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

Purpose: This study aims to evaluate the inter-observer variability in assessing the optic disc in fundus photographs and its implications for establishing ground truth in AI research.

Methods: Seventy subjects were screened during a screening campaign. Fundus photographs were classified into normal (NL) or abnormal (GS: glaucoma and glaucoma suspects) by two masked glaucoma specialists. Referrals were based on these classifications, followed by intraocular pressure (IOP) measurements, with rapid decisions simulating busy outpatient clinics.In the second stage, four glaucoma specialists independently categorized images as normal, suspect, or glaucomatous. Reassessments were conducted with access to IOP and contralateral eye data.

Results: In the first stage, the agreement between senior and junior specialists in categorizing patients as normal or abnormal was moderately high. Knowledge of IOP emerged as an independent factor influencing the decision to refer more patients. In the second stage, agreement among the four specialists varied, with greater concordance observed when additional clinical information was available. Notably, there was a statistically significant variability in the assessment of optic disc excavation.

Conclusion: The inclusion of various risk factors significantly influences the classification accuracy of specialists. Risk factors like IOP and bilateral data influence diagnostic consistency among specialists. Reliance solely on fundus photographs for AI training can be misleading due to inter-observer variability. Comprehensive datasets integrating multimodal clinical information are essential for developing robust AI models for glaucoma screening.

Purpose: To evaluate real-world outcomes in subjects with pre-existing neovascular age-related macular degeneration (AMD) undergoing intravitreal avacincaptad pegol (IVA) treatment for geographic atrophy (GA).

Methods: This study was undertaken as a retrospective, case-controlled assessment of patients undergoing IVA treatment for GA from 2 community-based retina practices. Patients were separated into 1) a Study Group consisting of subjects with pre-existing neovascular AMD prior to initiation of IVA for GA, and 2) a Control Group consisting of AMD subjects without neovascularization prior to initiation of IVA for GA. Study and Control Group subjects had a baseline visual acuity of ≥ 20/200, a total GA lesion area of ≥ 1 mm² and ≤ 17.5 mm², and follow-up of 12-months following IVA commencement.

Results: A total of 64 patients were analyzed. No significant differences in baseline characteristics were found between cohorts. The Study Group had a greater decrease in visual acuity [-0.2 (-0.24 to -0.16) logMAR versus -0.04 (-0.06 to 0.02) logMAR; p<0.0001], a greater increase in GA lesion growth [1.36 (1.09-1.63) mm² versus 0.52 (0.34-0.70) mm²; p<0.0001], and a higher incidence of exudation (p=0.0002) compared to the Control Group during the study period.

Conclusion: This study suggests that patients undergoing IVA therapy for GA with pre-existing neovascular AMD have worse visual and anatomic outcomes at 12-months compared to a matched control group without pre-existing neovascularization; such patients therefore should be carefully counseled prior to initiation of IVA for the management of GA.

Purpose: Osteogenesis imperfecta (OI) is a rare hereditary disorder of the connective tissue. Despite recent attention to corneal abnormalities in OI, understanding remains limited. This study aimed to comprehensively evaluate corneal changes in a large sample of OI patients compared to controls using in vivo confocal microscopy (IVCM).

Patients and methods: Nineteen OI patients (mean age: 34.0 ± 16.00 years; 9 females, 10 males) and 20 healthy controls (mean age: 35.5 ± 12.00; 12 females, 8 males) were included, matched for age and gender. The integrity of corneal cell layers, with a focus on Bowman's layer and sub-epithelial stroma, was evaluated. Additionally, we conducted a quantitative analysis of the corneal sub-basal nerve plexus (CSNP), measuring nerve fiber density (NFD), nerve branch density (NBD), nerve fiber length (NFL), and dendritic cells (DCs) density. Clinical parameters including blue discoloration of the sclera, corneal thickness and sensitivity were also evaluated.

