://doi.org/10.1136/bjo-2024-325366","url":null,"abstract":"Aims To investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes. Methods A prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial corneal dystrophy or pseudophakic bullous keratopathy undergoing a first EK procedure in that eye between 2005 and 2020. EK procedures were either Descemet Stripping Endothelial Keratoplasty (DSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK). Primary outcome was transplant survival at 2 years. Secondary outcomes at 1-year post-transplant were (1) best-corrected visual acuity, (2) requirement for repeat air injection procedures to treat graft detachment and (3) iatrogenic primary graft failure. Results Following analysis of 11 516 EK transplants, significant impact of surgeon learning was indicated by (1) the influence of surgeon prior experience in that EK technique, (2) the influence of surgeon prior experience in postoperative management and (3) the time interval from introduction of that EK technique in the United Kingdom to time of surgery. EK grafts reported to have failed within the first 6 months were a significant proportion of all transplant failures. Conclusions Influence of surgeon learning and inexperience in EK of clinical and statistical significance can be quantified and diminishes over time. Equivalent analyses may be feasible for novel procedures in other ophthalmology specialties and surgical training. Training programmes and nationwide advisory networks may be helpful in reducing the duration and impact of surgeon learning curves. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"125 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490297","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

Traumatic Optic Neuropathy Treatment Trial 2 (TONTT-2): evaluating the efficacy of different doses of erythropoietin – a multicentre, randomised, double-blind clinical trial 创伤性视神经病变治疗试验 2（TONTT-2）：评估不同剂量促红细胞生成素的疗效--一项多中心、随机、双盲临床试验

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-26 DOI: 10.1136/bjo-2024-325828

Parya Abdolalizadeh, Mohsen Bahmani Kashkouli, Mahya Ghazizadeh, Farzad Pakdel, Mohammad Etezad Razavi, Marzieh Nojomi, Kaveh Abri Aghdam, Mostafa Soltan Sanjari, Nasser Karimi, Hossein Ghahvehchian, Mohammad Soleimani, Seyed Ali Tabatabaei

Aim The aim is to compare the efficacy and safety of three different weight-adjusted intravenous erythropoietin (EPO) doses in patients with indirect traumatic optic neuropathy (TON). Methods This study is a multicentre, randomised, parallel-group, double-blind, dose-finding trial on patients aged ≥7 years with a confirmed diagnosis of indirect TON in ≤3 weeks. The trial had a 3-day treatment period and a 3-month follow-up period. Patients were randomly allocated (1:1:1) to receive EPO at doses of 900 IU/kg (300 IU/kg/day), 1800 IU/kg (600 IU/kg/day) or 3600 IU/kg (600 IU/kg/day on presentation and then 1 month later) EPO. The changes in the best-corrected visual acuity (BCVA), colour vision and relative afferent pupillary defect (RAPD) were assessed. Results Out of 118 eligible patients, 95 were randomised and 93 (31 in each group) completed the follow-ups. Three groups were not different regarding baseline BCVA (p=0.66), colour vision (p=0.25) and RAPD (p=0.79). All three groups showed a significant improvement of BCVA and RAPD with no significant differences among the groups. Colour vision showed a significant improvement only in the group with 3600 IU/kg EPO (p=0.005), even though final colour vision was not significantly different between the groups (p=0.49). Initial vision of no light perception (OR=7.79 (95% CI: 2.98 to 20.36), p<0.001), older age (OR=4.76 (95% CI: 1.92 to 11.76), p<0.001), longer trauma-treatment interval (OR=2.72, 95% CI: 1.16 to 6.33, p=0.02) and posterior orbital fractures (OR=2.63 (95% CI: 1.13 to 6.13), p=0.02) led to a significantly worse visual recovery. Conclusion Increasing dose of EPO in patients with TON did not result in a better BCVA, colour vision and RAPD improvement. Trial registration number [NCT03308448][1]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03308448&atom=%2Fbjophthalmol%2Fearly%2F2024%2F10%2F25%2Fbjo-2024-325828.atom

