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

Purpose: To characterize the clinical phenotype and elucidate the pathogenic mechanism of the novel TIMP3 p.Y191C variant in a multigenerational Asian pedigree with Sorsby Fundus Dystrophy (SFD).

Methods: Affected family members underwent comprehensive ophthalmic evaluations. Genetic analysis was performed via whole-exome and Sanger sequencing. An ARPE-19 cell models overexpressing wild-type or mutant TIMP3 were generated. Functional analysis including co-immunoprecipitation (Co-IP), MMP inhibition, and immunofluorescence were performed.

Results: A heterozygous TIMP3 p.Y191C variant was identified in seven affected members, co-segregating with bilateral choroidal neovascularization and disciform scarring. The tyrosine-191 residue is highly conserved, and structural/computational analyses predicted that the cysteine substitution introduces a smaller, hydrophobic residue and reduces protein stability. Functionally, the Y191C variant impaired TIMP3 binding to MMP2 and MMP9, reduced its inhibitory activity, and altered MMP2 localization following LPS stimulation. Consistent with this loss of function, the mutant TIMP3 significantly inhibited cell viability and promoted apoptosis in ARPE-19 cells under inflammatory stress.

Conclusion: The novel TIMP3 p.Y191C variant causes SFD in an Asian pedigree. Its pathogenicity arises from distinct disruptions in MMP2/9 binding and inhibition, coupled with altered MMP2 localization, thereby providing a mechanistic basis for the disease.

Purpose: Keratopathy can be caused by multiple factors including neuropathy, inflammation, radiation, among others. Amniotic membrane (AM) is known to have anti-inflammatory and anti-scarring properties, which helps promote epithelialization. Herein, we assessed application of AM to promote epithelialization in the treatment of recalcitrant keratopathy.

Patients and methods: A single-center, retrospective review was performed of consecutive patients with recalcitrant keratopathy that failed to respond to conservative treatment who were subsequently treated with shelf-stable cryopreserved AM. Corneal staining, corneal sensitivity, tear osmolarity, uncorrected visual acuity (UCVA), and complications were assessed before treatment as well as one-week, one-month, and three-months post-treatment.

Results: A total of 34 eyes of 18 subjects were included in the analysis. All eyes were diagnosed with recalcitrant keratopathy (n=34), of which 7 (20.6%) eyes had reduced corneal sensation. Eyes were treated with shelf-stable AM for an average of 2.0 ± 0.6 days. Corneal staining scores significantly improved from 1.52 ± 0.68 at baseline to 0.50 ± 0.85 at 1 week (p=0.01), 0.25 ± 0.43 at 1 month (p<0.001), and 0.47 ± 0.91 at 3 months (p=0.007). The percentage of eyes with no corneal staining was 70.0% at 1-week, 72.7% at 1-month, and 73.7% at 3-months. Corneal sensitivity improved from 2.3 ± 1.4 at baseline to 1.6 ± 0.9 at 1 week (p=0.31), 1.38 ± 0.7 at 1 month (p<0.001), and 1.11 ± 0.32 at 3 months (p=0.002). UCVA changed from 0.24 ± 0.26 at baseline to 0.14 ± 0.16 at 1 week (p=0.41), 0.18 ± 0.23 at 1 month (p=0.013), and 0.11 ± 0.08 at 3 months (p=0.08). Tear osmolarity did not significantly change from baseline at any timepoint. No complications or adverse events were noted.

Conclusion: Shelf-stable cryopreserved AM transplantation led to a significant improvement in corneal epithelization, corneal sensitivity, and visual acuity in patients with recalcitrant keratopathy.

Purpose: To compare test duration and the agreement of summary metrics between the TEMPO, Virtual Eye ELITE (VEE), and Humphrey Field Analyzer (HFA) perimeters.

Methods: This was a prospective, randomized, comparative study. Subjects were excluded if they were unable to tolerate ophthalmic imaging or had any ocular or systemic conditions that could affect visual field test results, such as age-related macular degeneration, peripheral retinal disease, or severe glaucoma. Eligible subjects were assessed at 1 visit with all perimeters for total bilateral acquisition time, mean deviation (MD), pattern standard deviation (PSD), foveal threshold (FT), visual field index (VFI), false positives and false negatives, and administered a questionnaire.

