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

Purpose: This study aims to explore the diagnostic utility of ultrasound B-scan while introducing the "Triangle" sign as a novel indicator. It also validates the sign's efficacy in distinguishing between choroidal detachment (CD) and suprachoroidal hemorrhage (SCH) from retinal detachment (RD) and vitreous hemorrhage (VH).

Patients and methods: Retrospective analysis of consecutive cases of total CD and SCH undergoing B-scan at a single tertiary imaging center. The study examined the presence of the "Triangle" sign (a hypoechoic/anechoic triangular shape of vitreous noted anterior to the optic disc) in total CD & SCH, categorized cases by subtype and etiology, and its role in differentiating from RD and VH.

Results: Thirty-six eyes with a total CD and SCH were analyzed. Amongst the cases of total SCH 31 (86.1%), (58.1%) were linked to intraocular surgery, and (41.9%) were linked to post-traumatic events. The "Triangle" sign was consistently present in all 36 eyes, with additional findings indicating concurrent VH (52.8%) or RD (5.6%). Among the 31 eyes with total SCH, 58.3% initially had detectable choroidal membrane seen on B scan, while 41.7% did not. Despite this, the "Triangle" sign was consistently visible in all 36 eyes, and monitoring with B-scans revealed choroidal membrane as the hemorrhage resolved.

Conclusion: The "Triangle" sign is a distinctive and reliable ultrasound feature for total CD and SCH diagnosis, offering clarity in challenging cases where traditional methods face limitations.

Purpose: To assess the diagnostic capability of pattern electroretinography (PERG) and varying circumpapillary optical coherence tomography (OCT) scan diameters in glaucoma suspects (GS).

Methods: This is a prospective, cross-sectional study. Circumpapillary retinal nerve fiber layer thickness (RNFLT) was measured using spectral domain OCT in 49 eyes from 26 patients (36 normal, 13 GS) in three circle diameters (3.5, 4.1, and 4.7 mm). PERG measurements (Magnitude [Mag], MagnitudeD [MagD], MagnitudeD/Magnitude [MagD/Mag] ratio) were used. Based on clinical examination, participants were classified as controls or GS. Independent t-test and areas under the receiver operating characteristic curve (AUC) were obtained to determine the diagnostic capability of PERG and OCT.

Results: Independent t-test revealed significant differences between controls and GS in age, sex, central corneal thickness (CCT), all PERG parameters, and global RNFLT (gRNFLT) in three circle diameters. All PERG parameters were correlated to all RNFLT sectors (r > 0.291; p < 0.041), except in the temporal and nasal sectors of the three circle scans. Spearman rho was highest in 3.5 and lowest in 4.7 mm circle scan. AUC demonstrated 3.5 mm gRNFLT had the highest diagnostic capability (AUC = 0.877), followed by 4.1 mm gRNFLT (AUC = 0.852), and 4.7 mm gRNFLT (AUC = 0.821). MagD showed the foremost diagnostic capability (AUC = 0.81), followed by Mag (AUC = 0.799) and MagD/Mag (AUC = 0.762).

Conclusion: Global, superior, and inferior RNFLT in 3.5 and 4.1 mm diameters, and MagD performed best in discriminating GS from controls, suggesting that a larger scan of 4.1 mm may be equally useful in glaucoma diagnosis as the conventional 3.5 mm diameter. We recommend using PERG with OCT of 3.5 or 4.1 mm diameters for glaucoma suspect diagnosis.

Purpose: The corneal epithelium is the outermost layer of the cornea. It plays a vital role in both normal and pathological conditions of the eye surface and serves as a protective layer. This study aimed to evaluate corneal epithelial thickness (ET) and create a normative database of corneal ET for pediatric and adult age groups using MS-39 AS-OCT.

Patients and methods: This is a cross-sectional multi-center study conducted among the Saudi population.

Results: A total of 268 eyes of 268 patients were analyzed (male 50.7% vs female 49.3%). 53.8% were pediatric age group. Higher mean values of central, paracentral, and peripheral were associated with the adult age group except for superior paracentral, temporal peripheral, and nasal peripheral. Male patients had higher mean values of central, paracentral, and peripheral in each quadrant, except for inferior peripheral. There was a significant correlation between inferior, superior, nasal, and temporal in both paracentral and peripheral. No significant correlations were observed between the spherical equivalent and epithelial thickness map.

Conclusion: The study found sex differences, with females generally having lower ET values than males, and older age having higher values than children.

Purpose: To determine the effect on intraocular pressure (IOP) of switching to a once-daily netarsudil/latanoprost fixed dose combination (FDC) from various topical treatment regimens including latanoprost monotherapy or latanoprost combined with other IOP-lowering agents for the treatment of open-angle glaucoma or ocular hypertension.