Results: Bowman's layer alterations were observed in 42.11% of OI patients. NFD was significantly reduced in OI patients (27,3±6.98 vs controls 37.85±13,74 fiber/mm2; p-value=0.005). NBD and NFL were lower in OI patients but did not reach statistical significance (p=0.650 and p=0.120, respectively). DCs density was higher in OI patients than controls (11,37 ± 12.79 vs 2.09±2,91 cells/mm2; p-value < 0.001). Corneal thickness and sensitivity were significantly reduced in OI patients compared to controls (p<0.001, p=0.001, respectively). OI patients with blue sclera or abnormal Bowman's layer exhibited even lower central corneal thickness (CCT) (p=0.010, p=0.005, respectively).

Conclusion: OI patients demonstrated Bowman's layer abnormalities, neuropathic changes and higher inflammatory cell count. These results suggest potential corneal complications, and hold promise for diagnostic applications and intervention strategies in OI.

Purpose: To determine if demographic factors and calculated areas of nonperfusion (NP) and neovascularization (NV) on ultra-widefield (UWF) fluorescein angiography (FA) in the eyes of patients with diabetes are associated with treatment with intravitreal injections (IVIs), panretinal photocoagulation (PRP), and diabetic retinopathy (DR) progression.

Patients and methods: This retrospective, cross-sectional study included 363 patients (651 eyes) treated at the University of Michigan Kellogg Eye Center between January 2009 and May 2018. Eligible participants were 18 years or older diagnosed with diabetes who received UWF FA. Patients with previous PRP or poor-quality images were excluded. Main outcome measures included comparison analyses of measured surface areas in millimeters squared (mm²) of total and regional retinal nonperfusion and neovascularization, number of IVIs and PRP treatments, and DR progression.

Results: Our cohort received 3,041 IVIs and 878 PRP treatments with a mean follow-up of 915 days (SD ±714). IVIs were positively associated with posterior NP (difference, 1.15 mm²; 0.43-1.86; P=0.0017). PRP treatments were positively associated with total NP (difference, 27.24 mm²; 14.68-39.79; P<0.001) and total NV (difference, 1.75 mm²; 0.84-2.65; P<0.001), as well as regional areas. While progression was not associated with NP/NV area, it was positively associated with a pre-existing diagnosis of type 2 as compared to type 1 diabetes (147% increase; 7-373% increase; p=0.03).

Conclusion: Areas of NP and NV on UWF FA demonstrated associations with PRP and IVIs in DR patients.

Purpose: This study evaluates the discrepancies between ACV measurements obtained from the Heidelberg Anterion and Zeiss IOLMaster 700 and investigates the significance of ACV and other ocular biometry parameters.

Patients and methods: To investigate intraocular fluid circulation, a robust formula was developed for ACV measurement using the Zeiss IOLMaster 700. A pilot study was conducted to validate this formula, which relied on WTW, CCT, and ACD. The formula used was ACV = (RAC)^2 × (CCD) × 1.51. ACV measurements showed a median of 155.38 (IQR = 131.15-180.06) for the Heidelberg Anterion and 144.11 mm³ (IQR = 125.62-159.81) for the Zeiss IOLMaster 700. The intraclass correlation coefficient (ICC) for ACV was 0.908, indicating excellent agreement between devices.

Results: Intraocular fluid volume was significantly lower in eyes with PEXS compared to those without. Eyes with PEX had an ACV of 133 ± 28.3 mm³ versus 142 ± 30.7 mm³ in non-PEX eyes, a statistically significant difference (t (196) = -2.09, p = 0.038, d = -0.301). Significant differences were also observed in ACD and AL between PEX and non-PEX eyes, with PEX eyes showing reduced measurements.

Conclusion: Our findings reveal that age-related changes in ACD and ACV are significant, with the redefined formula showing excellent agreement with AS-OCT methods. Eyes with PEX exhibit reduced ACD, ACV, and AL measurements. Additionally, an accessible method for ACV measurement, not relying on Pentacam or AS-OCT, would be valuable, particularly in developing countries, to facilitate broader clinical research.

Purpose: To report the 12-month clinical outcomes in eyes with mild to moderate open-angle glaucoma (OAG) in Hispanic adults undergoing STREAMLINE Surgical System (STREAMLINE) canaloplasty combined with phacoemulsification.