Results: A total of 54 subjects completed the study. Mean bilateral visual field acquisition time differences were significant between TEMPO and HFA (p < 0.001) and TEMPO and VEE (p < 0.001), and not significant between HFA and VEE (p = 0.34). Mean MD differences were not significant between TEMPO and HFA (p = 0.96) and were significant for TEMPO and VEE (p = 0.01) and HFA and VEE (p = 0.02). Mean PSD differences were not significant between TEMPO and HFA (p = 0.27), TEMPO and VEE (p = 0.72), or HFA and VEE (p = 0.72). Mean foveal threshold differences were significant between TEMPO and HFA (p < 0.001), TEMPO and VEE (p < 0.001), and HFA and VEE (p < 0.001). A significantly higher percentage of subjects reported agreement that the testing was "Easy" to perform with the TEMPO compared to HFA (p < 0.001), TEMPO compared to VEE (p = 0.006), and with VEE compared to HFA (p = 0.002).

Conclusion: The results suggest similar summary metrics between the HFA, TEMPO, and VEE perimeters. There was faster acquisition time with the TEMPO. These results also indicate the potential for streamlined clinical workflow.

Purpose: Myopia causes retinal structural and microvascular alterations, impairing visual function. This study examined macular vessel density using optical coherence tomography angiography (OCTA) and its relationship with macular light sensitivity (MLS) in myopic eyes, particularly in extreme myopia, to determine if vessel density can serve as an early marker for detection and monitoring of functional changes.

Patients and methods: A cross-sectional study included 283 myopic eyes (age 18-60 years) grouped into low/moderate (LM&MM: -0.50D ≥ SE > -6.00D), high (HM: SE -6.00D to -10.00D), and extremely high myopia (EHM: SE ≤-10.00D). All eyes underwent OCT and OCTA (6 × 6mm macular scans) to measure retinal and ganglion cell complex thicknesses and superficial (SVD) and deep vessel densities (DVD), as well as MP-1 microperimetry to assess MLS in central and parafoveal regions. Key outcome parameters were SVD, DVD, GCCT, and MLS.

Results: Macular SVD, DVD, and MLS decreased with increasing myopia severity (p < 0.01). Extremely myopic eyes had significantly lower SVD (47.37 vs 49.57), DVD (52.33 vs 55.55), and MLS (18.54 dB vs 19.24 dB) than low/moderate myopia eyes (all p < 0.01). These reductions were significant in most parafoveal quadrants, sparing the central foveal area (for vessel density) and nasal quadrant (for sensitivity). DVD correlated positively with MLS, especially in EHM and in the overall cohort, whereas SVD showed more limited correlations, primarily in the superior and temporal sectors. Multivariate regression identified DVD as an independent predictor of MLS, alongside SE and axial length.

Conclusion: Macular vessel density, particularly in the deep vascular plexus, declines with greater myopia and correlates with diminished macular function. OCTA-derived macular vessel density could be a promising biomarker candidate for early detection and monitoring of retinal functional impairment in myopic eyes.

Purpose: To compare six-month refractive accuracy, visual performance, and patient-reported outcomes of a bi-aspheric trifocal intraocular lens (IOL) in Asian and European patients.

Methods: In this prospective observational study at Chang Gung Memorial Hospital (Taiwan) and Oftalvist Alicante (Spain), 50 patients (25 Taiwanese, 25 Spanish) received bilateral implantation of the same trifocal IOL during routine phacoemulsification. Visual acuity and defocus curves were measured with Landolt C charts (culturally neutral). Binocular contrast sensitivity was tested under photopic (85 cd/m²) and mesopic (3 cd/m²) conditions, with and without glare. Patient satisfaction was evaluated using the Catquest-9SF.

Results: Both groups achieved near-emmetropic outcomes, with 98% of Spanish and 80% of Taiwanese eyes within ±0.50 D of target refraction. Spanish eyes showed significantly lower residual astigmatism (-0.11 ± 0.20 D) than Taiwanese eyes (-0.72 ± 0.41 D; p < 0.001), corresponding to superior monocular and binocular acuities at distance, intermediate, and near. Despite this, Taiwanese patients reported comparable or higher satisfaction scores, suggesting cultural factors and visual demands affect perceived quality of vision. Contrast sensitivity for both cohorts fell within or above normative ranges, with minor losses at higher spatial frequencies under mesopic glare.

Conclusion: The bi-aspheric trifocal IOL delivers excellent refractive and functional results in both Asian and European eyes. The divergence between objective metrics and patient-reported satisfaction underlines the necessity of including subjective outcomes in multifocal IOL assessments.

Purpose: Angle-closure glaucoma is more common among Asians, including Japanese individuals, and iris curvature (I-Curv) is reportedly useful for its diagnosis. To investigate age-related changes in iris configuration and their associated factors in Japanese participants using I-Curv measured using anterior segment optical coherence tomography (AS-OCT).

