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

Objective: To compare the visual outcomes, safety, and patient-reported outcomes of ISBCS versus DSBCS in adults undergoing cataract surgery.

Evidence review: A systematic search of PubMed, Embase, CENTRAL, Web of Science, and gray literature (conference abstracts, registries) was conducted for studies published up to March 2023. Eligible studies directly compared ISBCS and DSBCS in adults, reporting best corrected visual acuity (BCVA), complications, or patient-reported outcomes. Two reviewers independently screened studies, extracted data, and resolved discrepancies by consensus.

Findings: Nine studies were included (3 randomized controlled trials, 5 retrospective cohorts, 1 review), encompassing sample sizes ranging from 298 patients to over 496,000 eyes. Both ISBCS and DSBCS resulted in significant improvements in BCVA, with comparable refractive accuracy. No significant differences were observed in serious complications such as endophthalmitis, cystoid macular edema, or posterior capsular rupture. Some studies reported a trend toward slightly higher patient satisfaction and faster rehabilitation in the ISBCS group.

Conclusions and relevance: ISBCS appears to be a safe and effective alternative to DSBCS in carefully selected patients, offering potential benefits in efficiency, recovery time, and patient satisfaction. Rigorous randomized controlled trials with standardized outcome measures and long-term follow-up are needed to further validate these findings.

The B vitamins are a varied family whose members are integral to metabolic pathways and cellular processes throughout the body. Unlike vitamins A, C, and E, the B complex has generally not been considered among the key ingredients of supplements intended to maintain eye health and prevent age-related disease and vision loss. This perspective may be shifting with the emergence of 3 elements: (1) a greater understanding of the pathogenic mechanisms involved in conditions such as age-related macular degeneration, diabetic retinopathy, glaucoma, cataracts, dry eye disease, and other ocular surface disorders; (2) observational studies linking B vitamins to risk of eye disease development or progression; and (3) preclinical and clinical evidence supporting supplementation with B vitamins to improve potential ocular outcomes. This review synthesizes the available data on the role of B vitamins in promoting healthy eye structure and function, highlighting connections between individual vitamins and disease, and discussing the clinical considerations for B vitamin supplementation.

Purpose: To quantify how anatomical variation in vitreous cavity volume, estimated from axial length (AL) using the VIVEX formula, influences intravitreal drug concentration, therapeutic exposure duration, and immediate intraocular pressure (IOP) dynamics under fixed-dose intravitreal therapy.

Patients and methods: This theoretical pharmacokinetic modeling study utilized the VIVEX equation {V = (π/6) × AL³ × [0.76 + 0.012(AL - 24)]} to calculate vitreous volume (VV) for three representative eye types: small hyperopic (AL 20 mm), emmetropic (AL 23.5 mm), and large myopic (AL 30 mm). A one-compartment first-order elimination model was applied to two commonly used intravitreal agents: triamcinolone acetonide (4 mg) and vancomycin (1 mg). Primary outcomes included initial concentration (C₀), duration above therapeutic threshold (t_eff), and modeled acute IOP rise. A Monte-Carlo simulation (10,000 virtual eyes) was performed to estimate population-level variability.

Results: Modeled VV increased from 2.98 mL (AL 20 mm) to 11.76 mL (AL 30 mm), producing an approximately fourfold difference in C₀. For triamcinolone, C₀ decreased from 1.34 to 0.34 mg/mL and t_eff decreased from 67.4 to 31.8 days (≈50% reduction). For vancomycin, C₀ decreased from 0.336 to 0.085 mg/mL and t_eff decreased from 9.1 to 6.1 days. Predicted immediate IOP elevations were ~4.3 mmHg in small eyes versus ~1.1 mmHg in large eyes. Monte Carlo analysis suggested that anatomical variability accounts for ~30% of modeled pharmacokinetic variance.

Conclusion: Anatomical differences in VV substantially and predictably influence intravitreal pharmacokinetics. The modeled results demonstrate that fixed intravitreal dosing leads to substantial geometry-driven differences in drug exposure across eye sizes. Fixed dosing strategies may increase peak exposure and IOP load in small eyes and shorten effective therapeutic duration in large myopic eyes. Biometry-stratified clinical studies are warranted to validate these modeling predictions and to assess their clinical relevance in intravitreal antibiotic and corticosteroid therapies.

Purpose: To investigate characteristics of choroidal involvement in sarcoid uveitis.

Patients and methods: Included were patients with confirmed sarcoidosis and uveitis with an eye examination at the Tays Eye Center at Tampere University Hospital between January 2014 and January 2021.