目的比较三种不同体重调整剂量的静脉注射促红细胞生成素（EPO）对间接创伤性视神经病变（TON）患者的疗效和安全性。方法该研究是一项多中心、随机、平行组、双盲、剂量调查试验，对象是年龄≥7 岁、确诊间接性视神经病变时间≤3 周的患者。试验的治疗期为 3 天，随访期为 3 个月。患者被随机分配（1:1:1）接受900 IU/kg（300 IU/kg/天）、1800 IU/kg（600 IU/kg/天）或3600 IU/kg（发病时600 IU/kg/天，1个月后）剂量的EPO。对最佳矫正视力（BCVA）、色觉和相对传入瞳孔缺损（RAPD）的变化进行了评估。结果在 118 名符合条件的患者中，95 人被随机选中，93 人（每组 31 人）完成了随访。三组患者的基线视力（BCVA）（P=0.66）、色觉（P=0.25）和相对传入性瞳孔缺损（RAPD）（P=0.79）均无差异。所有三组的 BCVA 和 RAPD 均有明显改善，组间无明显差异。只有 EPO 3600 IU/kg 组的色觉有明显改善（p=0.005），尽管最终色觉在各组间无明显差异（p=0.49）。初始视力无光感（OR=7.79（95% CI：2.98 至 20.36），p<0.001）、年龄较大（OR=4.76（95% CI：1.92 至 11.76），p<0.001）、创伤治疗间隔时间较长（OR=2.72，95% CI：1.16 至 6.33，p=0.02）和眼眶后部骨折（OR=2.63（95% CI：1.13 至 6.13），p=0.02）导致视力恢复明显较差。结论对TON患者增加EPO剂量并不能改善BCVA、色觉和RAPD。试验注册号[NCT03308448][1]。如有合理要求，可提供相关数据。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03308448&atom=%2Fbjophthalmol%2Fearly%2F2024%2F10%2F25%2Fbjo-2024-325828.atom

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引用次数: 0

Learning new surgical techniques: are we doing it well? 学习新的外科技术：我们做得好吗？

IF 4.1 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-26 DOI: 10.1136/bjo-2024-326411

Gerard Reid, Augusto Azuara-Blanco

Shunmugaranjan et al report that surgical experience is strongly associated with better outcomes after endothelial transplantation.1 The authors used prospective national registry data from over 11 000 endothelial keratoplasties, including Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) to evaluate the impact of surgeon experience. The authors provide compelling evidence that surgical expertise is strongly associated graft survival at 2 years, primary graft failure and need for additional interventions for both DSAEK and DMEK. Visual acuity was better among experienced surgeons post DSEK/DSAEK. In medicine, learning curves were used in the 1980s to describe the uptake of new surgical skills for minimally invasive surgery.2 The ‘learning curve’ describes the fact that a learner’s performance and skills improve over time when the task is repeated. This improvement is quicker in the initial stages and then flattens with subsequent small improvements. In the context of surgical practice, the learning curve is associated with increased risk to patients during the study period when a surgeon is gaining …

Shunmugaranjan 等人报告说，手术经验与内皮移植后更好的疗效密切相关1。作者使用了超过 11000 例内皮角膜移植手术的前瞻性国家登记数据，包括 Descemet 剥脱（自动）内皮角膜移植术（DSEK/DSAEK）或 Descemet 膜内皮角膜移植术（DMEK），以评估外科医生经验的影响。作者提供了令人信服的证据，证明手术专业技能与 DSAEK 和 DMEK 的移植物 2 年存活率、初次移植物失败以及是否需要额外干预密切相关。DSEK/DSAEK术后，经验丰富的外科医生视力更好。在医学领域，学习曲线在 20 世纪 80 年代被用来描述微创手术中新手术技能的吸收情况2。2 "学习曲线 "描述了这样一个事实，即当学习者重复执行任务时，其表现和技能会随着时间的推移而提高。在外科手术实践中，学习曲线与外科医生在学习期间对病人的风险增加有关。