Patients and methods: A total of 480 healthy Japanese individuals aged 20-99 years were enrolled. The anterior segment parameters of the anterior chamber, angle, and iris were measured using AS-OCT (CASIA2). The relationships between I-Curv and other parameters were assessed using Spearman's rank correlation coefficient. Differences in the I-Curv among age groups were analyzed using the Kruskal-Wallis test, followed by pairwise comparisons with Bonferroni correction. Multiple regression analysis was performed with I-Curv as the dependent variable and age, refractive error, sex, axial length, and anterior segment parameters as the independent variables. Further, eyes were classified into concave and convex groups based on the sign of I-Curv, and clinical characteristics were compared between these groups.

Results: I-Curv tended to increase (become more anteriorly convex) with age, showing significant differences among age groups (P < 0.001). However, no significant differences were observed between the adjacent age groups. Spearman correlation revealed significant negative correlations between I-Curv and angle/anterior chamber parameters such as AOD500 and ACD, and positive correlations with LV, age, and refractive error. Multiple regression analysis identified AOD500, ARA500, LV, refractive error, age, and pupil diameter as significant factors influencing the I-Curv (R² = 0.824, P = 0.043). Compared with the convex group, the concave group was significantly younger, had greater myopia, wider anterior chambers and angles, and tended to include more males (P < 0.05).

Conclusion: The iris tended to become more anteriorly convex with increasing age, and these changes appeared to be strongly influenced by angle configuration.

Purpose: To compare the histological effects of a novel endo-cyclophotocoagulation (ECP) device (Leos, BVI Medical, Waltham, MA), a standard ECP (BVI Medical, Waltham, MA), and transscleral cyclophotocoagulation (TCP) on the ciliary body and processes in human cadaveric eyes.

Patients and methods: Cross-sectional histological analysis of three cadaveric human eyes, where each laser method was used to treat a segment of the ciliary body and ciliary processes of each eye. Each treated eye was then prepared for histologic assessment by dissecting the anterior segment away from the posterior segment to isolate the ciliary processes and adjacent tissues, followed by segmenting them according to the specific treatment protocol. After fixation in blocks, 8 μm sections were prepared, dewaxed in xylene, hydrated in decreasing concentrations of ethanol, stained with haematoxylin and eosin/phloxine, and examined histologically using standard light microscopy.

Results: Histologic examination revealed that both standard and novel ECP caused contraction of the ciliary processes and disruption of the pigmented epithelium with minimal effect on stromal architecture. TCP resulted in disruption of the ciliary body muscle, stroma, ciliary processes, and both pigmented and non-pigmented ciliary epithelium.

Conclusion: The novel ECP led to similar tissue changes to the standard ECP in human cadaveric eyes. TCP led to extensive tissue disruption that extended beyond the ciliary processes into the stroma and adjacent ciliary muscles, which is consistent with previous studies of TCP. Future prospective clinical studies would provide data on how the novel ECP device compares to both standard ECP and TCP in both safety and efficacy.

Purpose: To evaluate the anatomical and functional effects of optic chiasm compression caused by a pituitary adenoma both before and after surgery.

Patients and methods: Short-term prospective study of 48 eyes from 24 patients who underwent radical surgery for pituitary adenoma. Comprehensive ophthalmological assessment was performed and OCT (optical coherence tomography) parameters (RNFL - retinal nerve fiber layer, GCL - ganglion cell layer, BMO-MRW - Bruch's membrane opening-minimum rim width) and BVCA (best corrected visual acuity) using ETDRS (Early Treatment Diabetic Retinopathy Study) chart were evaluated before surgery and 3 months after surgery.

Results: Over time, a decline in RNFL was observed in circular scans of 3.5 mm, 4.1 mm, and 4.7 mm (p = 0.001-0.04), as well as in GCL (p = 0.001-0.022) and BMO-MRW (p = 0.001-0.033). The median improvement in vision was 4 letters (IQR 0-6) (p < 0.001). A positive correlation between RNFL and visual improvement was found only in the TS (temporo-superior) sector in the 4.7 mm circle (p = 0.018). A negative correlation was observed between the difference between preoperative and normative RNFL and GCL values and the postoperative BCVA (RNFL p = 0.005-0.046, GCL p = 0.009-0.022).

Conclusion: Following radical surgery all three OCT parameters show a significant decline. While the reduction between preoperative and postoperative values does not influence the final visual outcome, preoperative atrophy of the RNFL and the GCL is negatively correlated with postoperative BCVA. The BMO-MRW may represent a novel marker of compressive neuropathy.