Results: Choroidal involvement was found in 31 of 97 sarcoid uveitis patients (32%), and 5 of them were detected only after reviewing the ocular images for this study. None of our patients presented with vasculitis. Choroidal nodules were found in 10%, multifocal choroiditis in 90% and serpiginous choroiditis in 3% of patients with choroidal involvement. They had a higher rate of chronic course of uveitis (71% vs 29%, p < 0.001), bilateral uveitis (90% vs 58%, p = 0.001), vitreal snowballs (65% vs 15%, p < 0.001), and macular edema (36% vs 9%, p = 0.001).

Conclusion: Choroidal involvement is common and may be underdiagnosed in sarcoid uveitis. Therefore, we recommend carefully looking for choroidal involvement not only with slit-lamp but also with ocular imaging in patients with uveitis.

Purpose: This study evaluated the correlation between the Standardization of Uveitis Nomenclature (SUN) scale and anterior chamber cell counts measured by anterior segment optical coherence tomography (AS-OCT) in pediatric uveitis. We hypothesized that analyzing the central 7 frames of AS-OCT scans would improve measurement consistency and accuracy, as this region may provide greater anatomical relevance than peripheral frames, while also simplifying image acquisition in children.

Patients and methods: One hundred and thirteen clinical episodes from pediatric uveitis patients aged ≤16 years, over 28 months, were retrospectively analyzed. All patients underwent AS-OCT imaging on the same day as clinical review. Only scans with ≥9 frames were included. SUN Scale grades were: 0 (n=49), 0.5+ (n=22), 1+ (n=17), 2+ (n=15), and 3+ (n=10). Mean anterior chamber cell counts were calculated from the central 7 frames. Spearman's rank correlation assessed the relationship between SUN grades and AS-OCT counts; analyses were performed in R.

Results: There was a strong positive correlation between SUN Scale grades and mean AS-OCT cell counts (ρ = 0.933, 95% CI 0.89-0.96, p < 0.001). Restricting analysis to the central seven frames improved measurement reproducibility and reduced exclusions due to patient movement or scan misalignment. Intra-grader repeatability of manual cell counts was excellent (ICC = 0.968, 95% CI 0.93-0.99), confirming high measurement reliability.

Conclusion: AS-OCT, particularly when focusing on the central 7 frames, provides a consistent and reproducible method for quantifying anterior chamber inflammation in pediatric uveitis. This approach offers enhanced accuracy and operational feasibility, supporting its integration into clinical practice to improve monitoring and management in children.

Retinal vein occlusion (RVO) represents a heterogeneous group of disorders that remains the second most common retinal vascular disease and can be associated with vision loss. RVO confers a substantial burden of illness that affects patients, caregivers, medical systems, and physicians. Complications of RVO - including cystoid macular edema, macular ischemia, and neovascularization sequelae - may result in severe visual morbidity and blindness. Canadian expert consensus recommendations on the optimal treatment of patients with RVO were published in 2015. Since that time, advances in diagnosis and pharmacotherapy have been made, changing the clinical approach of retina specialists. This article presents updated data and recommendations for the management of patients with RVO.

Background: African-derived populations are disproportionately affected by primary open-angle glaucoma (POAG) and face increased risks of surgical failure due to anatomical and genetic factors. This report identifies challenges in glaucoma care and strategies to optimize surgical outcomes in patients from African-derived backgrounds.

Methods: Six UK-based consultant ophthalmic glaucoma surgeons with extensive experience in diverse patient populations convened to discuss challenges and key approaches for optimising glaucoma filtration surgery outcomes in African-derived populations. Their opinions were supplemented by published literature to propose tailored recommendations and address some of the known challenges in this important patient group.

Results: Surgical treatment of glaucoma among African-derived populations includes challenges such as Tenon's thickness, variable wound healing, and an increased risk of scarring. Preoperatively, outcomes can be improved through patient education, counselling and ocular surface optimisation, including reduction of preservative exposure. Intraoperatively, surgeons may consider the use of general anaesthesia or conscious sedation in younger patients, higher or prolonged mitomycin C exposure tailored to individual risk, and separate closure of Tenon's capsule and conjunctiva to reduce bleb failure. Proactive postoperative care should include intensified steroid regimens and 5-fluorouracil use when indicated.

Conclusion: These insights support the delivery of culturally informed, evidence-based glaucoma care tailored to patients from African-derived backgrounds. By adopting a personalised and proactive approach, healthcare professionals may achieve more consistent and favourable surgical outcomes in this high-risk group.

Purpose: To establish population-specific normative data for non-strabismic binocular vision (NSBV) parameters in Nepalese young adults and to evaluate their association with age and gender.

Materials and methods: This cross-sectional analytical study included asymptomatic adults aged 18-35 years who underwent comprehensive ophthalmic evaluation and standardized accommodative and binocular vision assessments. The mean and standard deviation were used to describe the central tendency and dispersion of the study parameters, respectively. Intergroup comparisons were performed using ANOVA and independent t-tests.

