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

Purpose: To evaluate visual and anatomical outcomes of pars plana vitrectomy (PPV) with subretinal tissue plasminogen activator (tPA) and gas or air tamponade for large submacular haemorrhage (SMH>4 disc diameters) of varied etiologies and assess postoperative anti-vascular endothelial growth factor (anti-VEGF) requirements in a multicenter real-world cohort.

Patients and methods: This retrospective, two-center study included 32 eyes undergoing PPV with subretinal tPA (25-50 µg/0.1-0.2 mL) and SF₆ or air tamponade, followed for ≥6 months. The primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included central macular thickness (CMT), SMH dimensions, subretinal/intraretinal fluid (SRF/IRF) status, intraocular pressure (IOP), and anti-VEGF use.

Results: Mean patient age was 60.8 ± 19.1 years; etiologies included polypoidal choroidal vasculopathy (PCV; 53.1%), neovascular age-related macular degeneration (nAMD; 28.1%), trauma (12.5%), and retinal artery macroaneurysm (RAM; 6.3%). BCVA improved significantly from 1.13 ± 0.30 to 0.56 ± 0.26 logMAR (P<0.001), with 55.2% gaining ≥3 lines. CMT reduced from 501 ± 219 to 276 ± 70 µm (P<0.001), and SMH size decreased from 5 ± 2 to 0 disc diameters by 6 months. SRF resolved in 65.65% of eyes (P<0.001), while IRF remained stable (P=0.51). IOP normalized after a transient 1-month rise. Mean anti-VEGF use was 1.2 injections/eye (bevacizumab 88.2%, brolucizumab 11.8%). No major complications occurred; one transient vitreous hemorrhage and three cataract progressions were noted.

Conclusion: PPV with subretinal tPA achieved rapid hemorrhage clearance, significant visual gain, and durable anatomical restoration with minimal complications and limited anti-VEGF need. It offers an effective, safe option for large SMH across etiologies, enabling timely foveal recovery and improved long-term functional outcomes.

Purpose: To longitudinally characterize structural and vascular density changes in demyelinating optic neuritis (DON) using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA).

Methods: This prospective study included 23 patients (mean age 41.1 ± 15.3 years; 75.9% female) with first unilateral DON at a Portuguese tertiary center. Baseline (T0) and 6-month (T6) assessments included best-corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer (pRNFL), ganglion cell complex (GCC), focal loss volume (FLV), global loss volume (GLV), and vessel densities from the radial peripapillary capillary (RPC) and macular superficial vascular plexus (SVP). Affected and fellow eyes were compared. The Wilcoxon test was applied, and p-values were adjusted using the Benjamini-Hochberg method (p < 0.05).

Results: At baseline, affected eyes showed increased pRNFL thickness compared with fellow eyes, particularly in nasal sectors including nasal, inferonasal, nasal-upper, and nasal-lower regions (p ≤ 0.024). At 6 months, significant thinning was detected in average pRNFL and temporal quadrant (both p = 0.036), accompanied by higher FLV and GLV values (p ≤ 0.036). Longitudinally (T0-T6), progressive thinning occurred across all quadrants and ONH sectors in affected eyes (p < 0.05), while fellow eyes remained stable. OCTA revealed reduced vessel density in whole-image all-vessels, as well as in superior and inferior peripapillary sectors (p ≤ 0.028) at T6, with no significant longitudinal change after correction.

Conclusion: Demyelinating optic neuritis exhibits a dynamic course with early structural thickening followed by progressive neuroaxonal loss. Significant longitudinal pRNFL and ONH thinning supports sustained axonal degeneration beyond the acute phase. OCTA changes were restricted to selected peripapillary sectors, suggesting subtle parallel microvascular alterations. OCT and OCTA offer complementary information for comprehensive assessment and monitoring of demyelinating optic neuropathies.

Purpose: To evaluate the diagnostic and referral agreement between non-retina specialists (NRS) using the PathFinder artificial intelligence (AI) assistant and fellowship-trained retina specialists (RS - gold standard) in interpreting macular optical coherence tomography (OCT) scans.

