Background: To assess predictive value of short-term choroidal changes for future myopic shift in children.
Methods: 577 eyes of 289 primary school children were prospectively followed for 2 years. Cycloplegic refractions at baseline, 1 year and 2 years, and choroidal measurements by optical coherence tomography at baseline and 3 months, were used for analyses. Myopic shift was defined as refraction change of at least -0.50 dioptre/year, at 2 years compared with baseline.
Results: 228 participants (455 eyes) completed 2-year follow-up. Approximately 37.6% of 311 initially non-myopic eyes and 73.6% of 144 initially myopic eyes developed a myopic shift. Notably, at 3 months greater reductions were found in initially myopic eyes with myopic shift, than in those without myopic shift-in choroidal thickness (ChT), luminal area (LA), stromal area (SA) and total choroidal area (TCA), but no significant differences in any choroidal parameters were observed between non-myopic eyes, with and without myopic shift. Multivariable analyses showed that in myopic eyes, each percentage increase in ChT, LA, SA and TCA was associated with reduced odds of myopic shift (all p<0.001). Similar associations were observed in non-myopic eyes, with smaller effects than in myopic eyes. Adding a 3-month percentage change of each choroidal parameter to a basic model including age, gender, parental myopia and baseline refraction significantly improved the predictive performance in myopic eyes (area under the receiver operating characteristic curves increasing from 0.650 to approximately 0.800, all p<0.05), but not in non-myopic eyes.
Conclusion: Short-term choroidal changes could act as early indicators for future myopic shift in children.
{"title":"Short-term choroidal changes as early indicators for future myopic shift in primary school children: results of a 2-year cohort study.","authors":"Hao Wu, Mengqi Liu, Yuanyuan Wang, Xiang Li, Weihe Zhou, Haoer Li, Zhu Xie, Pengqi Wang, Tingting Zhang, Wei Qu, Jing Huang, Yunpeng Zhao, Jiefang Wang, Sen Zhang, Jia Qu, Cong Ye, Xiangtian Zhou","doi":"10.1136/bjo-2024-325871","DOIUrl":"https://doi.org/10.1136/bjo-2024-325871","url":null,"abstract":"<p><strong>Background: </strong>To assess predictive value of short-term choroidal changes for future myopic shift in children.</p><p><strong>Methods: </strong>577 eyes of 289 primary school children were prospectively followed for 2 years. Cycloplegic refractions at baseline, 1 year and 2 years, and choroidal measurements by optical coherence tomography at baseline and 3 months, were used for analyses. Myopic shift was defined as refraction change of at least -0.50 dioptre/year, at 2 years compared with baseline.</p><p><strong>Results: </strong>228 participants (455 eyes) completed 2-year follow-up. Approximately 37.6% of 311 initially non-myopic eyes and 73.6% of 144 initially myopic eyes developed a myopic shift. Notably, at 3 months greater reductions were found in initially myopic eyes with myopic shift, than in those without myopic shift-in choroidal thickness (ChT), luminal area (LA), stromal area (SA) and total choroidal area (TCA), but no significant differences in any choroidal parameters were observed between non-myopic eyes, with and without myopic shift. Multivariable analyses showed that in myopic eyes, each percentage increase in ChT, LA, SA and TCA was associated with reduced odds of myopic shift (all p<0.001). Similar associations were observed in non-myopic eyes, with smaller effects than in myopic eyes. Adding a 3-month percentage change of each choroidal parameter to a basic model including age, gender, parental myopia and baseline refraction significantly improved the predictive performance in myopic eyes (area under the receiver operating characteristic curves increasing from 0.650 to approximately 0.800, all p<0.05), but not in non-myopic eyes.</p><p><strong>Conclusion: </strong>Short-term choroidal changes could act as early indicators for future myopic shift in children.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124885","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}
