Clinical ophthalmology (Auckland, N.Z.)最新文献

Purpose: To investigate early postoperative microvascular and structural changes in the macular and peripapillary regions after posterior chamber phakic intraocular lens (ICL) implantation in high myopia.

Patients and methods: This prospective cohort included 122 eyes of 61 patients with high myopia undergoing ICL implantation. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. Outcomes included corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), axial length (AL), macular and peripapillary vessel density parameters, retinal thickness, choroidal thickness (CT), and choroidal vascularity index (CVI), analyzed globally and by sector.

Results: At 3 months, SE and CDVA improved significantly (both P<0.05), while IOP remained stable (P>0.05). Global macular perfusion decreased, including total macular vessel density (MVD; Δ=-4.11, 95% CI -5.78 to -2.44; P<0.0001) and macular small-vessel density (MSmVD; Δ=-3.56, 95% CI -4.22 to -2.90; P<0.0001), with similar reductions across macular subregions. Layer-specific analysis showed reduced superficial vessel density (SVD; Δ=-3.61, 95% CI -4.51 to -2.70; P<0.0001), whereas deep vessel density (DVD) showed no significant global change (Δ=0.78, 95% CI -0.63 to 2.18; P=0.279), with regional heterogeneity. Peripapillary vessel density also decreased (OVD: Δ=-4.21, 95% CI -5.30 to -3.11; P<0.0001; OSmVD: Δ=-2.11, 95% CI -2.85 to -1.36; P<0.0001), with sectoral variation. AL was negatively correlated with several macular and peripapillary vascular parameters (all P<0.05). In an exploratory sub-analysis (32 patients, 64 eyes) with 2-year AL follow-up, mean AL change was not significant, but greater 3-month foveal CT reduction was associated with longer AL at 2 years (estimate=-0.003 mm/μm; P=0.008).

Conclusion: ICL implantation significantly improved visual and refractive outcomes and was accompanied by early macular and peripapillary microvascular and structural changes. Early postoperative CT changes may be associated with longer-term axial length outcomes.

Objective: To assess and compare the knowledge, attitudes, and practices (KAP) toward sustainability among ophthalmic surgeons and nurses, and to explore factors influencing the implementation of sustainable practices in eye-care delivery.

Design: Cross-sectional observational study.

Setting: Public and private hospitals and eye-care facilities across Saudi Arabia.

Participants: Licensed ophthalmic surgeons and nurses working in public and private hospital settings across Saudi Arabia.

Methods: An online questionnaire assessed sustainability-related KAP using binary and Likert-scale items. Scores were normalized to percentages and categorized as low, moderate, or high. Group differences were analyzed using independent t-tests and one-way ANOVA. Perceived barriers and institutional factors were explored descriptively and using Chi-square tests.

Main outcome measures: Knowledge, attitude, and practice scores related to sustainable behavior in ophthalmic care delivery.

Results: A total of 83 respondents were included in this study. Ophthalmic surgeons demonstrated significantly higher attitude scores toward sustainability compared with nurses (66.1% ± 7.5 vs 54.1% ± 9, p < 0.001), while nurses achieved higher knowledge scores (67.1% ± 16.8 vs 42.7% ± 17.1, p < 0.001). Practice scores were comparable between groups (p = 0.1). Attitude (p < 0.001) and practice (p < 0.001) scores varied significantly by hospital type, highlighting differences in institutional engagement with sustainable ophthalmic practices.

Conclusion: Sustainability-related knowledge, attitudes, and practices vary across professional roles and healthcare settings in ophthalmology. Addressing these gaps through targeted education, multidisciplinary collaboration, and institutional support may enhance the integration of sustainable practices into routine ophthalmic care and contribute to more efficient and environmentally responsible service delivery.