Methods: This cross-sectional study included 202 consecutive patients undergoing OCT on the CIRRUS platform with the PathFinder AI module. Three RS independently graded all scans without clinical data, while three NRS interpreted the same scans using PathFinder assistance and full clinical information. The gold standard for both diagnosis and referral was defined by agreement of at least two of the three RS. The NRS recorded diagnostic confidence and time to AI-assisted decision. Agreement was assessed with Cohen's and Fleiss' κ and sensitivity, and specificity were computed for four major pathologies.

Results: Among 202 eyes (mean age 62.7 ± 12.3 years), RS inter-agreement was moderate for diagnosis (overall κ = 0.59) and referral (κ = 0.47). NRS showed substantial (NRS1 κ = 0.78) to moderate (NRS2 κ = 0.64; NRS3 κ = 0.54) diagnostic agreement and high specificity (> 90% for all). Sensitivity varied across raters and diagnoses (0.57-0.89), with comparatively lower sensitivity observed for certain vision-threatening conditions such as age-related macular degeneration and macular hole. Referral agreement varied (κ = 0.68, 0.24, 0.34) amongst NRS. Visual acuity was the only significant predictor of referral discordance (OR 0.66, 95% CI 0.55-0.80, p < 0.001). Median NRS with PathFinder assistance processing time was < 20s. The most significant false-positive diagnoses made by PathFinder-assisted NRS in eyes deemed normal by RS was ERM (40.0%), followed by PED (20.0%) and AMD (13.3%), observed across a small number of eyes and does not affect the results.

Conclusion: PathFinder is a valuable real-time decision-support tool in resource-limited settings; however, disease-specific refinements and clinical oversight remain important, particularly for vision-threatening conditions.

Purpose: To investigate the IOLMaster 700 variability of posterior curvature readings in relation to ocular surface parameters.

Patients and methods: Eligible cataract patients underwent two consecutive IOLMaster 700 exams and ocular surface assessments including non-invasive and fluorescein tear film break-up time (NIKBUT first and average, FBUT) during one preoperative visit. Intradevice repeatability was assessed based on within-subject standard deviation (Sw), test-retest variability (TRT), and intraclass correlation coefficient (ICC). The device composite standard deviation (SD) for biometric data, anterior corneal radii (R, R1, R2) and posterior corneal radii (PR, PR1, PR2) were analyzed in relation to ocular surface indices. Subgroup analysis evaluated the effect of FBUT on repeatability of trimmed-mean astigmatism vectors.

Results: One hundred eyes of 67 patients were evaluated. Posterior keratometric indices had lower ICCs than anterior indices. The TRT for R and PR was 0.01 and 0.09 mm, respectively. The mean PR composite-SD was significantly higher than mean R composite-SD (34.49 vs 2.55 μm, respectively, p < 0.001, t-test). The mean R1 composite-SD was negatively correlated with FBUT (ρ = -0.35, p < 0.001). The mean PR composite-SD was not correlated with ocular surface parameters. A trend towards increasing PR composite-SD with age was observed, approaching statistical significance. Subgroup analysis showed no statistically significant differences for repeat astigmatism vectors in relation to FBUT.

Conclusion: The OCT-based posterior curvature readings show greater variability than the telecentric anterior keratometry. Unlike anterior corneal measurements, posterior corneal readings variability was not linked to tear film parameters.

Purpose: Patients increasingly seek information about medical treatment options from the internet. This study evaluated the quality and accuracy of YouTube and Facebook videos on glaucoma treatment options.

Methods: A comprehensive search of "glaucoma" and "eye pressure" combined with "treatment" or "cure" was performed. YouTube videos with at least 25,000 views and 25 views per day and Facebook videos with at least 1000 total views were included. Videos were excluded if they were not in English or about humans. The quality of videos was evaluated by two independent reviewers using a modified Currency, Relevance, Authority, Accuracy, and Criteria (CRAAP) metric. Videos were categorized as educational, testimonial, or advertisement.

