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

Purpose: We evaluated the late-onset ocular hypotensive effect of ripasudil after long-term administration in real-world clinical data and investigated its associated factors in primary open-angle glaucoma (POAG).

Patients and methods: We reviewed the clinical patients with POAG who newly started ripasudil without changes of treatment. Enrolled eyes were assigned to two groups: positive group with the late-onset effect and negative group. Eyes that show the late-onset effect 6 months after starting ripasudil were defined as positive. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the late-onset effect.

Results: We enrolled 74 eyes of 74 patients with POAG (age, 67.5 ± 10.9 years; mean deviation, -11.2 ± 5.9 dB) and followed them for 14.2 ± 5.0 months. Among them, 12 (16.2%) eyes were assigned to the positive group. Retinal nerve fiber layer (RNFL) thickness (73.4 ± 12.9 vs 64.0 ± 9.8 μm, P = 0.04) and primary IOP (18.8 ± 4.1 vs 15.8 ± 4.3 mmHg, P = 0.01) before starting ripasudil were higher in the positive group than in the negative group. The late-onset effect was associated with higher IOP (OR, 1.22; 1.01-1.48) and thicker RNFL (2.76; 1.15-6.63).

Conclusion: Some patients with POAG showed the late-onset IOP-lowering effect of ripasudil, and its associated factors were higher IOP and thicker RNFL. The addition of ripasudil may offer potential benefits particularly for early-stage glaucoma with thicker RNFL.

Purpose: To evaluate the anatomical and visual outcomes of patients with rhegmatogenous retinal detachment (RRD) who received primary repair by combined pars plana vitrectomy with scleral buckling (PPV/SB) or pars plana vitrectomy (PPV) alone by using a propensity analysis.

Patients and methods: This study was a single center retrospective observational study. Medical records of patients who underwent surgical interventions between January 2013 and December 2019 were retrospectively reviewed. The single surgery anatomic success (SSAS) and final anatomic success were the primary outcomes, whereas the final visual acuity changes was the secondary outcome.

Results: This study included a total of 683 patients (683 eyes), with a median (interquartile range, IQR) follow-up duration of 13 (5.5 to 28.8) months. Of them, 211 patients (30.9%) underwent PPV/SB, while 472 patients (69.1%) underwent PPV as their primary procedure. The two treatment groups did not significantly differ in the risk of achieving SSAS (weighted risk difference: 0.012, 95% confidence interval (CI): -0.067 to 0.092, p value = 0.776) or achieving final retinal anatomic attachment (weighted risk difference: -0.038, 95% CI: -0.106 to 0.030, p value = 0.272). The occurrence of proliferative vitreoretinopathy was identical between the two treatment groups (56 patients (26.5%) for the PPV/SB group and 104 patients (22.0%) for the PPV group), p = 0.199. Nonetheless, the patients who received PPV alone showed a significantly greater mean improvement in VA (weighted mean difference; 0.295, 95% CI; 0.150, 0.440, p <0.001).

Conclusion: This work supports the findings that adding SB to PPV had little impact on anatomical results (either a single surgical success rate or the overall final success rate) for RRD repair. Although PPV alone is shown to improve vision, confirmation of these associations requires further prospective studies using standardized surgical techniques.

Purpose: To evaluate the safety and efficacy of sublingual methazolamide in patients with open-angle glaucoma (OAG) and inform future trial design.

Methods: Fourteen participants (28 eyes) aged 50 to 90 years with bilateral OAG and intraocular pressure (IOP) between 18 and 35 mmHg after medication washout were included. Participants were randomized to receive either 25 mg or 50 mg of sublingual methazolamide once daily for one week, followed by twice-daily administration during the second week. The primary outcome was change in IOP from baseline to days 7 and 14. Secondary outcomes included changes in serum methazolamide levels, serum electrolytes, urine pH and electrolytes, and side effects.

Results: After randomization, exclusion, and two dropouts, four patients in the 25 mg group and ten in the 50 mg group completed the study in full. Both doses of sublingual methazolamide resulted in significant reductions in IOP from the post-washout baseline at all follow-up points (all p < 0.05). Lowest mean IOPs were recorded 8 hours post-dose; after a week of daily dosing, the 25 mg and 50 mg groups achieved reductions of 6.6 mmHg (-26.5%) and 4.2 mmHg (-19.3%), respectively (both p < 0.001). Twice-daily dosing resulted in significantly lower morning IOPs compared to once-daily in each group (p = 0.05 for 25 mg; p = 0.003 for 50 mg). Serum methazolamide levels correlated with dose amount and frequency. Serum electrolyte levels were stable throughout, while urinary pH and urinary electrolytes fluctuated based on time since last dose. Side effects of mild headaches and/or fatigue were reported by 3 out of 14 (21.4%) participants, with no serious adverse events.

