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

This study investigates the association between self-reported birth weight (BW) and the frequency of cataract and pseudophakia in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). Slit lamp examination and Scheimpflug imaging of 8205 participants, aged 35 to 74, were assessed and signs of cataract or pseudophakia analyzed. The research aimed to explore the correlation between fetal growth restriction and/or prematurity indicated by BW and the frequency of cataract and pseudophakia. In the univariable analysis, cataract was initially associated with low and high BW, but this association disappeared after adjusting for age, sex, examiner and cardiovascular risk factors. No association was found between low BW and pseudophakia or the frequency of cataract surgery within 5 years. The study reveals novel insights from a large population-based study specifically exploring this association.

Purpose: To assess real-world efficacy and safety of standalone travoprost intracameral implant (iDose TR) implantation by a US glaucoma surgeon in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT).

Methods: This non-randomized, retrospective, unmasked, consecutive case series included all cases of standalone iDose TR implantation from a single US glaucoma surgeon since the product's approval by the US Food and Drug Administration (FDA) in December 2023. Patients were pseudophakic, had OAG or OHT, and had undergone prior SLT and/or bimatoprost intracameral implant injection (Durysta). Intraocular pressure (IOP), medications, and adverse events were evaluated through 3 months postoperatively.

Results: All patients (n=65 eyes) were implanted with iDose TR and experienced no intraoperative complications. In the consistent cohort of eyes with 3-month follow-up data (n=54), mean IOP reduced from 19.6±3.8 mmHg preoperatively to 13.1±2.5 mmHg at 3 months (33.2% reduction, p=0.001). The percentage of eyes with IOP ≤15 mmHg increased from 11.1% preoperatively to 83.3% at 3 months (p=0.001). Mean number of IOP-reducing medications reduced from 0.28±0.71 preoperatively to 0.0±0.0 at 3 months (100% reduction; p=0.006). The percentage of eyes off topical medication increased from 85% preoperatively to 100% at 3 months. One eye was reported to have mild iritis at 1-2 weeks postoperatively, and was treated with a topical prednisolone acetate taper. No secondary procedures occurred in any eye.

Conclusion: Standalone implantation of the travoprost intracameral implant yielded statistically and clinically significant IOP and medication reductions through 3 months in eyes with prior SLT and/or bimatoprost intracameral implant injection with favorable safety.

Background: The Eyhance Toric intraocular lens (IOL) builds upon the Tecnis Toric platform, initially associated with considerable post-operative rotational instability. Version 2, the Eyhance Toric IOL has been modified to enhance rotational stability. This study evaluates the post-operative rotational stability of the Eyhance Toric IOL compared to the Clareon Toric IOL, recognized for its stable performance.

Methods: Patients undergoing cataract surgery received either the Eyhance or Clareon Toric IOLs. Placement was guided by the Barrett Toric Calculator at baseline (P0). IOL stability, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive astigmatism were assessed at 6-24 hours (P1) and 3 weeks to 6 months (P2) post-operatively. IOL rotational measurements were recorded at each interval.

Results: The study included 187 patients (median age: 74 for Clareon, 79 for Eyhance, p = 0.004). No significant differences were found in UDVA, CDVA, or refractive astigmatism at P2. Median rotation from P0 to P1 (3.0 vs 4.0 degrees, p = 0.091) and P0 to P2 (1.0 vs -0.5 degrees, p = 0.482) were not statistically different. However, the Clareon IOL showed less rotation between P1 and P2 (0.0 vs 1.0 degrees, p = 0.049). Absolute rotation from P0 to P1 (4.0 degrees), P1 to P2 (1.0 vs 2.0 degrees, p = 0.064), and P0 to P2 (4.0 vs 3.5 degrees, p = 0.095) were comparable.

Conclusion: The Eyhance Toric IOL demonstrated comparable rotational stability and visual outcomes to the Clareon Toric IOL. Modifications in the Eyhance design have successfully improved its rotational stability, positioning it as a viable alternative to the Clareon Toric IOL in clinical practice.

Purpose of review: Intimate partner violence (IPV) is a leading cause of death and disability across the world. We sought to investigate the prevalence and clinical presentation of ocular injuries in IPV.