High-risk factors for intraoperative zonular complications due to pre-existing zonular dehiscence in eyes with pseudoexfoliation syndrome were poor mydriasis, a shallow anterior chamber, and large lens decentration, emphasising the importance of preoperative assessment of these clinical parameters. Ocular inflammatory events following COVID-19 vaccination are rare, the most commonly reported phenotype being anterior uveitis. Lower corneal hysteresis was significantly associated with the presence of glaucoma, primary open angle glaucoma and exfoliation glaucoma in a general Japanese population. Corneal hysteresis provides additional information for elucidating the aetiology of glaucoma. Advanced glaucoma is the major risk factor for lifetime blindness. This study presents evidence that surgery is a cost-effective strategy compared with medical treatment in patients with advanced glaucoma over the patient’s lifetime. This post hoc analysis showed a trend for loss of vision gains in patients with macular oedema due to retinal vein occlusion …
{"title":"At a glance","authors":"Frank Larkin","doi":"10.1136/bjo-2024-326260","DOIUrl":"https://doi.org/10.1136/bjo-2024-326260","url":null,"abstract":"High-risk factors for intraoperative zonular complications due to pre-existing zonular dehiscence in eyes with pseudoexfoliation syndrome were poor mydriasis, a shallow anterior chamber, and large lens decentration, emphasising the importance of preoperative assessment of these clinical parameters. Ocular inflammatory events following COVID-19 vaccination are rare, the most commonly reported phenotype being anterior uveitis. Lower corneal hysteresis was significantly associated with the presence of glaucoma, primary open angle glaucoma and exfoliation glaucoma in a general Japanese population. Corneal hysteresis provides additional information for elucidating the aetiology of glaucoma. Advanced glaucoma is the major risk factor for lifetime blindness. This study presents evidence that surgery is a cost-effective strategy compared with medical treatment in patients with advanced glaucoma over the patient’s lifetime. This post hoc analysis showed a trend for loss of vision gains in patients with macular oedema due to retinal vein occlusion …","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021959","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}
Elin Bohman, Johanna Berggren, Olof Neumann, Rafi Sheikh, Malin Malmsjö
Background/aims It is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test which may be affected by the pooling of tears behind the prosthesis. In this study, direct imaging of the lacrimal gland has been performed to measure tear secretion in anophthalmic sockets. The relation between the area of meibomian glands and dry eye symptoms was also assessed. Methods 12 patients were included. The amount of tear secretion was measured by direct imaging of the lacrimal gland while the presence of meibomian glands was determined using meibography. The 5-item Dry Eye Questionnaire was used to assess symptoms of dry eye. Results No difference was found in tear secretion between the anophthalmic socket and the contralateral eye. The area of meibomian glands was significantly reduced in eyelids on the side of the prosthetic eye, compared with the contralateral eye. Seven patients reported symptoms indicative of dry eye in the anophthalmic socket, compared with only two in the contralateral eye. Conclusions The effects of an eye prosthesis on meibomian glands may contribute to the frequently perceived symptoms of dry eye despite unaffected in tear secretion. All data relevant to the study are included in the article.
{"title":"Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye","authors":"Elin Bohman, Johanna Berggren, Olof Neumann, Rafi Sheikh, Malin Malmsjö","doi":"10.1136/bjo-2024-325777","DOIUrl":"https://doi.org/10.1136/bjo-2024-325777","url":null,"abstract":"Background/aims It is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test which may be affected by the pooling of tears behind the prosthesis. In this study, direct imaging of the lacrimal gland has been performed to measure tear secretion in anophthalmic sockets. The relation between the area of meibomian glands and dry eye symptoms was also assessed. Methods 12 patients were included. The amount of tear secretion was measured by direct imaging of the lacrimal gland while the presence of meibomian glands was determined using meibography. The 5-item Dry Eye Questionnaire was used to assess symptoms of dry eye. Results No difference was found in tear secretion between the anophthalmic socket and the contralateral eye. The area of meibomian glands was significantly reduced in eyelids on the side of the prosthetic eye, compared with the contralateral eye. Seven patients reported symptoms indicative of dry eye in the anophthalmic socket, compared with only two in the contralateral eye. Conclusions The effects of an eye prosthesis on meibomian glands may contribute to the frequently perceived symptoms of dry eye despite unaffected in tear secretion. All data relevant to the study are included in the article.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100746","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}