Conclusion: Sublingual methazolamide demonstrated effective IOP reduction with a favorable safety profile. Twice-daily dosing may offer more sustained IOP control. These findings support further investigation into sublingual methazolamide as an alternative glaucoma treatment.

Purpose: To compare the refractive prediction accuracy of the Optiwave Refractive Analysis (ORA) SYSTEM with the Barrett True-K (BTK) formula in calculating intraocular lens (IOL) power in eyes that underwent cataract surgery after previous myopic photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK).

Methods: This retrospective study evaluated patients aged ≥22 years with prior myopic PRK or LASIK who underwent unilateral or bilateral cataract removal and monofocal IOL implantation using the ORA SYSTEM at 177 sites in the United States. Two datasets were analyzed: All Eyes (ie, all eligible eyes) and First Surgery Eyes (ie, each patient's first implanted eye). All Eyes were subgrouped by axial length (AL) and further analyzed. The main outcomes included paired differences in absolute prediction errors (APEs) between the ORA SYSTEM and BTK and differences in the proportion of eyes with APEs of ≤0.25 diopter (D) and ≤0.50 D.

Results: 1067 eyes were analyzed, including 897 First Surgery Eyes. Significantly higher proportions of All Eyes had APEs of ≤0.25 D (P = 0.0128) and ≤0.50 D (P < 0.0001) using the ORA SYSTEM than the BTK formula. Similarly, significantly higher proportions of First Surgery Eyes had APEs of ≤0.25 D (P = 0.0037) and ≤0.50 D (P = 0.0004) using the ORA SYSTEM than the BTK formula. In both datasets, mean (P < 0.0001) and median (P ≤0.0005) APEs were significantly lower with the ORA SYSTEM than with the BTK formula. AL did not affect the differences in prediction accuracy between these IOL power calculations.

Conclusion: In post-myopic PRK or LASIK eyes undergoing cataract surgery, the ORA SYSTEM provided significantly more accurate refractive predictability than the BTK formula, as determined by mean and median APE.

Objective: To report the results and feasibility of a pilot expansion of the Toronto Tele-Retinal Screening Program in an elderly long-term care home.

Methods: Long term care patients with Type II diabetes mellitus (DM) were screened between April 1, 2022, and July 1, 2022. Demographic and health data were collected through surveys.

Results: A total of 28 patients were screened, with 85.7% successfully undergoing retinal imaging. Among imaged patients, 8.3% (2/24) required urgent follow-up. Pathologies identified included uncontrolled glaucoma (4.1%, 1/24), non-proliferative diabetic retinopathy (8.3%, 2/24), and age-related macular degeneration (45.8%, 11/24). The handheld camera successfully screened 60% (3/5) of patients with mobility issues. Overall, 90% (17/19) of patients rated their experience as either "brilliant" or "really good".

Discussion: This pilot project demonstrated the necessity for routine eye care in the elderly and the potential for widespread implementation of teleophthalmology in long-term care facilities. With only 14.3% (4/28) of patients unable to be imaged, this program offers a feasible, patient-friendly alternative to in-clinic screening. Future policies and practices in teleophthalmology should consider the unique needs of long-term care residents and the potential for reducing healthcare disparities through such a program.

Purpose: Our aim is to evaluate the sensitivity and specificity of Acuity 360 telemedicine system, as compared to in-person clinic examination, in identifying clinically significant eye disease. Acuity 360 is a combination of commercially available ocular imaging devices used together to provide a comprehensive evaluation of the structures and diseases of the eye.

Methods: Observational cross-sectional study of consecutively examined patients where 19 remote examiners analyzed 80 patients using Acuity 360 images. The examiners' diagnoses were compared to the diagnosis obtained from in-person clinic examination of all the patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-negative rate, and inter-rater agreement were calculated.

Results: Compared to in-person clinic examination, the sensitivity, specificity, PPV, NPV, and false-negative rate for the optical coherence tomography (OCT) of optic nerve were 95.8%, 98.5%, 86.8%, 99.6%, 0.39% and for the combined retina examination (OCT of the macula and widefield fundus photography) were 93.4%, 88.5%, 80.2%, 96.4%, 2.19%, respectively. The median inter-rater agreement the OCT of optic nerve and the combined retina examination were each 95%.

Conclusion: The Acuity 360 telemedicine system has a low false-negative rate and is highly sensitive and specific when compared to an in-person clinic examination. It can determine the necessity for specialist referral and triage the patients that require urgent treatment. High inter-rater agreement shows that it is effective with minimal variability in analyzing the Acuity 360 images by remote examiners.

Purpose: To study the effects of anti-VEGF injections on the prevalence of ocular hypertension (OHT), sustained elevated intraocular pressure (SE-IOP), and primary open-angle glaucoma (POAG) with age-matched controls.