Recent findings: Literature review revealed 16 published studies that evaluated ocular injuries in IPV, of which the study types included 9 retrospective studies, 2 prospective, 1 review, 1 invited commentary, 2 case reports, and 1 population-based cross-sectional survey. These studies suggest that 45% of IPV incidents involve ocular injury. Various injury types have been described including traumatic cataract, dislocated lens, retinal detachment, intraocular hemorrhage, orbital and zygomaticomaxillary complex fractures, optic nerve avulsion, and open globe injuries. Implementation of IPV screening programs in various clinical settings, including an emergency department evaluating ocular trauma, suggests a positive association with identification of IPV and improving access to resources.

Summary: Within IPV, ocular injuries are a prevalent and important cause of vision loss. Various injuries have been reported affecting nearly every anatomical region of the eye. Routine screening for IPV among patients that present with ocular injuries and evaluating for visual complaints among patients experiencing IPV are both important. Future work focused on prospective studies and evaluation of screening techniques may be impactful.

Objective: To assess the visual quality in patients with primary angle-closure glaucoma (PACG) complicated by cataracts after cataract phacoemulsification with intraocular lens (IOL) implantation and goniosynechialysis, and to explore the relationship between pupil size and visual quality.

Methods: A retrospective, non-randomized study was conducted, including 65 PACG patients (75 eyes) who underwent cataract surgery with IOL implantation and goniosynechialysis from July 2021 to June 2023, as well as a control group of cataract-only patients. Visual quality was evaluated using objective and subjective methods at least 3 months postoperatively. PACG patients were divided into large-pupil (≥5 mm) and normal-pupil (<5 mm) groups. Visual quality parameters were compared among groups, and correlations between pupil size and objective visual quality measures were analyzed.

Results: Visual Parameters: The large-pupil PACG group showed significantly higher higher-order aberrations, including coma and spherical aberrations, compared to both the cataract and normal-pupil groups. Contrast sensitivity was also worse in the large-pupil group. Visual Quality Questionnaire: The large-pupil group reported higher scores for night glare and difficulty driving at night. Correlations: Pupil size was positively correlated with higher-order aberrations and negatively correlated with contrast sensitivity.

Conclusion: Pupil dilation is a major factor affecting postoperative visual quality in PACG patients, even after surgery. Larger pupil size significantly increases higher-order aberrations and reduces contrast sensitivity. Techniques like pupil suturing may help improve visual quality in these patients.

Purpose: To assess the 12-month outcomes in subjects developing macular neovascularization (MNV) during intravitreal avacincaptad pegol (IVA) treatment for geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Methods: This research was conducted as a case-controlled, retrospective study of AMD subjects undergoing IVA treatment for GA from two private practice institutions. Subjects were divided into 1) a Study Group of patients who developed MNV and then underwent anti-vascular endothelial growth factor (VEGF) therapy during the study period, and 2) a Control Group of patients who were complication-free during the study period. Both cohorts had a baseline Snellen visual acuity of ≥ 20/200, a baseline GA total area of ≥ 1 mm²and ≤ 17.5 mm², and 12 months of follow-up after initiation of IVA for GA.

Results: There were 56 patients analyzed. There were no significant differences in baseline features between cohorts. The Study Group had a greater decrease in visual acuity [-0.22 logMAR (-0.27 to -0.17) versus -0.06 logMAR (-0.12 to 0.00); p=<0.0001], and greater GA total lesion growth [1.78 mm² (1.53-2.03) versus 0.78 mm² (0.54-1.02); p=<0.0001] during the 12-month study period compared to the Control Group.

Conclusion: Patients developing MNV while undergoing IVA treatment for GA secondary to AMD have worse clinical outcomes despite undergoing anti-VEGF therapy compared to patients who were complication-free at 12-months. This highlights the seriousness of MNV in this patient population and may help specialists counsel patients when considering treatment for GA secondary to AMD.

Purpose: To investigate the influence of systemic and serum measures and hypoglycemic medications on the initial presentation and ongoing development of diabetic retinopathy (DR) and diabetic macular edema (DME).

Design: Using Veterans Affairs electronic health records, we identified patients with a diabetes mellitus diagnosis and at least one eye examination between 1997 and 2010. After adjusting for sociodemographic factors, we used multivariable Cox regression models to evaluate the association of hemoglobin A1c (HbA1c) levels, blood pressure, albuminuria, blood urea nitrogen (BUN), and prescribed medications with the subsequent diagnosis of 1) any diabetic eye disease (defined for this analysis as DR and/or DME, 2) diabetic retinopathy, and 3) diabetic macular edema.