Results: A total of 74 YouTube videos and 19 Facebook videos were included. Of the YouTube videos, 89.7% were educational, 5.5% testimonials, and 4.8% adverts. Of the Facebook videos, 65.8% were educational, 21.1% testimonials, and 13.2% adverts. The inter-rater reliability was acceptable after kappa values were calculated. Fifteen percent of YouTube videos and eighteen percent of Facebook videos were graded as containing misinformation or misleading information. Audio and video quality scores were similar between categories. Higher accuracy and comprehensiveness scores were seen for educational videos. Seventy-four percent of YouTube videos and 66% of Facebook videos addressed the question of what is glaucoma, 65% of YouTube videos and 47% of Facebook videos discussed the course of untreated disease, 64% of YouTube videos and 34% of Facebook videos discussed the goals of treatment, and only 17% of YouTube videos and 0% of Facebook videos discussed the risks of the proposed treatment options.

Conclusion: Patients are increasingly using YouTube and Facebook for medical information. This study found that many videos lack useful information and some provide information that may be detrimental. Physicians should be aware of this risk and educate patients appropriately.

Purpose: ELITA Femtosecond Laser System (Johnson & Johnson) is a next-generation ophthalmic laser platform designed for Smooth Incision Lenticular Keratomileusis (SILK). A retrospective study evaluated refractive outcomes, visual acuity, higher-order aberrations (HOAs), tear film parameters, and dry eye symptoms 30 days postoperatively.

Patients and methods: A retrospective, non-comparative, case series analyzing real-world data from patients with myopia treated using the SILK procedure with the ELITA femtosecond laser. The study included 144 eyes from 73 consecutive patients (47 female, 26 male) with myopia (-4.51 ± 1.36 D; range -1.50 D to -8.250 D). Refraction and uncorrected distance visual acuity (UDVA) were assessed preoperatively and at 1, 7, and 30 days postoperatively. A subset of 18 patients (36 eyes) underwent additional evaluation of tear film (Keratograph, LipiView, Schirmer II, NIBUT), dry eye symptoms (OSDI), and HOAs/contrast sensitivity (iTrace).

Results: At 30-days, 96.5% of eyes (139/144) achieved 20/20 UDVA while the remaining 3.5% achieved 20/25. The mean spherical equivalent was -0.22 ± 0.68 D. No significant changes were observed in tear film metrics, HOAs, or contrast sensitivity. A statistically significant difference in vertical coma was noted (0.05 ± 0.04 µm vs 0.1 ± 0.09 µm, P = 0.008), though not clinically relevant. No serious adverse events occurred.

Conclusion: The SILK procedure with the ELITA femtosecond laser platform is safe and effective for myopia correction (with and without astigmatism), with no detrimental effect on tear film stability, dry eye symptoms, or visual quality at 30 days post-surgery.

Purpose: To determine the safety of an intracanalicular dexamethasone ophthalmic insert (IDOI) and topical Ketorolac tromethamine 0.5% (ketorolac) versus ketorolac and topical prednisolone acetate 1% (PA) over the first month after cataract surgery (POM1).

Patients and methods: Retrospective study of uncomplicated cataract surgeries between June 2020 and March 2023 at the University of Michigan. Patients received either IDOI and ketorolac or PA and ketorolac (control) during POM1. Outcomes included breakthrough inflammation necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1.

Results: 100 eyes of 78 patients were included in the IDOI/ketorolac group, and 102 eyes of 83 individuals in the control group. Demographics, ocular comorbidities, and baseline IOP were comparable between groups. There were no differences between groups in the distribution of race (p = 0.137), the preoperative presence of epiretinal membrane (43.5% vs 57.83%; p = 0.88), or history of diabetic retinopathy (19.23% vs 15.6%; p = 0.59) in the surgical eyes. There were no differences in the rates of postoperative rebound inflammation in the IDOI/ketorolac compared to the PA/ketorolac group (2.0% vs 2.0%; p = 1.00) or in the development of cystoid macular edema (2.0% vs 2.9%; p = 1.00). There were no cases of increased IOP > 10 mmHg at POM1 compared with baseline in either group.

Conclusion: There was no difference in the rate of rebound inflammation or CME in the IDOI/ketorolac regimen compared to the PA/ketorolac regimen. IDOI can be a safe and effective dropless alternative to PA/ketorolac therapy after cataract surgery in patients susceptible to inflammation.