Traumatic submacular haemorrhage is a vision-threatening ocular emergency that can result in permanent visual loss if not treated promptly. Following blunt ocular trauma, rapid accumulation of blood beneath the macula leads to photoreceptor damage through iron-mediated oxidative stress, mechanical disruption, and impaired metabolic exchange. Pneumatic displacement, with or without intravitreal tissue plasminogen activator (tPA), has emerged as a minimally invasive therapeutic option; however, standardized clinical guidelines for its use in traumatic cases remain lacking. A narrative literature search was conducted across Scopus, Web of Science, Medline, Embase, PubMed, OpenAlex, and Dimensions up to November 24, 2025, supplemented by citation tracking. After duplicate removal and title/abstract screening, full-text assessment was performed based on predefined inclusion criteria focusing on traumatic submacular haemorrhage managed with pneumatic displacement. Of 177 identified records, four studies met the final eligibility criteria. The available evidence suggests that pneumatic displacement using intravitreal gas alone, most commonly 100% perfluoropropane (C₃F₈), achieved anatomical displacement in some cases but showed lower functional success, particularly in thick or dense haemorrhages. In contrast, intravitreal tPA combined with expansile gas was the most frequently employed minimally invasive approach and resulted in high rates of complete subfoveal blood displacement and clinically meaningful visual improvement, especially in younger patients. Pars plana vitrectomy with subretinal tPA was reserved for large or complex haemorrhages and produced favorable outcomes, albeit with higher surgical risk. Although the current evidence is limited, largely retrospective, and derived from small-sample studies, early treatment appears to be associated with favorable anatomical and functional outcomes. Intravitreal tPA combined with pneumatic displacement appears to be the most effective first-line therapy, while gas-only displacement may be considered when tPA is unavailable. Well-designed prospective studies with standardized outcome measures are needed to define optimal management strategies.

Purpose: Evaluate the safety and efficacy of ray tracing‒based LASIK surgery to correct myopia in eyes with and without astigmatism.

Patients and methods: This prospective study included adults with myopia up to -10.00 D, with or without astigmatism (NCT04219891). For each eye, a 3D virtual model and personalized ablation profile were developed using data from InnovEyes™ Sightmap and ray-tracing algorithm, followed by a wavelight plus LASIK treatment. Efficacy endpoints included percentage of eyes achieving manifest refraction spherical equivalent (MRSE) within 1.00 and 0.50 D of emmetropia at refractive stability and uncorrected distance visual acuity (UDVA) assessments. Follow-up was up to 12 months. Safety endpoints included percentage of eyes that lost ≥2 lines corrected distance visual acuity (CDVA) at refractive stability versus preoperative CDVA and non‒flap-related ocular serious adverse events (SAEs). Mean optical aberrations were assessed. Dry eye symptoms were evaluated using ocular surface disease index scores. Patient-reported outcomes were assessed using Patient-Reported Outcomes With LASIK questionnaire.

Results: A total of 163 patients (326 eyes) completed the study. Refractive stability was achieved at 3 months; during a 1- to 3-month interval, 99.4% of eyes had ≤1.00 D change in MRSE. MRSE within 0.50 and 1.00 D of emmetropia was achieved in 92.0% and 98.5% of eyes. At 12 months, 94.4% of eyes achieved UDVA of 20/20 or better. No eyes lost ≥2 lines of CDVA; no ocular SAEs or non-ocular adverse device effects were reported. Slight increase in coma (0.086 µm) and decrease in spherical aberration (-0.030 µm) were reported at 12 months. Dry eye symptoms improved after procedure (preoperative, 14.90±13.07; 12 months, 7.69±8.12). Postoperatively, 98% of patients reported being very/completely satisfied with their vision.

Conclusion: Ray tracing‒guided LASIK treatment was safe and effective for correcting myopia in individuals with and without astigmatism, producing stable visual outcomes and high satisfaction.

Introduction: Pediatric cataracts are a significant cause of vision loss in children and may present in isolation or in association with other ocular or systemic diseases. Despite advances in molecular diagnostics, the underlying etiology of cataracts in most patients remains unknown, even in the setting of a positive family history. Genetic testing for pediatric cataracts is neither standardized nor widely utilized. Lack of standardization is multifold, including limited published clinical and experimental reports and the absence of a comprehensive list of candidate genes with grading of the strength of gene-disease relationships.

Areas covered: The purpose of this review is to provide a comprehensive list of the 81 candidate genes potentially associated with non-syndromic pediatric cataracts and the accompanying case-based and experimental literature support in order to start the process of developing a standardized approach to genetic testing. Inheritance patterns, other associated ocular findings, and proposed mechanisms of pathogenesis will be described for the candidate genes. Genes that are associated with two distinct phenotypes, one syndromic and one characterized by non-syndromic cataracts, will also be presented. The types of cataracts and age of onset are often highly variable at both the gene and variant level, so they will not be the focus of this review, but are of interest for future studies.

