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

Purpose: To describe the visual, refractive, functional, and patient satisfaction outcomes of the Bi-Flex POB-MA 877PEY (Elon^®, Medicontur Medical Engineering Ltd. Zsámbék, Hungary) extended depth-of-focus intraocular lens (EDoF IOL).

Patients and methods: This was a prospective longitudinal descriptive study. Patients who underwent cataract surgery with the implantation of Bi-Flex POB-MA 877PEY IOL were included. Monocular refractive outcomes and visual acuity at distance, intermediate, and near were evaluated 1- and 3-month post-op. Binocular contrast sensitivity (CSV-1000, VectorVision, USA), binocular defocus curve, and patient satisfaction with the Visual Functioning Questionnaire (VFQ) were assessed at 3-month post-op.

Results: 20 Bi-Flex POB-MA 877PEY IOL were implanted bilaterally in 10 patients. The mean age of the patients was 68.60±4.45 years. At 1-month post-op the monocular Corrected Distance Visual Acuity (CDVA), intermediate (CIVA) and near (CNVA) was 0.02±0.03, 0.29±0.08, and 0.40±0.05 LogMAR respectively. At 3-month post-op the CDVA decrease to 0.05±0.06 LogMAR (p=0.042), and CIVA and CNVA remained stable at 3-month post-op (p>0.05). No statistical differences were found in post-op spherical equivalent at 1 and 3 month (-0.03±0.19 D and -0.03±0.13 D; p=1.000). 100% of eyes were within ±0.5 D at 1 month and 3-month post-op. Binocular defocus curve shows a peak of maximum visual acuity (VA) at 0 D (0.00±0.04 LogMAR), and a constant and progressive decrease at -1.50 D, and -2.50 D (0.15±0.08 LogMAR and 0.33±0.10 LogMAR, respectively). Contrast sensitivity decreased at high spatial frequencies. In patient satisfaction at 3 months post-op, VFQ reveals that 90% of patients revealed no or minor difficulty with glare/flare and 100% of patients have no or minor difficulty with halos. In overall satisfaction, 80% of patients rate their vision between 8 and 9 from a scale from 0 to 10.

Conclusion: The Bi-Flex POB-MA 877PEY EDoF IOL provides good visual outcomes for distance, and adequate intermediate vision, with low visual disturbances.

Background: Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management of various ocular conditions, including diabetic macular edema (DME), retinal vein occlusion (RVO)-related macular edema (ME), and neovascular age-related macular degeneration (nAMD). However, there remains a need to systematically assess its effectiveness across these distinct conditions.

Methodology: A systematic review was conducted to identify studies evaluating the efficacy of anti-VEGF therapy in improving ocular outcomes in patients with DME, RVO-related ME, and nAMD. PubMed, Embase, and Cochrane Library databases were searched for relevant articles published up to 2024. Studies meeting the inclusion criteria were critically appraised, and data on the proportion of patients gaining ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in best-corrected visual acuity (BCVA), mean change in BCVA (ETDRS letters), and reduction in central macular thickness (CMT) (μm) were extracted and synthesized.

Results: The systematic review identified 18 studies comprising randomized controlled trials, prospective studies, retrospective analyses, and observational studies. Anti-VEGF therapy demonstrated efficacy across all three conditions, with varying proportions of patients experiencing improvements in BCVA and reductions in CMT. Notably, the proportion of patients gaining ≥15 ETDRS letters ranged from 18.1% to 44.8% in DME, while mean changes in BCVA ranged from +4.2 letters to +21.4 letters in RVO-related ME and nAMD. Reductions in CMT ranged from 183.1 μm to 294 μm in DME and RVO-related ME.

Conclusion: Anti-VEGF therapy represents a cornerstone in the management of DME, RVO-related ME, and nAMD, with significant improvements observed in BCVA and reductions in CMT across diverse patient populations. While our findings support the effectiveness of anti-VEGF therapy in improving ocular outcomes, further research is warranted to compare its efficacy with alternative treatment modalities and to elucidate its long-term safety profile.