Methods: A total of 136 participants enrolled. Eligible participants were aged ≥18 years and had a current diagnosis of open-angle glaucoma or ocular hypertension. Additional inclusion criteria were current treatment regimens with latanoprost monotherapy, latanoprost plus 1 additional IOP-lowering agent, or latanoprost plus 2 agents; current IOP-lowering regimen stable for ≥30 days prior to baseline visit; treated morning IOP ≥20 mmHg at baseline visit; and best corrected visual acuity (BCVA) of 20/100 or better in both eyes. Regardless of their initial regimens, all participants stopped their IOP-lowering medication(s) and were switched directly to netarsudil/latanoprost FDC alone.

Results: Participants experienced substantial reductions in IOP. At week 12, the mean percent change from baseline in IOP was -18.5% (SD 18.96) in the overall study population and was similar in the latanoprost monotherapy group (-21.2% [SD 17.46]), the latanoprost +1 agent group (-15.7% [SD 21.91]), and the latanoprost +2 agents group (-16.9% [SD 17.31]). Less than one-third of participants (31.6%) experienced any ocular adverse event or an ocular adverse event related to treatment (27.2%). The most common ocular adverse event was conjunctival hyperemia (18.4%). Most ocular adverse events were mild, and two severe ocular adverse events of hyperemia (1.5%) were reported; no serious ocular adverse events were reported.

Conclusion: In this study, additional IOP lowering was achievable when patients switched to netarsudil/latanoprost FDC after treatment with latanoprost alone or latanoprost with 1 or 2 additional agents. The once-daily administration of netarsudil/latanoprost FDC and reduced treatment burden for those on latanoprost combined with additional agents may prove more manageable for patients.

Purpose: To evaluate the 2-year outcomes of resveratrol oral supplement given as an adjunctive treatment in patients with wet age-related macular degeneration (AMD) that were treated with intravitreal injections of aflibercept.

Patients and methods: In our retrospective study, 50 treatment-naïve patients suffering from wet-AMD were included. They were assigned to two subgroups of 25 patients each. Every participant was treated according to "Pro Re Nata" protocol; 3 monthly intravitreal injections of 2.0 mg aflibercept were applied followed by injections according to need. The patients in the second group also consumed daily two tablets of resveratrol enriched oral supplement (60 mg of resveratrol in total). For 2 years, the patients were monthly assessed with best corrected visual acuity (BCVA) measurement, fundus autofluorescence, optical coherence tomography (OCT) scans and OCT-angiography. The main endpoints were the change of BCVA, the number of anti-VEGF injections, the change of central foveal thickness values, and the expansion or new development of fibrosis.

Results: Between the studied groups, no significant differences were detected in the baseline demographic and clinical data (p>0.05 for all). Over the 24-month study period, both BCVA and central foveal thickness values did not differ significantly between the two groups. As for the number of applied injections, they were significantly fewer in the group of patients that were treated with the resveratrol supplement (9.32±1.37 vs 7.40±1.88, p<0.001). Notably, the frequency of fibrosis progression was significantly lower in the resveratrol group (p=0.04).

Conclusion: In conclusion, our findings suggest that resveratrol oral supplement could be considered as a useful adjunctive aid to the established treatment in cases suffering from wet AMD, highlighting the superiority of the combination treatment regimen, since it was accompanied by lower rates of both intravitreal aflibercept injections and progression of macular fibrosis.

Purpose: To understand patient experiences using the iCare HOME tonometer through assessing ease of use, device usage patterns, proficiency, and patient comments.

Methods: We conducted a prospective survey-based cohort study of 19 patients (35 eyes) with glaucoma or glaucoma suspect diagnoses. Patients received training on home tonometer usage and were loaned the device for one week to measure intraocular pressure at home multiple times daily. Participants completed a journal and survey at the end of the study period.

Results: On average, participants measured intraocular pressure ≥4 times per eye each day (4.19±1.54 OD and 4.06±1.41 OS). Most found the home tonometer moderately or very easy to use (75% total, 31% and 44% respectively) and would be happy to use the device in the future (94%). The home tonometer was deemed comfortable to use (94%). Most participants were able to use the device without assistance from another person (88%). Many felt that they became proficient at using the home tonometer (94%) and proficiency was achieved typically by day 3 of usage. Patient comments provided insight into sources of difficulty in usage and motivations for home tonometry.

Conclusion: Home tonometry was easy to use and comfortable for most patients with proficiency in usage quickly achieved by day 3. Surveying patient perspectives revealed sources of difficulties in home tonometer usage. Patients were eager to obtain home intraocular pressure measurements that could help with disease management.

Purpose: To evaluate visual outcomes and quality of vision following bilateral implantation of a hydrophobic acrylic intraocular lens (IOL) in eyes targeted for emmetropia.

Methods: This was a prospective, single arm study. Subjects were bilaterally implanted with the Clareon PanOptix IOL and evaluated at 1 and 3 months postoperatively. Endpoints included binocular uncorrected and distance-corrected visual acuities at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60 cm), and near (UNVA, DCNVA; 40 cm, 33 cm), defocus curve, manifest refraction, and administration of a visual disturbance questionnaire (QUVID) and a satisfaction questionnaire (IOLSAT).

