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

Netarsudil, a Rho-associated protein kinase (ROCK) inhibitor, was initially approved for the treatment of glaucoma and ocular hypertension due to its intraocular pressure-lowering effects. More recently, its pharmacologic activity in corneal tissues has generated interest in its therapeutic use for endothelial dysfunction. However, with widespread adoption, an unanticipated and visually significant adverse effect has emerged, reticular epithelial edema (REE). This condition is characterized by superficial microcystic epithelial changes arranged in a distinctive honeycomb pattern. REE most commonly arises in eyes with reduced endothelial reserve, such as those with Fuchs endothelial dystrophy, prior keratoplasty, or glaucoma drainage devices, and typically resolves following drug discontinuation. Experimental and clinical data suggest that while netarsudil enhances endothelial pump function and cellular adhesion, it may concurrently disrupt epithelial tight junctions, leading to paracellular fluid accumulation and REE. This review provides the first comprehensive synthesis of case reports, case series, clinical studies, and experimental data to characterize the dual effects of netarsudil on the cornea, with particular emphasis on the pathogenesis and risk factors for REE. By integrating mechanistic and clinical evidence, the review aims to support risk stratification and inform patient selection. Further research is needed to clarify the incidence, risk modifiers, and pathophysiology of REE, and to better identify patient populations most likely to benefit from netarsudil versus those at increased risk for epithelial adverse effects.

Background: Type 2 diabetes mellitus (T2DM) is associated with increased cataract risk, potentially due to osmotic imbalance from intracellular sorbitol accumulation affecting lens cell volume regulation.

Objective: To evaluate the expression of Kir4.1, TRPV4, and LRRC8A channels-key regulators of cell volume-in the anterior lens capsule of patients with and without T2DM.

Methods: A cross-sectional observational study was conducted using anterior lens capsules from 50 patients undergoing cataract surgery (24 with T2DM, and 26 non-diabetic). Cataract severity was graded using the Lens Opacities Classification System III, and immunofluorescence was used to quantify protein expression.

Results: T2DM patients exhibited greater severity in cortical and nuclear cataracts, particularly among women. Diabetic samples showed increased Kir4.1 and decreased TRPV4 and LRRC8A expression.

Conclusion: The study identifies associations between T2DM and altered expression of osmoregulatory proteins in the lens capsule, which may relate to the formation and severity of cataracts. These exploratory findings warrant further investigation to clarify underlying mechanisms.

Purpose: This literature review examines the literature on surgical modifications and post-operative strategies designed to minimize visible scarring following external dacryocystorhinostomy (Ext-DCR).

Methods: A comprehensive search of PubMed, Medline, Embase, Cochrane Central, and CINAHL databases was performed on July 25th 2024, to identify studies evaluating scar formation after Ext-DCR. Studies were included if they assessed incision techniques, closure methods, or post-operative care protocols and reported aesthetic outcomes related to scar visibility.

Results: Forty studies comprising 3750 Ext-DCR procedures with scar reports from 3715 individuals met the inclusion criteria. The prevalence of visible scarring varied widely (0-50%), though most studies reported rates below 10%. Techniques associated with improved aesthetic outcomes included alternative incision designs, minimal incision approaches, and sutureless skin closures.

Conclusion: Various surgical modifications have demonstrated potential in reducing visible scarring after Ext-DCR; however, no single technique has achieved universal acceptance. Tailoring incision design and closure techniques based on patient-specific factors, including skin type and aesthetic concerns, has been reported to improve outcomes. Future studies should incorporate standardized scar assessment scales to facilitate direct comparisons and optimize best practices in Ext-DCR surgery.

Purpose: To evaluate the long-term efficacy of the bimatoprost sustained-release (SR) implant focusing on time to additional intraocular pressure (IOP) lowering intervention and changes in medication burden and IOP, with subgroup analyses by lens status and prior trabecular meshwork (TM) procedures.

Patients and methods: This retrospective study included patients who received a single bimatoprost SR implant between September 2020 and June 2022 at a single center. Data was obtained from electronic medical records. The primary outcomes were time to failure defined as addition of IOP-lowering medications, procedures, or surgery, changes in topical medication use, and IOP over time. Kaplan-Meier survival analysis and linear mixed-effects models were used to assess overall outcomes and within subgroups.

Results: The study included 223 eyes from 134 patients. At 6-, 12-, and 24-months post-implantation, 67.3%, 38.5%, and 20.5% of eyes, respectively, remained free of additional IOP-lowering treatment. The rates of survival were not statistically significant when stratified by lens status or history of TM procedures. The mean number of topical medications was 1.8 ± 1.3 at baseline and was significantly reduced beginning at 1 month and through 18 months (p < 0.001). There was not a significant IOP decrease post implantation. Subgroup analysis showed no significant differences in IOP and a borderline significant difference in medication use (p = 0.051) between phakic and pseudophakic eyes. Eyes with a history of TM procedures had higher IOP compared to those without prior intervention (p = 0.042), and medication use was not significantly different between groups.