Natalia Porporato, Benjamin Y Xu, Bingyao Tan, Yu Q Chang, Tin A Tun, Shamira Perera, Rahat Husain, Ching Lin Ho, Rehena Sultana, Tin Aung, Leopold Schmetterer
Aim To evaluate reproducibility and agreement of angle closure assessment by a novel hyperparallel optical coherence tomography (OCT) system (HP-OCT, Cylite Optics, Melbourne, Australia), in comparison with swept-source OCT (SS-OCT, CASIA SS-1000, Tomey Corporation, Nagoya, Japan) and gonioscopy. Methods Cross-sectional study. Phakic subjects >40 years, with no relevant ophthalmic history were consecutively recruited from the glaucoma clinic. Subjects underwent same-day evaluation with HP-OCT, SS-OCT and gonioscopy. The primary outcome was the presence of angle closure, defined as iridotrabecular contact in HP-OCT and SS-OCT images at 0°−180° meridional and as non-visibility of the posterior trabecular meshwork (TM) by gonioscopy. Visibility of TM was also assessed (secondary outcome). Intra and interdevice agreement analysis (Gwet AC1) and logistic regression analysis were performed for primary and secondary outcomes, respectively. Results 154 sectors from horizontal scans of 77 subjects were analysed. The reproducibility of angle closure assessment by HP-OCT was excellent (AC1 of 0.95 for temporal angle and 1.00 for nasal). Agreement for angle closure detection was very good between HP-OCT and SS-OCT (AC1 of 0.88 for temporal and 0.81 for nasal angle) and good between HP-OCT and gonioscopy (AC1 of 0.71 for temporal and 0.78 for nasal angle). TM was identifiable in 64.4% (94/146) of unprocessed HP-OCT images (both open and closed angles), however not visible in any of the SS-OCT unprocessed images. Conclusions HP-OCT showed excellent reproducibility for angle closure assessment and good agreement with SS-OCT and gonioscopy. HP-OCT technology also provides a unique capability to visualise regions around TM and Schlemm’s canal, opening new avenues for clinical research of distal outflow pathways. Data are available upon reasonable request.
{"title":"Novel hyperparallel optical coherence tomography for angle closure assessment: comparison with swept-source OCT and gonioscopy","authors":"Natalia Porporato, Benjamin Y Xu, Bingyao Tan, Yu Q Chang, Tin A Tun, Shamira Perera, Rahat Husain, Ching Lin Ho, Rehena Sultana, Tin Aung, Leopold Schmetterer","doi":"10.1136/bjo-2023-323429","DOIUrl":"https://doi.org/10.1136/bjo-2023-323429","url":null,"abstract":"Aim To evaluate reproducibility and agreement of angle closure assessment by a novel hyperparallel optical coherence tomography (OCT) system (HP-OCT, Cylite Optics, Melbourne, Australia), in comparison with swept-source OCT (SS-OCT, CASIA SS-1000, Tomey Corporation, Nagoya, Japan) and gonioscopy. Methods Cross-sectional study. Phakic subjects >40 years, with no relevant ophthalmic history were consecutively recruited from the glaucoma clinic. Subjects underwent same-day evaluation with HP-OCT, SS-OCT and gonioscopy. The primary outcome was the presence of angle closure, defined as iridotrabecular contact in HP-OCT and SS-OCT images at 0°−180° meridional and as non-visibility of the posterior trabecular meshwork (TM) by gonioscopy. Visibility of TM was also assessed (secondary outcome). Intra and interdevice agreement analysis (Gwet AC1) and logistic regression analysis were performed for primary and secondary outcomes, respectively. Results 154 sectors from horizontal scans of 77 subjects were analysed. The reproducibility of angle closure assessment by HP-OCT was excellent (AC1 of 0.95 for temporal angle and 1.00 for nasal). Agreement for angle closure detection was very good between HP-OCT and SS-OCT (AC1 of 0.88 for temporal and 0.81 for nasal angle) and good between HP-OCT and gonioscopy (AC1 of 0.71 for temporal and 0.78 for nasal angle). TM was identifiable in 64.4% (94/146) of unprocessed HP-OCT images (both open and closed angles), however not visible in any of the SS-OCT unprocessed images. Conclusions HP-OCT showed excellent reproducibility for angle closure assessment and good agreement with SS-OCT and gonioscopy. HP-OCT technology also provides a unique capability to visualise regions around TM and Schlemm’s canal, opening new avenues for clinical research of distal outflow pathways. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142101945","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}