Methods: A retrospective case-control study was performed with neovascular age-related macular degeneration (AMD) or diabetic macular edema (DME) against a control group involving atrophic AMD or diabetic retinopathy (DR) without DME. Bevacizumab, ranibizumab, or a combination of both were used in the treatment group. OHT was defined as IOP>21 mm Hg while SE-IOP was defined as IOP that increased by > 6 mmHg or was >25 mm Hg on two or more visits, 30 days apart. Patients with a pre-existing history of glaucoma, vein occlusions, IVI steroids, and pars plana vitrectomy were excluded.

Results: A total of 1312 eyes of 784 patients were included in the study. Using age-matched controls, the treatment and control group was further refined to 394 eyes of 224 patients compared to 340 eyes from 170 patients respectively. The mean age was 58.4 ± 8.7 for the control versus 58.8 ± 8.8 years for the treatment group. The average IOP was higher in the injection group compared to the control with 25.8 ± 9.3 versus 19.5 ± 5.1 mmHg respectively, P<0.001. Significant increases in POAG (10.7% vs 2.9%, p<0.01), OHT (67.0% vs 22.4%, p<0.001), and SE-IOP (41.1% vs 7.6%, p<0.001) were seen in the injection group compared to the age-matched control group. The rates of POAG and OHT were positively associated with the number of injections, R²=0.856, P<0.01 and R²=0.749, P<0.05, respectively.

Conclusion: Compared to age-matched controls, patients treated with anti-VEGF agents demonstrated an increased rate of OHT, SE-IOP, and POAG which correlated with the number of IVIs. However, additional prospective studies are needed to determine if there is a true association between intravitreal anti-VEGF injections and glaucoma.

Background: Refractive target of low simple myopic astigmatism allows increased depth-of-focus and near visual performance in monofocal intraocular lens (IOL) implants. This study investigated the effect of astigmatism and its axis on distance and near visual acuity (VA), and near visual performance for the Thai alphabet using the Thai MNREAD chart.

Design: Investigational simulation.

Methods: Distance (6.0 m) VA, near (40 cm) VA and near visual performance (maximum reading speed [MRS], threshold print size [TPS] and reading acuity [RA]), were assessed by the Thai MNREAD chart monocularly in 31 pseudophakic eyes (62.8 ± 8.55 years). Six refractive conditions were simulated using trial lenses: ±0.00 DS [in-focus at distance], +1.00 × 90 [ATR (Against-the-Rule)], +2.00 × 90 [ATR], +1.00 × 180 [WTR (With-the-Rule)], +2.00 × 180 [WTR], and +3.00 DS [in-focus at near].

Results: Distance VA was degraded by spherical and astigmatic defocus compared with +0.00 DS [in-focus (distance)] (p < 0.001). No significant difference in distance VA was found between ATR and WTR astigmatism at the same magnitude. Near VA was better with +3.00 DS (p-value < 0.001) compared with other refractive conditions. Near visual performance (threshold print size [TPS]) was significantly better in ATR compared with WTR astigmatism (p <0.001 for both +1.00 DC and 2.00 DC).

Conclusion: Low simple myopic astigmatism improved near visual performance in monofocal IOL implants at the expense of degradation of distance VA. ATR astigmatism provided better TPS than WTR astigmatism. This benefit of ATR over WTR astigmatism on reading performance on the Thai alphabet confirmed the role of axis orientation on near visual performance.

Purpose: To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation with subsequent trans-scleral diode cyclophotocoagulation (CPC) as the main intervention if IOP remained medically uncontrolled.

Patients and methods: Charts of 108 consecutive eyes (90 patients) that underwent AGV implantation from 2003 to 2018 at a single clinical practice were retrospectively reviewed. The procedure was considered a failure if any of the following occurred: additional incisional glaucoma surgery, IOP >21 mmHg or < 20% reduction from baseline on 2 consecutive study visits after 3 months, IOP ≤ 5 mmHg on 2 consecutive study visits after 3 months, loss of light perception, or AGV removal.

Results: The mean follow-up time was 5.4 ± 3.1 years. Diode CPC was performed in 32%. The mean IOP was 24.8 ± 8.2 mmHg before intervention, and 12.5 ± 5.6 mmHg at last follow-up (p<0.0001). The mean logMAR VA decreased by 0.24 (p=0.002). The success rate was 68%. The reasons for failure were additional incisional glaucoma surgery in 7%, AGV removal in 4%, loss of light perception in 4%, inadequate IOP reduction in 13%, and IOP ≤ 5 mm HG in 6%. The probability of survival by Kaplan Meier analysis was 88%, 76% and 69% at 1, 3, and 5 years after the procedure, respectively. Complications of AGV and CPC were comparable to those previously reported in the literature.

Conclusion: The treatment approach of AGV implantation with subsequent trans-scleral diode CPC, as needed, was successful in over 2/3rd of subjects. This study adds to the literature supporting the use of CPC when IOP is medically uncontrolled after AGV.