Results: A total of 24 subjects (48 eyes) completed the study. Mean postoperative binocular CDVA, DCIVA (60 cm), DCNVA (40 cm), and DCNVA (33 cm) were -0.04 ± 0.08 logMAR, -0.08 ± 0.10 logMAR, 0.01 ± 0.10 logMAR, and 0.04 ± 0.11 logMAR, respectively. Mean postoperative binocular UDVA, UIVA (60 cm), UNVA (40 cm), and UNVA (33 cm) were 0.02 ± 0.19 logMAR, -0.08 ± 0.09 logMAR, 0.04 ± 0.12 logMAR, and 0.08 ± 0.15 logMAR, respectively. Overall, postoperative spectacle independence at distance, intermediate, and near were 100%, 93%, and 73%, respectively. A total of 9%, 12%, and 0% of subjects were bothered "quite a bit" or "very much" by halos, starburst, and glare, respectively.

Conclusion: The results of this study suggest that bilateral implantation with the Clareon PanOptix can achieve excellent visual outcomes, high spectacle independence, and low reports of bothersome dysphotopsia.

Purpose: To correlate the optical coherence tomography (OCT) based morphological patterns of diabetic macular edema (DME) and prognostic biomarkers with severity of anaemia in patients with diabetic kidney disease (DKD).

Patients and methods: Single centre, observational cross sectional study of 42 eyes of 42 patients with DME and DKD. Eyes were divided into 2 groups: Group A (Haemoglobin level above 10 g% and group B with haemoglobin less than 10 g%). The OCT pattern and biomarkers were compared between the two groups.

Results: Mean age of the patients was 56.9 ± 8.1 (range 42-79). Out of 42 participants, 22 patients had hemoglobin level more than 10g%(group A) while 20 patients had hemoglobin less than 10g%(Group B). The most common morphological pattern seen was combination of cystoid macular edema (CME) with diffuse retinal thickening (DRT) in both groups. Disruption of the external limiting membrane (ELM) and ellipsoid zone (EZ) was found to be associated with lower hemoglobin levels (p= 0.0155 and p= 0.0154 respectively). None of the other OCT biomarkers showed correlation with hemoglobin levels.

Conclusion: CME with DRT is the most common morphological pattern of macular edema seen in DKD patients with anemia. ELM-EZ disruption can be considered as important biomarker of anaemia in patients with DKD.

Purpose: Among patients with angle-closure glaucoma, it is common to have a short-axial eye, which also makes it difficult to select an appropriate intraocular lens. Previous studies have focused on the ocular biometry of the long-axial eye, whereas only a few reports have focused on the short-axial eye. This study aimed to clarify the characteristics of the short-axial eye on ocular biometry among the elderly Japanese.

Patients and methods: This retrospective cross-sectional study included 142 patients who consulted at our hospital. The ocular axial length (AL), central corneal thickness (CCT), average anterior corneal radius of curvature (CR), white-to-white (WTW), anterior chamber depth (ACD), and lens thickness (LT) were measured using OA-2000. The short-axial and normal-axial groups (short-axial [SA] and normal-axial [NA] groups) included those with an AL less than 22.5 mm and ranging from 22.5-26.5 mm, respectively. Comparisons between groups were analyzed using the Wilcoxon rank sum test. Spearman's rank correlation coefficient tests and multiple regression analyses were performed for all parameters overall and per group.

Results: The parameters that were significantly different between the SA and NA groups were CR, WTW, and ACD (all P < 0.0001). In the SA group (42 patients), only ACD was significantly correlated with AL (r = 0.33, P = 0.031). On multiple regression analysis for the SA group, none of the parameters had a significant effect on AL (all P > 0.05).

Conclusion: In the SA group, ACD was the only factor that positively correlated with AL; it was significantly shallower than in the NA group. Thus, in the SA eye, it is clinically important to be aware of ACD.

Purpose: To evaluate the efficacy and safety of the Paul Glaucoma Implant (PGI) surgery in patients with secondary glaucomas.

Patients and methods: Retrospective chart review of adult patients with medically recalcitrant secondary glaucoma who underwent PGI implantation at a single tertiary center between August 2022 and June 2023. The primary outcome measure was surgical success. Surgical success was defined as intraocular pressure (IOP) between 6 and 21 mmHg with a ≥20% reduction compared to baseline (with or without medications) with no need for implant removal, further glaucoma reoperation, or development of vision-threatening complications at 1 year of follow-up. The secondary outcomes were IOP, glaucoma medication numbers, visual acuity, and surgical complications.

Results: Thirty eyes of 30 patients were identified. Nine patients (30%) had neovascular glaucoma, and 9 patients (30%) had silicone-oil-induced glaucoma. At 12 months postoperatively, 28 eyes (93.3%) fulfilled the success criteria. The mean IOP at 12 months was 15.2 ± 4.6 mmHg compared to the mean baseline IOP of 32.6 ± 10 mmHg (p < 0.001). A significant reduction in the mean number of glaucoma medications at 12 months compared to the baseline was observed. The complication rate was 13.3% (4 eyes), with most complications being mild and transient.

Conclusion: The PGI demonstrated favorable efficacy and safety profiles in the management of medically uncontrolled secondary glaucomas.