Jingyuan Wang, Runhan Shi, Qihua Le, Kun Shan, Zhi Chen, Xujiao Zhou, Yao He, Jiaxu Hong
Aims To evaluate the quality of responses from large language models (LLMs) to patient-generated conjunctivitis questions. Methods A two-phase, cross-sectional study was conducted at the Eye and ENT Hospital of Fudan University. In phase 1, four LLMs (GPT-4, Qwen, Baichuan 2 and PaLM 2) responded to 22 frequently asked conjunctivitis questions. Six expert ophthalmologists assessed these responses using a 5-point Likert scale for correctness, completeness, readability, helpfulness and safety, supplemented by objective readability analysis. Phase 2 involved 30 conjunctivitis patients who interacted with GPT-4 or Qwen, evaluating the LLM-generated responses based on satisfaction, humanisation, professionalism and the same dimensions except for correctness from phase 1. Three ophthalmologists assessed responses using phase 1 criteria, allowing for a comparative analysis between medical and patient evaluations, probing the study’s practical significance. Results In phase 1, GPT-4 excelled across all metrics, particularly in correctness (4.39±0.76), completeness (4.31±0.96) and readability (4.65±0.59) while Qwen showed similarly strong performance in helpfulness (4.37±0.93) and safety (4.25±1.03). Baichuan 2 and PaLM 2 were effective but trailed behind GPT-4 and Qwen. The objective readability analysis revealed GPT-4’s responses as the most detailed, with PaLM 2’s being the most succinct. Phase 2 demonstrated GPT-4 and Qwen’s robust performance, with high satisfaction levels and consistent evaluations from both patients and professionals. Conclusions Our study showed LLMs effectively improve patient education in conjunctivitis. These models showed considerable promise in real-world patient interactions. Despite encouraging results, further refinement, particularly in personalisation and handling complex inquiries, is essential prior to the clinical integration of these LLMs. All data relevant to the study are included in the article or uploaded as online supplemental information.
{"title":"Evaluating the effectiveness of large language models in patient education for conjunctivitis","authors":"Jingyuan Wang, Runhan Shi, Qihua Le, Kun Shan, Zhi Chen, Xujiao Zhou, Yao He, Jiaxu Hong","doi":"10.1136/bjo-2024-325599","DOIUrl":"https://doi.org/10.1136/bjo-2024-325599","url":null,"abstract":"Aims To evaluate the quality of responses from large language models (LLMs) to patient-generated conjunctivitis questions. Methods A two-phase, cross-sectional study was conducted at the Eye and ENT Hospital of Fudan University. In phase 1, four LLMs (GPT-4, Qwen, Baichuan 2 and PaLM 2) responded to 22 frequently asked conjunctivitis questions. Six expert ophthalmologists assessed these responses using a 5-point Likert scale for correctness, completeness, readability, helpfulness and safety, supplemented by objective readability analysis. Phase 2 involved 30 conjunctivitis patients who interacted with GPT-4 or Qwen, evaluating the LLM-generated responses based on satisfaction, humanisation, professionalism and the same dimensions except for correctness from phase 1. Three ophthalmologists assessed responses using phase 1 criteria, allowing for a comparative analysis between medical and patient evaluations, probing the study’s practical significance. Results In phase 1, GPT-4 excelled across all metrics, particularly in correctness (4.39±0.76), completeness (4.31±0.96) and readability (4.65±0.59) while Qwen showed similarly strong performance in helpfulness (4.37±0.93) and safety (4.25±1.03). Baichuan 2 and PaLM 2 were effective but trailed behind GPT-4 and Qwen. The objective readability analysis revealed GPT-4’s responses as the most detailed, with PaLM 2’s being the most succinct. Phase 2 demonstrated GPT-4 and Qwen’s robust performance, with high satisfaction levels and consistent evaluations from both patients and professionals. Conclusions Our study showed LLMs effectively improve patient education in conjunctivitis. These models showed considerable promise in real-world patient interactions. Despite encouraging results, further refinement, particularly in personalisation and handling complex inquiries, is essential prior to the clinical integration of these LLMs. 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":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100879","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}