Conclusion: In this retrospective, single-center study the bimatoprost SR implant provided significant reduction in topical medication burden for 18 months. The implant provided six months of freedom from additional IOP lowering interventions in more than half of the eyes with an expected decline. A small group continued to be free from additional IOP lowering intervention for up to 24 months.

Purpose: We evaluated iridocorneal angle biometrics using anterior segment spectral-domain optical coherence tomography (SD-OCT) compared with Shaffer grade clinical assessments in Chinese patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) to determine which method is most suitable for preoperative angle assessment.

Methods: This noninterventional, prospective study enrolled 206 patients with OAG or OHT in both eyes and Shaffer grade >1 iridocorneal angles at 3 sites in China. Shaffer grades and SD-OCT 5-line raster scans (Zeiss Cirrus HD-OCT 4000) of the inferior angle were obtained under dark conditions. Images were evaluated for visualization of Schwalbe's line, the superior iris surface, and angle recess. ImageJ software was used to measure the angle-opening distance at Schwalbe's line (SL-AOD) in gradable images.

Results: Almost all study eyes had Shaffer grade 4 (91.0%) or grade 3 (8.3%) angles. Mean (standard deviation) SL-AOD was 0.75 (0.33) mm (median 0.73, range 0.051-1.9, n=322). The SL-AOD was <0.635 mm (the tube outer diameter of the Ahmed glaucoma valve and Baerveldt glaucoma implant) in 37.6% of the eyes. SL-AOD values did not differ significantly between OAG and OHT diagnoses or between phakic and pseudophakic eyes.

Conclusion: Iridocorneal angle biometrics derived from SD-OCT images in Chinese patients with OAG or OHT showed large variation in the SL-AOD in eyes with open angles on gonioscopy. Over one-third of patients had SL-AOD too small to safely accommodate commonly used glaucoma tube shunts. Expanded preoperative use of SD-OCT could potentially be beneficial to detect angles at risk for corneal complications and inform device selection.

Purpose: To analyse the clinical outcomes of a hydrophobic trifocal diffractive intraocular lens (IOLs) implanted in eyes with different axial lengths.

Methods: This prospective study enrolled 116 eyes implanted with the FineVision HP IOL (Beaver-Visitec International, Inc. USA). The eyes were allocated into 3 groups according to their preoperative axial length: Group A (21.00-22.50 mm, n=17), Group B (>22.50-24.00 mm, n=83), and Group C (>24.00-28.50 mm, n=16). Post-operative outcomes at 3 months considered manifest refraction, monocular LogMAR uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA, at 40 cm).

Results: For Group A, 70.59% and 100% of eyes were within ±0.50D and ±1.00D, respectively (mean spherical equivalent [SE]: 0.23±0.39D); for Group B, these figures were 84.34% and 100%, respectively (mean SE: -0.12±0.41D); and for Group C, all eyes were within ±0.50D (mean SE: 0.16±0.21D). SE did not differ between groups (p>0.4). The mean CDVA was -0.01±0.07, -0.02±0.06, and -0.05±0.07 for Groups A, B, and C, respectively (p=0.147), and the mean DCNVA was 0.09±0.03, 0.08±0.05 and 0.09±0.03, respectively (p=0.716). For distance vision, in Group A, 76.47% and 100% of eyes had a cumulative CDVA of ≥20/20 and ≥20/25, respectively. These percentages changed to 92.77% and 100% for Group B, and 93.75% and 100% for Group C, respectively. For near vision, for Group A, 11.76% and 100% of eyes had a cumulative DCNVA of ≥20/20 and ≥20/25, respectively. These percentages changed to 18.07% and 100% for Group B, and 12.50% and 100% for Group C, respectively.

Conclusion: The hydrophobic trifocal diffractive FineVision HP IOL provides good visual and refractive outcomes for eyes with different axial length.

Purpose: To investigate whether dynamic pupillary responses differ between patients with age-related macular degeneration (AMD) and healthy controls (HC), and to evaluate their potential as functional biomarkers using high-frequency, VR-based video-oculography.