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引用次数: 0

Choroidal neovascularisation secondary toX-linked retinoschisis. 继发于 X 连锁视网膜裂孔症的脉络膜新生血管。

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-22 DOI: 10.1136/bjo-2023-324165

Linyan Zhang, Xinyu Liu, Limei Sun, Xiaodi Zhou, Shuya Ke, Xiaoyan Ding

Aims: Choroidal neovascularisation (CNV) in patients with X-linked retinoschisis (XLRS) has been poorly documented. This study aims to investigate the prevalence and clinical characteristics of CNV in patients with XLRS, as well as analyse the preliminary genotype-phenotype correlation.

Methods: A retrospective case series of patients with genetically confirmed XLRS was included. Demographic, clinical and genetic features were analysed, with a comparison between CNV and non-CNV eyes.

Results: Among 185 eyes of 129 patients with XLRS, the prevalence of CNV was 8.1% (15/185). The mean diagnostic age of all patients with CNV is 5.1±2.56 years. CNV eyes exhibited a mean best-corrected visual acuity (BCVA) (logarithm of the minimal angle of resolution) of 1.37±0.74. All CNVs were classified as subretinal and active. Peripapillary CNVs accounted for 80.0% (12/15), while subfoveal CNVs accounted for 20.0% (3/15). In CNV eyes, the prevalence of macular atrophy (5/15, 33.3%, p=0.013) and bullous peripheral schisis (14/15, 93.3%, p=0.000) was higher compared with non-CNV eyes. Additionally, CNV eyes exhibited poorer integrity of the outer retina and BCVA (p=0.007) compared with non-CNV eyes. All 15 eyes with CNV underwent anti-vascular endothelial growth factor (anti-VEGF) therapy. Genotype analysis revealed that 7 of 10 patients (70.0%, 10 eyes) were predicted to have missense variants, while 3 of 10 patients (30.0%, 5 eyes) exhibited severe variants.

Conclusions: The prevalence of CNV in XLRS eyes was found to be 8.1%. All CNVs secondary to XLRS were active and classified as type 2. CNV eyes demonstrated poorer visual function and compromised retinal structures. Anti-VEGF therapy demonstrated effectiveness in treating XLRS-CNVs. No significant genotype-phenotype correlation was established.

目的：关于X连锁视网膜裂孔症（XLRS）患者脉络膜新生血管（CNV）的文献很少。本研究旨在调查 XLRS 患者脉络膜新生血管的发病率和临床特征，并分析基因型与表型之间的初步相关性：方法：研究人员对经基因确诊的 XLRS 患者进行了回顾性病例系列研究。结果：129 名 XLRS 患者的 185 只眼睛中，有 129 只出现了 CNV：结果：在 129 名 XLRS 患者的 185 只眼睛中，CNV 患病率为 8.1%（15/185）。所有 CNV 患者的平均诊断年龄为（5.1±2.56）岁。CNV 眼的平均最佳矫正视力（BCVA）（最小分辨角的对数）为 1.37±0.74。所有 CNV 均被归类为视网膜下和活动性 CNV。毛细血管周围 CNV 占 80.0%（12/15），而眼底 CNV 占 20.0%（3/15）。与非 CNV 眼相比，CNV 眼黄斑萎缩（5/15，33.3%，p=0.013）和黄斑周边裂孔（14/15，93.3%，p=0.000）的发生率更高。此外，与非 CNV 眼相比，CNV 眼的视网膜外层和 BCVA 的完整性较差（p=0.007）。所有 15 只患有 CNV 的眼睛都接受了抗血管内皮生长因子（anti-VEGF）治疗。基因型分析显示，10名患者中有7名（70.0%，10只眼）被预测为存在错义变异，而10名患者中有3名（30.0%，5只眼）表现出严重变异：结论：XLRS眼球中CNV的发生率为8.1%。所有继发于 XLRS 的 CNV 都是活跃的，并被归类为 2 型。CNV眼的视觉功能较差，视网膜结构受损。抗血管内皮生长因子疗法对治疗XLRS-CNVs有效。基因型与表型之间没有明显的相关性。