The recent publication by Lucchino et al reports on preoperative predictive factors for big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in keratoconus eyes.1 In a total of 140 eyes of 140 patients, the authors observed successful pneumatic dissection in 98 eyes (70.0%), with 94 type 1 BB (67.1%) and 4 type 2 BB (2.9%). The study provides topographic evidence for a higher BB success rate among earlier stages of keratoconus, as characterised by lower K-max, lower K-mean, higher corneal thickness at the thinnest point and lower difference in peripheral-minimal corneal thickness. Moreover, the anterior segment-optical coherence tomography (AS-OCT) classification2 was found to be the only factor that predicted BB formation, with mild to moderate keratoconus eyes, particularly those with no posterior stromal scars, demonstrating a greater likelihood of undergoing successful BB creation. DALK is widely accepted as a preferred type of keratoplasty for anterior stromal pathologies such as keratoconus or scars.3 4 While achieving similar visual recovery …
{"title":"Big bubble formation in deep anterior lamellar keratoplasty may be more successful in early keratoconus eyes","authors":"Hyeck-Soo Son, Uri Soiberman","doi":"10.1136/bjo-2024-326213","DOIUrl":"https://doi.org/10.1136/bjo-2024-326213","url":null,"abstract":"The recent publication by Lucchino et al reports on preoperative predictive factors for big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in keratoconus eyes.1 In a total of 140 eyes of 140 patients, the authors observed successful pneumatic dissection in 98 eyes (70.0%), with 94 type 1 BB (67.1%) and 4 type 2 BB (2.9%). The study provides topographic evidence for a higher BB success rate among earlier stages of keratoconus, as characterised by lower K-max, lower K-mean, higher corneal thickness at the thinnest point and lower difference in peripheral-minimal corneal thickness. Moreover, the anterior segment-optical coherence tomography (AS-OCT) classification2 was found to be the only factor that predicted BB formation, with mild to moderate keratoconus eyes, particularly those with no posterior stromal scars, demonstrating a greater likelihood of undergoing successful BB creation. DALK is widely accepted as a preferred type of keratoplasty for anterior stromal pathologies such as keratoconus or scars.3 4 While achieving similar visual recovery …","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089974","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}
Luca Lucchino, Giacomo Visioli, Fabio Scarinci, Rossella A M Colabelli Gisoldi, Chiara Komaiha, Marco Marenco, Giulio Pocobelli, Alessandro Lambiase, Augusto Pocobelli
Purpose To identify preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with keratoconus (KC). Design Retrospective cohort study in an Italian tertiary centre. Study population Consecutive patients with KC undergoing DALK from January 2021 to July 2023. Observation procedure Tomographic and topographic data including K-max, K-mean, keratometric astigmatism, thinnest point, mean peripheral corneal thickness, difference between the mean peripheral corneal thickness and the thinnest point (peripheral-minimal corneal thickness), position (central/paracentral) and cone area (%), Amsler-Krumeich classification and anterior segment optical coherence tomography (AS-OCT) analysis to assess the severity stage. Main outcome measures Rate of BB formation and type; multivariate logistic regression analysis was used to analyse all preoperative parameters in patients with BB formation versus failure. Results Pneumatic dissection succeeded in 98 of 140 eyes (70.0%), with 94 type 1 bubbles (67.1%) and four type 2 bubbles (2.9%). BB formation succeeded more frequently in patients with lower K-max (p=0.032), lower K-mean (p=0.010), higher thinnest point (p=0.017), lower peripheral-minimal corneal thickness (p=0.009) and lower Amsler-Krumeich stages (p=0.021). According to the AS-OCT analysis, BB formation was more frequent in the lower stages (p<0.001). After the logistic regression (pseudo-R²=0.176, constant=3.21, 95% CI 1.14 to 5.29, p=0.002), AS-OCT classification was found to be the only factor that predicted BB formation (coefficient=−0.81, 95% CI −1.18 to −0.43, p<0.001). Conclusions AS-OCT classification is a reliable predictor for BB formation. Tomographic and topographic analyses indicated that a steeper and more ectatic cornea is more prone to BB failure. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Tomographic and topographic predictive factors of big bubble formation during deep anterior lamellar keratoplasty in keratoconus","authors":"Luca Lucchino, Giacomo Visioli, Fabio Scarinci, Rossella A M Colabelli Gisoldi, Chiara Komaiha, Marco Marenco, Giulio Pocobelli, Alessandro Lambiase, Augusto Pocobelli","doi":"10.1136/bjo-2024-325810","DOIUrl":"https://doi.org/10.1136/bjo-2024-325810","url":null,"abstract":"Purpose To identify preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with keratoconus (KC). Design Retrospective cohort study in an Italian tertiary centre. Study population Consecutive patients with KC undergoing DALK from January 2021 to July 2023. Observation procedure Tomographic and topographic data including K-max, K-mean, keratometric astigmatism, thinnest point, mean peripheral corneal thickness, difference between the mean peripheral corneal thickness and the thinnest point (peripheral-minimal corneal thickness), position (central/paracentral) and cone area (%), Amsler-Krumeich classification and anterior segment optical coherence tomography (AS-OCT) analysis to assess the severity stage. Main outcome measures Rate of BB formation and type; multivariate logistic regression analysis was used to analyse all preoperative parameters in patients with BB formation versus failure. Results Pneumatic dissection succeeded in 98 of 140 eyes (70.0%), with 94 type 1 bubbles (67.1%) and four type 2 bubbles (2.9%). BB formation succeeded more frequently in patients with lower K-max (p=0.032), lower K-mean (p=0.010), higher thinnest point (p=0.017), lower peripheral-minimal corneal thickness (p=0.009) and lower Amsler-Krumeich stages (p=0.021). According to the AS-OCT analysis, BB formation was more frequent in the lower stages (p<0.001). After the logistic regression (pseudo-R²=0.176, constant=3.21, 95% CI 1.14 to 5.29, p=0.002), AS-OCT classification was found to be the only factor that predicted BB formation (coefficient=−0.81, 95% CI −1.18 to −0.43, p<0.001). Conclusions AS-OCT classification is a reliable predictor for BB formation. Tomographic and topographic analyses indicated that a steeper and more ectatic cornea is more prone to BB failure. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089973","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}
Purpose To evaluate the longitudinal rate of choriocapillaris flow deficits (CFD) in healthy participants and patients with diabetes mellitus. Methods This prospective cohort study included healthy individuals and diabetic patients without diabetic retinopathy (non-DR) or with mild-to-moderate non-proliferative DR (NPDR). The swept-source optical coherence tomography angiography (OCTA) was adopted for quantifying CFD annually, and linear mixed models were used to analyse the CFD change and its 95% CI overtime. Results A total of 1025 individuals were included, including 465 healthy controls, 454 in the non-DR group and 106 in the NPDR group. Significant increase in CFDs was observed in NPDR group (0.423%, 95% CI 0.230% to 0.616%) and non-DR group (0.319%, 95% CI 0.225% to 0.412%), which were higher than the CFD in healthy controls (0.173%, 95% CI 0.079% to 0.266%). After adjusting for other factors, the non-DR and NPDR group had a greater annual elevation of CFD by 0.171% (95% CI 0.060% to 0.283%; p=0.003) and 0.258% (95% CI 0.068% to 0.449%; p=0.008) in comparisons with controls. Furthermore, higher serum creatinine and glycated haemoglobin levels, poorer best-corrected visual acuity, lower OCTA image quality scores and smaller CFD at baseline were independently related to accelerated CFD worsening (all p<0.05). Conclusions The CFD among healthy individuals and patients with diabetes increased consistently overtime, regardless of the presence or absence of DR, suggesting that CFD alterations could be an early indicator of microvascular complications, potentially aiding in the earlier DR detection. All data relevant to the study are included in the article or uploaded as online supplemental information.