Patients and methods: This was a prospective, multi-center, interventional clinical trial involving 45 eyes of 45 Hispanic adult patients receiving topical medical therapy for mild to moderate OAG and undergoing phacoemulsification surgery for visually significant cataracts at three sites. All eyes underwent a Screening visit, followed by medication washout and a subsequent Baseline visit to determine eligibility for STREAMLINE canaloplasty. The primary outcome was the proportion of unmedicated eyes with intraocular pressure (IOP) reduction of ≥20% from Baseline at Month 12. Secondary outcomes included mean change in IOP from post-washout Baseline, mean change in IOP-lowering medications compared to pre-washout Screening, and adverse events (AEs).

Results: 43 eyes met the eligibility criteria for analysis and 40 eyes completed the 12-month visit. The mean (standard deviation) age was 68.7 (8.6 years), 76.7% were female, and 72.1% of the eyes were classified as having mild OAG. The mean number of IOP-lowering medications at Screening was 1.95 (0.82). After washout, the Baseline mean IOP was 23.0 (1.8) mmHg. At Month 12, 28/40 eyes (70.0%) remained medication-free, of which 27 (96.4%) had an IOP reduction of ≥20% from Baseline. The mean IOP at Month 12 was 15.3 (2.8) mmHg, a reduction of 7.8 (3.0) mmHg from Baseline (p<0.001). The mean medication use at Month 12 was 0.63 (1.19) per eye, representing a mean reduction of 1.38 (1.03) medications from Screening (p<0.001). Device- or procedure-related ocular AEs were mostly mild in severity and self-limited.

Conclusion: STREAMLINE canaloplasty in combination with phacoemulsification provides clinically and statistically significant reduction in IOP and IOP-lowering medications in eyes with mild to moderate OAG in Hispanic adults.

Anorexia nervosa (AN) is a psychiatric eating disorder characterized by body mass index (BMI) ≤ 18.5, fear of gaining weight, and a distorted perception of body weight. With increasing rates of myopia, there is a population of patients who concurrently develop AN and may seek corneal refractive surgery. This study reviews the ophthalmic manifestations of AN and provides preliminary guidelines for patients with AN undergoing corneal refractive surgery. The literature search was conducted through the PubMed, Scopus, and Ovid databases through June 2, 2024, for publications detailing the ocular manifestations of AN. These findings were then considered in the context of potential complications after corneal refractive surgery, and preoperative guidelines for patients with AN were formulated. Twelve articles described a total of 114 patients with AN (227 eyes) with ophthalmic manifestations. Among the studied eyes, 14% had ocular surface abnormalities, 5% had cataracts/visual disturbances, 64% had posterior segment abnormalities, and 20% had orbital/neurological abnormalities. Various ophthalmic findings of AN may increase the risk of delayed corneal wound healing, ocular surface dryness, perioperative bleeding, flap-related complications, and poor visual outcomes after corneal refractive surgery. The BMI of patients suspected with AN must be assessed, and patients should be screened for diagnosis of AN. If mildly and moderately underweight patients with AN have normal ophthalmic and medical workups, they may proceed with a typical preoperative workup for corneal refractive surgery. Ultimately, the decision to recommend elective corneal refractive surgery for these patients rests with the surgeon. This study should be considered a foundation for future research, encouraging collaboration across medical disciplines to develop more comprehensive guidelines for managing this patient population.

Objective: To investigate the relationship between postoperative oxidative stress and corneal endothelial cell loss in diabetic patients with cataract.

Methods: One hundred and twenty patients who underwent phacoemulsification were selected, including 80 diabetic patients with cataract and 40 patients with ordinary cataracts. Corneal endothelial cell loss was recorded, and the endothelial cell density (ECD), the proportion of hexagonal cells, and the corneal thickness within the central corneal area were compared. According to the severity of endothelial cell loss, the diabetic patients with cataract were divided into a general loss group (n = 37) and a serious loss group (n = 43), and the postoperative serum superoxide dismutase (SOD), malonaldehyde (MDA), and glutathione peroxidase (GSH-Px) were measured. The relationship between oxidative stress factors and corneal endothelial cell loss in diabetic patients with cataract was analyzed, and the predictive value of MDA, SOD, and GSH-Px was investigated by using receiver operating characteristic (ROC) curve.