Results: A total of 1,393 participants completed all NSBV assessments. The mean age of the participants was 25.04 ± 4.79 years. The mean values for key NSBV parameters were as follows: amplitude of accommodation, 8.75 ± 1.53 D; accommodative response (MEM), 0.50 ± 0.30 D; monocular accommodative facility, 9.98 ± 3.55 cpm; binocular accommodative facility, 6.39 ± 2.79 cpm; near point of convergence (break), 4.82 ± 1.50 cm; distance phoria, 0.19 ± 0.79 exophoria; near phoria, 2.96 ± 2.65 exophoria; and AC/A ratio, 2.61 ± 1.23. Amplitude of accommodation showed a strong negative association with age (AA = 16.20 - 0.30 × age; R² = 0.85; p < 0.001). Although gender differences were statistically significant for several parameters, the magnitude of these differences was small and not clinically meaningful.

Conclusion: This study provides the first large-scale normative clinical dataset of NSBV parameters in Nepalese young adults. Age significantly influences accommodative parameters, whereas gender-related differences are minimal. These population-specific normative values may support the screening, accurate diagnosis, and management of NSBVA and provide a contemporary reference for clinicians and researchers working with South Asian populations.

Purpose: To evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) for refractory glaucoma.

Patients and methods: This prospective multicenter study included 62 eyes of 57 refractory glaucoma patients. MP-TSCPC was performed from August 2022 to May 2023. All patients had a complete ophthalmic examination preoperatively, including medical history, slit-lamp examination, best-corrected visual acuity (BCVA) assessment, and pre- and post-operative intraocular pressure (IOP) measurements. The main outcomes included IOP change, antiglaucoma medication use, the cumulative incidence of treatment success, and the postoperative complications over 24 months. Treatment success was defined as an IOP reduction of more than 20% compared with baseline or a decrease in the number of antiglaucoma medications with stable target IOP. Retreatments were classified as failures.

Results: The glaucoma subtypes included primary glaucoma (n=29) and secondary glaucoma (n=33). Prior glaucoma surgery had been performed in 48 of the 62 eyes (77.4%), with 30 of them having multiple types of surgery. Preoperatively, the mean IOP was 38.2±10.3 mmHg and the median number of antiglaucoma medications used was 3.0 (2.0, 3.0); these values decreased to 20.9±8.8 mmHg (a reduction of 42.7%; P<0.001) and 2.0 (0.0, 3.0) (P<0.001) at month 24, respectively. The treatment success rate was 77.4% at 24 months. Postoperative complications included mydriasis (n=10), conjunctival hemorrhage (n=9), mild anterior chamber inflammation (n=1), hyphema (n=1), mild ciliary body detachment (n=3), and choroidal detachment (n=1), all reversible after treatment.

Conclusion: MP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.

Purpose: To evaluate postoperative changes in anterior chamber depth (ACD), intraocular lens (IOL) tilt, and decentration of the Clareon IOL in a capsular bag compared with those of the AcrySof IQ IOL.

Patients and methods: In this prospective multicenter study, we randomly assigned patients scheduled for bilateral cataract surgery to receive the Clareon IOL in one eye and the AcrySof IQ IOL (both manufactured by Alcon Vision LLC, Fort Worth, TX, USA) in the fellow eye. ACD, IOL tilt, decentration, visual acuity, and subjective refraction were measured 1 day, 1 week, and 1, 3, and 6 months after surgery. The primary objective was to demonstrate the equivalence between Clareon and AcrySof IQ IOL regarding ACD changes from 1 day to 6 months.

Results: Overall, 64 eyes from 32 patients were included. The Clareon IOL met the equivalence criteria; the 95% confidence interval for the difference in ACD change (0.026 mm; 95% confidence interval, -0.02 to 0.072) was within -0.15 and 0.15 mm. At 6 months, the means ± standard deviations of the ACD, IOL tilt, and decentration were 4.26 ± 0.30 mm, 4.3 ± 1.9°, and 0.17 ± 0.11 mm for Clareon IOL, and 4.23 ± 0.30 mm, 4.0 ± 1.9°, and 0.16 ± 0.11 mm for AcrySof IQ IOL, respectively (P = 0.052, 0.421, and 0.916, respectively). The subjective spherical equivalence at 6 months was -0.01 ± 1.03 and -0.08 ± 0.90 D for Clareon IOL and AcrySof IQ IOL, respectively.

Conclusion: The Clareon IOL was equivalent to the AcrySof IQ IOL regarding ACD changes from 1 day to 6 months. No significant differences were observed in ACD, IOL tilt, or refractive outcomes at 6 months between the two IOLs in the same patients. Both IOLs showed good stability in the bag through 6 months.