Congenital hereditary endothelial dystrophy (CHED) is a rare autosomal recessive disease more common in populations with high consanguinity. This review aims to provide a comprehensive overview of CHED focusing on the underlying genetic and molecular bases, listing identified mutations, and evaluating current and future therapeutic strategies. We performed a comprehensive literature review using PubMed with the keywords "Congenital hereditary endothelial dystrophy (CHED); SLC4A11 gene; Endothelial keratoplasty (EK) and pediatric corneal disease; Genetic therapy and corneal endothelial disease" from 1988 to 2025. Of the reviewed articles (n=494), English-language studies published in the last decade were prioritized and analyzed (n=107). CHED is commonly caused by biallelic SLC4A11 mutations, causing dysfunction of the corneal endothelium, progressive stromal edema, and visual loss. It typically manifests at birth or infancy as bilateral, asymmetric corneal opacification with variable severity. Although penetrating keratoplasty and EK remain the gold standards for the recovery of corneal transparency, novel therapeutics, including gene therapies and mitochondrial-targeted antioxidants, have shown promising results in preclinical studies. Emerging therapeutic strategies are likely to markedly change the current treatment of CHED with less invasive and more effective therapeutic options on the horizon.

Purpose: Cyclosporine ophthalmic emulsion 0.05% (CsA 0.05%) and cyclosporine ophthalmic solution 0.09% (CsA 0.09%) are approved to increase tear production in dry eye disease (DED). We investigated the effect of CsA 0.09% on DED signs and symptoms in patients whose disease was inadequately controlled on CsA 0.05%. In this Phase 4, single-arm, open-label study, adults with DED administered 1 drop of CsA 0.09% in both eyes twice daily for 12 weeks.

Patients and methods: Patients were ≥ 18 years of age with a history and clinical diagnosis of DED for ≥ 3 months, which was not adequately controlled by treatment with CsA 0.05%. The primary efficacy endpoints were mean changes from baseline in total corneal fluorescein staining (CFS) and modified Symptom Assessment iN Dry Eye (mSANDE) scores at Week 12. Secondary efficacy endpoints included mean changes from baseline in total conjunctival staining score, central CFS score, tear osmolarity, Schirmer test score, and frequency of artificial tear use at Week 12, and patient treatment preference at Week 12. Adverse events (AEs) were monitored.

Results: The intent-to-treat population comprised 124 patients (mean age, 65.6 years). The mean changes from baseline in total CFS and mSANDE scores were statistically significant at Weeks 4, 8, and 12 (P < 0.0001 for all). At Week 12, statistically significant improvements from baseline were also noted for total conjunctival staining score, central CFS score, Schirmer test score, and artificial tear use frequency (P ≤ 0.0029), and 69.4% of patients preferred CsA 0.09%. Most AEs were mild.

Conclusion: Treatment with CsA 0.09% elicited statistically significant improvement from baseline in DED signs and symptoms from Weeks 4 to 12 in patients inadequately controlled on CsA 0.05%. Overall, CsA 0.09% was well tolerated. The findings from this study suggest that switching from CsA 0.05% to CsA 0.09% may improve signs and symptoms in patients with DED.

Purpose: To compare the clinical performance of the divide and conquer and tilt and tumble techniques in cataract surgery with respect to surgical efficiency, safety and energy usage.

Setting: The research was conducted at two private clinics specialized in cataract surgeries located in the southern region of Sweden.

Design: The study was a prospective randomized controlled trial.

Methods: A total of 535 patients undergoing cataract surgery were randomized to either divide and conquer or tilt and tumble. Primary outcomes included total surgery time, phacoemulsification time, ultrasound time, cumulative dissipated energy (CDE) and intraoperative complications. Postoperative visual acuity, intraocular pressure (IOP) and, for a subset, central retinal thickness (CRT), were assessed at follow up.

Results: Tilt and tumble demonstrated significantly shorter operation time, 4.68 compared to 6.50 minutes (p<0.001), phaco time 60 versus 148 seconds (p<0.001) and ultrasound time, 32 versus 40 seconds (p<0.001) compared to divide and conquer. Baseline characteristics, Energy expenditure (CDE), intraoperative complications and postoperative outcomes did not differ significantly between groups.

Conclusion: Our results revealed that the tilt and tumble technique is notably swifter and demonstrates comparable safety, energy consumption and postoperative outcome compared to divide and conquer. This sheds light on the potential benefits of the tilt and tumble technique ultimately enhancing patient care.