目的 评估健康人和糖尿病患者绒毛膜血流缺损（CFD）的纵向比率。方法 这项前瞻性队列研究包括健康人和无糖尿病视网膜病变（非 DR）或轻度至中度非增殖性 DR（NPDR）的糖尿病患者。采用扫源光学相干断层血管造影（OCTA）量化每年的CFD，并使用线性混合模型分析CFD变化及其95% CI超时。结果 共纳入了 1025 人，其中包括 465 名健康对照组、454 名非复发性视网膜病变组和 106 名复发性视网膜病变组。在 NPDR 组（0.423%，95% CI 0.230% 至 0.616%）和非 NPDR 组（0.319%，95% CI 0.225% 至 0.412%）观察到 CFD 显著增加，高于健康对照组的 CFD（0.173%，95% CI 0.079% 至 0.266%）。调整其他因素后，与对照组相比，非DR 和 NPDR 组的 CFD 年升高幅度更大，分别为 0.171% (95% CI 0.060% to 0.283%; p=0.003) 和 0.258% (95% CI 0.068% to 0.449%; p=0.008)。此外，较高的血清肌酐和糖化血红蛋白水平、较差的最佳矫正视力、较低的 OCTA 图像质量评分和基线较小的 CFD 都与 CFD 的加速恶化有独立关系（均 p<0.05）。结论 无论是否存在DR，健康人和糖尿病患者的CFD都会随着时间的推移而增加，这表明CFD的改变可能是微血管并发症的早期指标，有助于更早地发现DR。与该研究相关的所有数据均包含在文章中或作为在线补充信息上传。
{"title":"Trajectories of choriocapillaris perfusion in healthy individuals and patients with diabetes mellitus: a prospective cohort study","authors":"Xiaoying Zhong, Shaopeng Yang, Ziyu Zhu, Huangdong Li, Weijing Cheng, Wei Wang","doi":"10.1136/bjo-2024-325515","DOIUrl":"https://doi.org/10.1136/bjo-2024-325515","url":null,"abstract":"Purpose To evaluate the longitudinal rate of choriocapillaris flow deficits (CFD) in healthy participants and patients with diabetes mellitus. Methods This prospective cohort study included healthy individuals and diabetic patients without diabetic retinopathy (non-DR) or with mild-to-moderate non-proliferative DR (NPDR). The swept-source optical coherence tomography angiography (OCTA) was adopted for quantifying CFD annually, and linear mixed models were used to analyse the CFD change and its 95% CI overtime. Results A total of 1025 individuals were included, including 465 healthy controls, 454 in the non-DR group and 106 in the NPDR group. Significant increase in CFDs was observed in NPDR group (0.423%, 95% CI 0.230% to 0.616%) and non-DR group (0.319%, 95% CI 0.225% to 0.412%), which were higher than the CFD in healthy controls (0.173%, 95% CI 0.079% to 0.266%). After adjusting for other factors, the non-DR and NPDR group had a greater annual elevation of CFD by 0.171% (95% CI 0.060% to 0.283%; p=0.003) and 0.258% (95% CI 0.068% to 0.449%; p=0.008) in comparisons with controls. Furthermore, higher serum creatinine and glycated haemoglobin levels, poorer best-corrected visual acuity, lower OCTA image quality scores and smaller CFD at baseline were independently related to accelerated CFD worsening (all p<0.05). Conclusions The CFD among healthy individuals and patients with diabetes increased consistently overtime, regardless of the presence or absence of DR, suggesting that CFD alterations could be an early indicator of microvascular complications, potentially aiding in the earlier DR detection. 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":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142090144","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}
Tatiana R Rosenblatt, Carolina A Chiou, Michael K Yoon, Nahyoung Grace Lee, Natalie Wolkow, Suzanne K Freitag
Prior studies of teprotumumab for thyroid eye disease report proptosis reduction in millimetres, which does not fully capture teprotumumab’s clinical effect since a given number of millimetres change can be of variable impact depending on patients’ degree of pre-treatment proptosis. In this retrospective study analysing proptosis change as a percentage of pre-treatment proptosis among 119 patients, 208 (87.4%) eyes of 110 patients had proptosis reduction averaging 14.4% (range 2.2–40.5%) of their pre-treatment proptosis, or 3.3 mm (range 0.5–10.0 mm). Reporting proptosis reduction as a percentage of pre-treatment proptosis provides a better understanding of teprotumumab’s clinical impact.