{"title":"Choroidal neovascularisation secondary toX-linked retinoschisis.","authors":"Linyan Zhang, Xinyu Liu, Limei Sun, Xiaodi Zhou, Shuya Ke, Xiaoyan Ding","doi":"10.1136/bjo-2023-324165","DOIUrl":"10.1136/bjo-2023-324165","url":null,"abstract":"Aims: Choroidal neovascularisation (CNV) in patients with X-linked retinoschisis (XLRS) has been poorly documented. This study aims to investigate the prevalence and clinical characteristics of CNV in patients with XLRS, as well as analyse the preliminary genotype-phenotype correlation.Methods: A retrospective case series of patients with genetically confirmed XLRS was included. Demographic, clinical and genetic features were analysed, with a comparison between CNV and non-CNV eyes.Results: Among 185 eyes of 129 patients with XLRS, the prevalence of CNV was 8.1% (15/185). The mean diagnostic age of all patients with CNV is 5.1±2.56 years. CNV eyes exhibited a mean best-corrected visual acuity (BCVA) (logarithm of the minimal angle of resolution) of 1.37±0.74. All CNVs were classified as subretinal and active. Peripapillary CNVs accounted for 80.0% (12/15), while subfoveal CNVs accounted for 20.0% (3/15). In CNV eyes, the prevalence of macular atrophy (5/15, 33.3%, p=0.013) and bullous peripheral schisis (14/15, 93.3%, p=0.000) was higher compared with non-CNV eyes. Additionally, CNV eyes exhibited poorer integrity of the outer retina and BCVA (p=0.007) compared with non-CNV eyes. All 15 eyes with CNV underwent anti-vascular endothelial growth factor (anti-VEGF) therapy. Genotype analysis revealed that 7 of 10 patients (70.0%, 10 eyes) were predicted to have missense variants, while 3 of 10 patients (30.0%, 5 eyes) exhibited severe variants.Conclusions: The prevalence of CNV in XLRS eyes was found to be 8.1%. All CNVs secondary to XLRS were active and classified as type 2. CNV eyes demonstrated poorer visual function and compromised retinal structures. Anti-VEGF therapy demonstrated effectiveness in treating XLRS-CNVs. No significant genotype-phenotype correlation was established.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1564-1570"},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174480","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

Choriocapillaris flow features in children with myopic anisometropia. 近视性斜视儿童的绒毛膜血流特征

IF 3.7 2区医学 Q1 OPHTHALMOLOGY

British Journal of Ophthalmology

Pub Date : 2024-10-22 DOI: 10.1136/bjo-2022-323020

Zhihao Jiang, Wu Bo, Zhengfei Yang, Xiaoling Luo, Yao Ni, Junwen Zeng

Aims: To examine differences between the eyes in choriocapillaris perfusion and choroidal thickness in children with myopic anisometropia.

Methods: In this observational and prospective study, 46 children with myopic anisometropia were enrolled. Choriocapillaris perfusion parameters, including the percentage of flow voids, the total number of flow voids and the average flow void area were obtained by optical coherence tomography angiography (OCTA). The OCTA image was divided into a 1 mm-diameter central circle (C1) and a 2.5 mm-diameter annulus (without the inner central 1 mm circle, C1-2.5). Both C1 and C1-2.5 are centred on the foveola. The C1-2.5 was divided into nasal (N1-2.5), temporal (T1-2.5), inferior (I1-2.5) and superior (S1-2.5) areas. Differences in these parameters in different regions between eyes were analysed.