Future work: Future work is needed to formalize a standardized list of established and candidate genes for non-syndromic pediatric cataracts and to systematically grade our confidence in the gene-disease relationships through the ClinGen framework. An improvement in genetic testing for pediatric cataracts will improve clinical care of these patients and their families regarding prognostication, personalized medical management, and clarification of recurrence risk for reproductive decision making. Further, a better understanding of the pathogenesis of pediatric cataracts can lead to targets for novel treatment development.

Purpose: Evaluate postoperative astigmatic outcomes in eyes implanted with an ultra-low cylinder powered toric (ULPT) intraocular lens (IOL) compared with a non-toric IOL for the surgical management of astigmatism in cataract surgery.

Patients and methods: This is a retrospective, controlled consecutive case series from 3 Canadian ophthalmology centers. Cases were included if they were adults (≥18 years), qualified for the 0.90D toric based on the Barrett Toric Calculator without "flipping" the axis of astigmatism by 0.2D or more, and underwent surgery either with the enVista Toric 0.9 D IOL (ULPT, Bausch + Lomb) or enVista Non-toric (spherical). All surgeries were performed using standard phacoemulsification and IOL implantation under topical anesthesia with 2.0 to 2.2-mm biplanar square clear corneal incision at 190° for OD and 10° for OS. The mean±SD incision angle was 94.0±89.70° for the ULPT group and 103.0±89.37° for the non-toric group. Primary effectiveness endpoint was the mean reduction in cylindrical power of the eye. Other endpoints were manifest refraction, keratometry, visual acuity, IOL axis, and safety.

Results: 290 screened patient charts were enrolled and included 383 eyes (192 eyes with the ULPT IOL and 191 eyes with the non-toric IOL). The mean reduction in cylindrical power was 0.432±0.447 D in the Toric 0.9 D IOL group and 0.071±0.407 D in the Non-toric group, with the mean difference (0.351 D) in favor of the ULPT IOL (P<0.0001). Significantly more of the ULPT group than the Non-toric group had plano outcomes or had a cumulative residual cylinder within 0.25 D, 0.50 D, and 0.75 D of plano (P≤0.001 for all). There were no serious AEs reported in patient charts.

Conclusion: The ULPT IOL was safe and effective for eyes with low to ultra-low preoperative astigmatism and resulted in significantly greater reduction in postoperative manifest cylinder compared to the monofocal IOL.

Purpose: To evaluate the difference in degrees between a digital marker and a manual marker as measured intraoperatively.

Methods: This was a prospective, single-site, comparative, observational study. Preoperative biometry and planning was assessed with the Argos SS-OCT biometer. All subjects received both digital and conventional marking. The ToriCAM application was used to mark the patient manually at the bedside. A Mendez marker was used to mark the final axis of the IOL, as calculated by Argos. Digital marking was performed using the VERION image guided system. The primary outcome measure was the difference in degrees between the digital marker and the manual marker as measured intraoperatively. Other outcome measures included IOL rotation, residual astigmatism, absolute prediction error (APE), and monocular visual acuity at 2 months postoperatively.

Results: A total of 41 eyes of 41 subjects completed the study. At 2 months postoperatively, the absolute difference in degrees between intraoperative digital and manual marking was 6.6 ± 5.2 (range 0.0 to 22.5). Mean absolute IOL rotation in degrees was 3.5 ± 2.9 (range 0.3 to 14.8) at 2 months. Mean postoperative residual astigmatism was 0.24 ± 0.24 D, and mean APE (spherical equivalent) was 0.39 ± 0.27 D. Mean monocular corrected distance visual acuity was 0.02 ± 0.05 logMAR.

Conclusion: Results suggest good postoperative refractive accuracy was achieved using Argos combined with a digital marker microscope. The manual marking was significantly misaligned when compared to the intended digital marking axis, which may cause significant postoperative residual astigmatism.

Objective: To evaluate the clinical efficacy and safety of shallow lamellar keratectomy combined with total conjunctival flap coverage and subsequent customized prosthetic shell fitting for the management of atrophic, silicone oil-filled eyes following severe open globe injury.

Methods: This retrospective case series included 24 patients (24 eyes) with phthisical, silicone oil-dependent eyes after open globe injury repair between October 2010 and May 2020. All patients underwent shallow lamellar keratectomy to remove diseased corneal tissue, followed by total conjunctival flap coverage. A customized prosthetic shell was fitted approximately one month postoperatively after confirmed flap healing. Outcome measures included corneal symptom relief assessed by the Numeric Rating Scale (NRS), palpebral fissure height, exophthalmometry, cosmetic satisfaction rated on a 5-point scale, and postoperative complications.