Methods: A controlled clinical study included 17 AMD patients and 17 age-matched HCs; four AMD participants were excluded for low recording quality. Dynamic pupillary responses were recorded with the BulbiCam video-oculography system (400 Hz), which presented independent monocular light stimuli through multiple permutations of bright (300 cd/m²) and dark (5 cd/m²) conditions. Measured variables included pupil diameter, latency, peak velocity, and pupil diameter-time integral (PDTI). Each eye was tested separately, and repeated sessions were analysed for reliability (intraclass correlation coefficient, ICC), repeatability (agreement index, AI), and stability (stability index, SI). Group differences were assessed using analysis of variance (ANOVA) and receiver operating characteristic (ROC) analysis.

Results: AMD eyes showed larger steady-state pupil diameter and higher PDTI than controls (p < 0.05). First peak velocity was reduced in the worst eye only, while latencies were unchanged. PDTI and diameter demonstrated high reliability and stability across repetitions, and ROC analysis confirmed effective group discrimination.

Conclusion: High-frequency VR pupillometry detected reproducible functional alterations in AMD, consistent with impaired macular photoreceptor input but preserved reflex transmission. PDTI and diameter serve as diagnostic (population-level) and monitoring (patient-level) biomarkers, offering a non-invasive and objective method for AMD detection and follow-up in clinical and research settings.

Background: The predominant theory, underlying most optical myopia control interventions, is that relative peripheral hyperopic defocus (RPHD) is a cause of myopia progression. However, interventions that reduce RPHD only slow myopia progression on average by ~50%, so other factors are likely to be involved.

Objective: To explore the literature on accommodation and binocular coordination as possible factors in myopia development and progression.

Methods: PubMed was searched for relevant keywords in September 2025. Non-human and non-English reports were excluded.

Results: (1) Concerning myopia onset, the CLEERE study found changes in the interaction between accommodation and convergence (increasing AC/A ratio) from four years before myopia onset. This is thought to indicate compromised accommodation, supported by reduced positive relative accommodation before myopia onset in other longitudinal studies. (2) Regarding myopia progression, the magnitude of accommodative lag is not strongly correlated with rate of myopia progression. The validity of clinical measurements of accommodative lag has been questioned. Tests of eye alignment during near vision show a more convergent posture (esophoria) in some myopes around the time of myopia onset, probably secondary to increased AC/A ratio. If compromised accommodation and/or near esophoria are relevant to myopia progression, prescribing a near addition should be helpful. However, myopia control trials of bifocal and progressive addition lens spectacles show poor efficacy. Despite early indications of greater efficacy in cases with higher accommodative lag and/or near esophoria, poor treatment effects in this sub-group were subsequently found. Nonetheless, some individual cases with symptomatic convergence excess esophoria are likely to benefit from bifocal spectacles for symptomatic relief.

Conclusion: Although accommodative dysfunction seems likely to play some role in myopia onset, accommodative and binocular factors are unlikely to be major causal factors in myopia progression. An additive risk factor risk-resilience model is presented and suggestions are made for further research.

Purpose: To assess the real-world performance of Clareon^® monofocal non-Toric and Toric intraocular lenses (IOLs) using intraoperative aberrometry (IA).

Patients and methods: This retrospective, postmarket analysis included anonymized data from a multicenter study conducted in the US. Data were collected from patients implanted with Clareon ultraviolet-absorbing (UVA) monofocal or monofocal Toric IOL(s), utilizing the WaveTec ORA System and had available corrected distance visual acuity (CDVA) data at 28 days to 3 years postoperative. The primary endpoint was the percentage of eyes achieving monocular CDVA of 20/40 at ≥ 1 month postoperative. Secondary and exploratory endpoints included monocular uncorrected distance visual acuity (UDVA), residual refractive cylinder, stratified visual acuity (VA) thresholds, manifest refraction spherical equivalent (MRSE), and prediction error comparisons between ORA and preoperative biometry.

Results: Based on 1404 eyes, 98.4% achieved CDVA of 20/40 or better (mean logMAR 0.04 non-Toric, 0.03 Toric). Among emmetropia targeted eyes, 93.9% achieved UDVA of 20/40 or better. The mean residual refractive cylinder for Toric models was 0.40 diopters (D). The mean (standard deviation) MRSE was -0.15 (0.45) D. The mean prediction error for emmetropia targeted eyes was -0.10 (0.49) D. Additionally, 78.7% had prediction error differences within ± 0.25 D between ORA and preoperative biometry. In 40.8% of cases, the implanted IOLs match the preoperative selection with no clinically significant VA differences between match and unmatch eyes.

Conclusion: Most patients implanted with the Clareon UVA IOLs, using WaveTec ORA IA achieved CDVA of 20/40 or better at ≥ 1 month postoperatively, with minimal residual refractive error and enhanced target accuracy, indicating ORA may support optimize IOL power calculation and axis positioning to improve refractive outcomes.