Results: There were no significant differences in the percentage of flow voids and the average flow void area between the fellow eyes. The total number of signal voids was significantly higher in the less myopic eyes in C1-2.5 (p=0.032), S1-2.5 (p=0.008) and N1-2.5 (p=0.019). Changes in spherical equivalent refraction and axial length were both correlated with the changes in the total number of flow voids in N1-2.5 (R=-0.431, p=0.03; R=-0.297, p=0.047).

Conclusions: The choroid in the macular region becomes thinner and the total number of flow voids in the nasal macular region decreased with the amplitude of myopia. This suggests that a decrease in total number of flow voids may indicate an early change in myopia.

目的：研究近视性斜视儿童双眼绒毛膜灌注和脉络膜厚度的差异：在这项观察性和前瞻性研究中，共招募了 46 名近视性斜视儿童。通过光学相干断层血管成像（OCTA）获得绒毛膜灌注参数，包括流空百分比、流空总数和平均流空面积。OCTA 图像分为直径为 1 毫米的中心圆（C1）和直径为 2.5 毫米的环面（不包括中心 1 毫米的内圆，C1-2.5）。C1 和 C1-2.5 都以眼窝为中心。C1-2.5 被分为鼻区（N1-2.5）、颞区（T1-2.5）、下区（I1-2.5）和上区（S1-2.5）。分析了这些参数在不同区域的差异：结果：两眼间的血流空洞百分比和平均血流空洞面积没有明显差异。近视度数较低的眼睛在 C1-2.5（p=0.032）、S1-2.5（p=0.008）和 N1-2.5 （p=0.019）的信号空洞总数明显较多。在 N1-2.5 中，球面等效屈光度和轴长的变化均与流空总数的变化相关（R=-0.431，p=0.03；R=-0.297，p=0.047）：结论：随着近视度数的增加，黄斑区的脉络膜变薄，鼻腔黄斑区的流动空洞总数减少。结论：黄斑区的脉络膜变薄，鼻腔黄斑区的流动空洞总数随近视幅度的增加而减少，这表明流动空洞总数的减少可能预示着近视的早期变化。

{"title":"Choriocapillaris flow features in children with myopic anisometropia.","authors":"Zhihao Jiang, Wu Bo, Zhengfei Yang, Xiaoling Luo, Yao Ni, Junwen Zeng","doi":"10.1136/bjo-2022-323020","DOIUrl":"10.1136/bjo-2022-323020","url":null,"abstract":"Aims: To examine differences between the eyes in choriocapillaris perfusion and choroidal thickness in children with myopic anisometropia.Methods: In this observational and prospective study, 46 children with myopic anisometropia were enrolled. Choriocapillaris perfusion parameters, including the percentage of flow voids, the total number of flow voids and the average flow void area were obtained by optical coherence tomography angiography (OCTA). The OCTA image was divided into a 1 mm-diameter central circle (C1) and a 2.5 mm-diameter annulus (without the inner central 1 mm circle, C1-2.5). Both C1 and C1-2.5 are centred on the foveola. The C1-2.5 was divided into nasal (N1-2.5), temporal (T1-2.5), inferior (I1-2.5) and superior (S1-2.5) areas. Differences in these parameters in different regions between eyes were analysed.Results: There were no significant differences in the percentage of flow voids and the average flow void area between the fellow eyes. The total number of signal voids was significantly higher in the less myopic eyes in C1-2.5 (p=0.032), S1-2.5 (p=0.008) and N1-2.5 (p=0.019). Changes in spherical equivalent refraction and axial length were both correlated with the changes in the total number of flow voids in N1-2.5 (R=-0.431, p=0.03; R=-0.297, p=0.047).Conclusions: The choroid in the macular region becomes thinner and the total number of flow voids in the nasal macular region decreased with the amplitude of myopia. This suggests that a decrease in total number of flow voids may indicate an early change in myopia.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1578-1582"},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288276","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