Results: The mean postoperative follow-up duration was 4.75 ± 2.51 years. All patients achieved complete resolution of pain and foreign body sensation (postoperative NRS=0 for all; preoperative median: 2.00 [IQR: 1.75-3.00] vs postoperative median: 0.00 [IQR: 0.00-0.00], P=0.001). Ocular protrusion increased significantly from a preoperative median of 7.00 mm (IQR: 6.00-8.00 mm) to 12.00 mm (IQR: 10.00-13.00 mm) postoperatively (P=0.001). Lid height increased from a preoperative median of 3.00 mm (IQR: 2.75-4.00 mm) to 10.00 mm (IQR: 8.00-11.25 mm) postoperatively (P=0.001). Patient satisfaction with ocular appearance improved markedly from a preoperative median of 1.00 (IQR: 1.00-1.25) to 5.00 (IQR: 4.75-5.00) postoperatively (P=0.001). Two eyes developed limbal epithelial implantation cysts, which were successfully managed without recurrence. Cranial CT revealed no silicone oil migration or sympathetic ophthalmia.

Conclusion: This globe-preserving technique effectively alleviates corneal irritation and restores ocular symmetry in atrophic, silicone oil-filled eyes, offering a safe, cost-effective, and satisfactory conservative alternative to enucleation or evisceration. Further prospective studies with longer follow-up are warranted.

Purpose: To evaluate the hard nuclear cataract surgery outcomes by comparing the combined burst mode and continuous torsional mode conducted of Centurion Vision System.

Methods: Prospective comparative cohort study. Based on the Emery-Little classification, this study assigned cataract patients with nuclear density grade III to V into two groups: the combined mode group (Group A) and the torsional mode group (Group B). Endothelial cell density (ECD), central corneal thickness (CCT), and best-corrected distance visual acuity (BCVA) were evaluated at different time intervals, including 1 day, 1 week, 1 month, and 3 months.

Results: 207 patients: 100 in the group A and 107 in the group B. Patients in group A with severe nuclei experienced lower cumulative dissipated energy (p = 0.007) and shorter ultrasound time (p < 0.001). Both groups exhibited a decrease in ECD after surgery, but the decrease was comparatively lower among group A patients with severe nuclei (p < 0.05). There was a notable increase in the CCT in both groups at the 1-day and 1-week time points compared to the baseline values (p < 0.001). Changes in CCT were significantly greater in group B at 1-day (p < 0.001), 1-week (p = 0.002), and 1-month (p = 0.004) intervals among patients with severe nuclei.

Conclusion: Burst torsional combined with longitudinal ultrasound can be more effective for harder nuclei phacoemulsification than the continuous torsional ultrasound.

Trial registration: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Fudan University's Eye & ENT Hospital. This study was registered as a clinical trial (number: NCT06991374).

Background: Optical coherence tomography (OCT) is essential for the management of retinal disease. Digitalization is a potential means of optimizing work practices and improving confidence in treatment decisions. This study compared digital and print/analog image review workflows for OCT images of eyes that underwent intravitreal injection (IVI).

Methods: This pilot study was an observer based workflow comparison study. Ten retinal specialists evaluated the OCT image sets of 30 eyes that had undergone IVI treatment. Each reviewer then rendered a simulated treatment decision (treat or not treat) for the most recent image of each set. The amount of time utilized by each specialist to review an image set or image review time (RT), self-rated decision confidence level, and ease-of-use ratings for digital and analog workflows were compared. Inter- and intra-rater variability was determined using exploratory analyses.

Results: The mean RT for print and digital workflows were 55.5 ± 37.2 and 28.6 ± 16.5 seconds, respectively (p = 0.007). The use of digital workflow reduced the mean RT by 48.5%. Stratified by disease chronicity, the digital workflow reduced the mean RT for acute, intermediate, and chronic patients by 35.2, 40.2%, and 59.6%, respectively. Treatment decision confidence levels and ease-of-use ratings were significantly higher when using digital workflows than print workflows. The inter-rater reliability was fair to moderate.

Conclusion: Digital image review workflows resulted in a shorter RT, higher treatment decision confidence, and enhanced ease of use. Digital workflows may optimize OCT image review efficiency, while also improving decision-making confidence. Gains in RT efficiency were correlated with disease chronicity.