Results: Diabetic patients with cataract had higher serum MDA and lower SOD and GSH-px, and higher fasting blood glucose concentration, glycosylated hemoglobin level, and low-density lipoprotein cholesterol (P < 0.05). The mean change in ECD in diabetic patients with cataract was 10.95%, which was greater than the 6.11% in non-diabetic patients with cataract (P < 0.05), and the proportion of hexagonal cells decreased and corneal thickness increased. MDA levels was negatively correlated with corneal endothelial cell loss in diabetic patients with cataract (r_s = 0.509), and SOD and GSH-px were negatively correlated (r_s = -0.361, r_s = -0.482). The area under the ROC curve of MDA, SOD, and GSH-px in corneal endothelial cell loss was 0.719, 0.773, and 0.752, respectively.

Conclusion: The degree of postoperative corneal endothelial cell loss in diabetic patients with cataract was greater and positively correlated with MDA, and negatively correlated with SOD and GSH-px.

Purpose: To evaluate the outcomes of scleral-fixated intraocular lenses (IOLs) implanted using either Yamane technique or Gore-Tex suture fixation, in comparison to intracapsular lens fixation, and to assess the efficacy of various lens formulas in achieving predicted refractive targets.

Patients and methods: This study included 45 eyes from 44 patients with scleral-fixated IOLs, comprising 37 Yamane eyes and 8 Gore-Tex eyes. Preoperative refractive predictions from various formulae were compared with final postoperative refraction. Outcomes assessed included effective lens position (ELP), postoperative predictive error, and changes in visual acuity. The ELP of scleral-fixated IOLs was compared with that of intracapsular IOLs in fellow eyes.

Results: Average ELP for Yamane IOLs was 0.62 mm more posterior relative to intracapsular IOLs but was not significantly different for Gore-Tex IOLs. Average postoperative logMAR acuity change was significant at -1.30 (p=4.5x10^-11) and -1.65 (p=5x10^-4) for Yamane and Gore-Tex eyes, respectively. Mean prediction error for Yamane eyes was +0.29±1.3 D, -0.53±0.40 D, +0.80±1.4 D, and +0.43±1.4 D using Barrett Universal II, Holladay, Hill-RBF, and Hoffer QST formulas, respectively. Mean prediction error for Gore-Tex eyes was -0.37±1.24 D and +0.53±1.19 D using Barrett Universal II and Holladay formulas, respectively.

Conclusion: Different scleral fixation techniques result in variations in ELP compared to intracapsular IOL placement. In our hands, when using the Yamane technique, surgeons should aim for a myopic refractive target to offset hyperopic errors when employing the Barrett Universal II, Hill-RBF, or Hoffer QST formulas, and a hyperopic target when using the Holladay formula. For Gore-Tex IOLs, a slightly hyperopic target is recommended to counter myopic error when using the Barrett Universal II formula, whereas a slightly myopic target is advised with the Holladay formula to offset hyperopic error. A limitation of our study is the small sample size for patients who underwent Gore-Tex suture fixation.

Purpose: To identify the minimally required number of distances of visual acuity (VA) measurements for the reliable estimation of the visual acuity curve (VAC) and area of the curve (AoC) in presbyopia correction.

Patients and methods: The study was divided into a validation and a clinical phase with a total recruitment of 120 participants (120 eyes) who underwent uncomplicated pseudophakic presbyopia surgery with bilateral premium intraocular lenses (IOL) implantation. This study was conducted in the Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. Postoperative VAC and AoC were calculated with VA measurements taken at nine pre-defined distances. A mathematical model based on cubic spline interpolation was developed and assessed comparing the VAC and AoC values obtained using nine distances, with the ones predicted when a subset of VA measurements was inserted into the model.

Results: Less than four measurements resulted in unreliable VAC and AoC assessment. Optimal distances for four to six VA measurements were determined. Mean error in the prediction of VAC and AoC of the clinical group ranged from 2.54 Letters/1.74% (6 measurements) to 2.90 letters/2.9% (4 measurements), respectively.

Conclusion: Mathematical models that use cubic spline interpolation provide reliable VAC and AoC estimation, even with four VA measurements, when obtained at specific distances.