{"title":"Percent reduction in proptosis after teprotumumab treatment for thyroid eye disease","authors":"Tatiana R Rosenblatt, Carolina A Chiou, Michael K Yoon, Nahyoung Grace Lee, Natalie Wolkow, Suzanne K Freitag","doi":"10.1136/bjo-2024-325527","DOIUrl":"https://doi.org/10.1136/bjo-2024-325527","url":null,"abstract":"Prior studies of teprotumumab for thyroid eye disease report proptosis reduction in millimetres, which does not fully capture teprotumumab’s clinical effect since a given number of millimetres change can be of variable impact depending on patients’ degree of pre-treatment proptosis. In this retrospective study analysing proptosis change as a percentage of pre-treatment proptosis among 119 patients, 208 (87.4%) eyes of 110 patients had proptosis reduction averaging 14.4% (range 2.2–40.5%) of their pre-treatment proptosis, or 3.3 mm (range 0.5–10.0 mm). Reporting proptosis reduction as a percentage of pre-treatment proptosis provides a better understanding of teprotumumab’s clinical impact.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050604","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}
Aims To construct and validate an optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) image model for predicting the occurrence of short-term vitreous haemorrhage (VH) in polypoidal choroidal vasculopathy (PCV) patients. Methods We retrospectively collected clinical and imaging information from patients diagnosed with PCV at Peking Union Medical College Hospital, Beijing, China, between January 2015 and October 2022. Six different screening strategies, including univariate analysis, multivariate analysis, least absolute shrinkage and selection operator, stepwise logistic regression, random forest and clinical-data-only approach, were used to select variables and build models. The nomogram was constructed based on the model with the best area under the curve (AUC) and was evaluated using receiver operating characteristic curves, calibration curves, decision curve analysis and clinical impact curves. Results A total of 147 PCV patients were included and randomly divided into a training set (103 patients) and a validation set (44 patients), with an average follow-up time of 17.56±14.99 months. The optimal model that achieved higher AUC in both training and validation sets incorporated seven significant variables identified through univariate analysis: male [OR=2.76, p=0.022], central macular thickness [OR=1.003, p=0.002], the presence of haemorrhagic pigment epithelial detachment (HPED) [OR=6.99, p<0.001], the height of HPED [OR=1.002, p<0.001], the area of HPED [OR=1.16, p<0.001], the presence of multiple PEDs [OR=2.94, p=0.016] and the presence of subretinal haemorrhage [OR=3.11, p=0.011]. A predictive nomogram based on these variables yielded an AUC of 0.896 (95% CI 0.827 to 0.965) in the training set and 0.861 (95% CI 0.749 to 0.973) in the validation set, demonstrating good calibration and clinical usefulness. Conclusion The proposed OCT/OCTA-based image nomogram, as a novel and non-invasive tool, achieved satisfactory prediction of VH secondary to PCV. Data are available upon reasonable request. All data are available within the manuscript and upon request to the corresponding author.
{"title":"Development and validation of optical coherence tomography (OCT) and OCT angiography prediction model for short-term vitreous haemorrhage secondary to polypoidal choroidal vasculopathy","authors":"Shiyu Cheng, Xinyu Zhao, Qing Zhao, Lihui Meng, Youxin Chen","doi":"10.1136/bjo-2024-325246","DOIUrl":"https://doi.org/10.1136/bjo-2024-325246","url":null,"abstract":"Aims To construct and validate an optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) image model for predicting the occurrence of short-term vitreous haemorrhage (VH) in polypoidal choroidal vasculopathy (PCV) patients. Methods We retrospectively collected clinical and imaging information from patients diagnosed with PCV at Peking Union Medical College Hospital, Beijing, China, between January 2015 and October 2022. Six different screening strategies, including univariate analysis, multivariate analysis, least absolute shrinkage and selection operator, stepwise logistic regression, random forest and clinical-data-only approach, were used to select variables and build models. The nomogram was constructed based on the model with the best area under the curve (AUC) and was evaluated using receiver operating characteristic curves, calibration curves, decision curve analysis and clinical impact curves. Results A total of 147 PCV patients were included and randomly divided into a training set (103 patients) and a validation set (44 patients), with an average follow-up time of 17.56±14.99 months. The optimal model that achieved higher AUC in both training and validation sets incorporated seven significant variables identified through univariate analysis: male [OR=2.76, p=0.022], central macular thickness [OR=1.003, p=0.002], the presence of haemorrhagic pigment epithelial detachment (HPED) [OR=6.99, p<0.001], the height of HPED [OR=1.002, p<0.001], the area of HPED [OR=1.16, p<0.001], the presence of multiple PEDs [OR=2.94, p=0.016] and the presence of subretinal haemorrhage [OR=3.11, p=0.011]. A predictive nomogram based on these variables yielded an AUC of 0.896 (95% CI 0.827 to 0.965) in the training set and 0.861 (95% CI 0.749 to 0.973) in the validation set, demonstrating good calibration and clinical usefulness. Conclusion The proposed OCT/OCTA-based image nomogram, as a novel and non-invasive tool, achieved satisfactory prediction of VH secondary to PCV. Data are available upon reasonable request. All data are available within the manuscript and upon request to the corresponding author.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142045561","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号