Results: Of 4089 diabetic Veteran patients, 821 (20%) were subsequently diagnosed with diabetic retinopathy and 88 (2%) had macular edema. Patients were more likely to receive a diabetic retinopathy diagnosis if they presented with HbA1c > 8.5 (HR=2.66, 95% CI 1.88-3.77, p<0.01), systolic blood pressure > 140 mmHg (HR=1.45, 95% CI 1.26-1.66, p<0.01), blood urea nitrogen (BUN) > 35 mg/dL (HR=2.17, 95% CI 1.60-2.93, p<0.01), and/or used insulin (HR=2.04, 95% CI 1.74-2.40, p<0.01). Patients were more likely to be diagnosed with diabetic macular edema if they had systolic blood pressure > 140 mmHg (HR=2.00, CI 1.29-3.08, p<0.01) and/or used insulin (HR=2.48, CI 1.53-4.03, p<0.01).

Conclusion: Markers of systemic health may be useful predictors for incident diabetic retinopathy or diabetic macular edema, evaluated collectively in Veteran patients. Higher HbA1c levels, systolic blood pressure, BUN levels, and insulin use (suggestive of more severe and/or long-standing diabetes) appear to be highly associated with the development of diabetic eye disease, and, in particular, diabetic retinopathy.

Purpose: To compare the meibographies and dry eye parameters of paretic vs non-paretic sides of patients with a facial palsy diagnosis.

Patients and methods: Twenty patients with unilateral facial palsy were recruited and the severity of the disease was staged using the House-Brackmann scale. A comprehensive dry eye evaluation was performed using the Oculus 5M Keratograph. A Pearson correlation coefficient was performed to determine correlation strength between House-Brackmann score and Meibomian gland atrophy. Meibographies were analyzed via ImageJ software to determine the affected area, and they were compared to the observer manual score. Cohen's Kappa coefficient was calculated to compare agreement between manual and ImageJ meibography scoring.

Results: Tear breakup time was reduced in the affected side (p = 0.21), tear meniscus height was much greater in the non-affected side (p = 0.02). Finally, Meibomian gland alterations were more evident in the affected side, with upper Meibomian glands having a loss of 29.55 ± 13.31% (p = 0.03) and lower glands presenting a loss of 44.44 ± 16.9% (p =< 0.001). Pearson correlation coefficient between House-Brackmann score and Meibomian gland atrophy was 0.841 (p < 0.001 [95% CI: 0.64-0.94]). Cohen's kappa coefficient was 0.643 (p < 0.001).

Conclusion: A clear difference in Meibomian gland and tear film dynamics can be observed in paretic vs non-paretic sides. A greater House-Brackmann score was correlated with a greater Meibomian gland atrophy area. A strong positive correlation is seen between the House-Brackmann score and Meibomian gland atrophy. Software-based analysis also showed a greater glandular area loss when compared to clinician's analysis. The level of agreement was moderate, so disparities are observed, especially in grade 2 Meibomian gland dropout where the least level of agreement was seen in cross tabulation. This study further incentivizes multimodal patient evaluation, which has been a growing area of interest in healthcare.

Purpose: To develop a comprehensively deep learning algorithm to differentiate between bacterial keratitis, fungal keratitis, non-infectious corneal lesions, and normal corneas.

Methods: This retrospective study collected slit-lamp photos of patients with bacterial keratitis, fungal keratitis, non-infectious corneal lesions, and normal cornea. Causative organisms of infectious keratitis were identified by either positive culture or clinical response to single treatment. Convolutional neural networks (ResNet50, DenseNet121, VGG19) and Ensemble with probability weighting were used to develop a deep learning algorithm. The performance including accuracy, precision, recall, F1 score, specificity and AUC has been reported.

Results: Total of 6478 photos from 2171 eyes, composed of 2400 bacterial keratitis, 1616 fungal keratitis, 1545 non-infectious corneal lesions, and 917 normal corneas were collected from hospital database. DenseNet121 demonstrated the best performance among three convolutional neural networks with the accuracy of 0.8 (95% CI 0.74-0.86). The ensemble technique showed higher performance than single algorithm with the accuracy of 0.83 (95% 0.78-0.88).

Conclusion: Convolutional neural networks with ensemble techniques provided the best performance in discriminating bacterial keratitis, fungal keratitis, non-infectious corneal lesions, and normal corneas. Our models can be used as a screening tool for non-ophthalmic health care providers and ophthalmologists for rapid provisional diagnosis of infectious keratitis.