Purpose: To assess the potential influence of serum biochemical factors, specifically lipid profile parameters, on visual outcomes in patients with non-arteritic anterior ischemic optic neuropathy (NAION).

Patients and methods: All patients diagnosed with NAION at Rajavithi Hospital between 1 January 2011 and 31 December 2020 were retrospectively reviewed. The primary outcome was defined as visual recovery, measured by an improvement of at least 0.2 logarithm of the minimal angle of resolution (logMAR) in their best-corrected visual acuity (BCVA) at the 12-weeks follow-up visit compared to the initial visit and determine whether those lipid profiles parameters are predictive of 12 weeks-visual outcomes. Factors of an initial poor VA were evaluated using logistic regression analysis.

Results: In this study, 84 patients with NAION were included to assess the impact of lipid parameters on visual outcomes. Majority of participants were male. The group with initial VA worse than 20/200 had significantly higher mean age of 58.3±7.6 years and levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL) (all p < 0.05 respectively). Throughout 12 weeks, a significant difference in change of BCVA between the two groups of initial VA was observed (p<0.001). Regarding lipid parameters on visual prognosis, lipid profile between the two groups of VA improvement of 0.2 logMAR was comparable different. The probability of VA improvement showed a weak association with TC levels. A gradual increase in probability slightly related to LDL parameter, while TG showed an inverse relationship. At elevated lipid levels, there was a greater degree of uncertainty in predicting visual outcomes.

Conclusion: While older age and elevated lipid levels, specifically TC, TGs, and LDL, were correlated with poorer initial visual acuity in NAION patients, no significant associations were identified between lipid parameters and long-term visual recovery. Early detection for individuals with dyslipidemia (DLP) and advanced age merit attention.

Purpose: Online circular contrast perimetry provides visual field testing on any computer or tablet without additional hardware. This study compared outcomes of online circular contrast perimetry (OCCP) and standard automated perimetry (SAP) in a developing world setting.

Methods: The longitudinal and observation study was conducted on patients sampled during 2023 at Hanoi Medical University Hospital. Participants were either healthy volunteers as controls or stable glaucoma patients with either primary angle closure or primary open-angle glaucoma. They underwent a comprehensive ocular examination, retinal nerve fiber layer optical coherence tomography scan, and visual field tests performed at baseline and after 3 months and 6 months, using OCCP and SAP in clinic.

Results: The current study was carried out in 168 eyes of 87 patients at baseline, 133 eyes of 69 patients at 3 months, and 121 eyes of 63 patients at 6 months. At baseline, OCCP mean deviation (MD) (R² = 0.804, p < 0.001) and visual index (VI) (R² = 0.892, p < 0.001) were strongly correlated with SAP MD and visual field index (VFI) respectively. There was strong agreement and correlation between MD and VI/VFI for SAP and OCCP on repeated testing after 6 months. At 6 months AUC of SAP VFI (0.79) was superior to AUC of OCCP VI (0.67, p = 0.036); otherwise there was no difference in AUC of MD or VI/VFI at baseline, 3 and 6 months, when comparing OCCP and SAP.

Conclusion: OCCP parameters are significantly correlated with those of SAP. OCCP has the potential to provide a complementary role to SAP in glaucoma screening and monitoring.

Purpose: To report our real-world experience using intravitreal faricimab, a novel anti-vascular endothelial growth factor (anti-VEGF) therapy, in eyes with neovascular age-related macular degeneration (nAMD) previously treated with other anti-VEGF therapy.

Patients and methods: A retrospective, single-center study of previously treated nAMD eyes treated with faricimab.

Results: In 88 eyes (73 patients), mean baseline best-corrected visual acuity (BCVA) was 20/63 (range 20/20 to CF) with mean anti-VEGF injection interval of 6.1+2.0 weeks. Mean baseline central subfield thickness (CST) was 291+73 µm. During mean follow-up of 30.1+13.5 (range 7.0 to 50.3) weeks on faricimab, the eyes received an average of 5.1+2.4 injections (range 1 to 11). Mean BCVA remained at 20/63 (p=0.11), but injection interval increased to 7.4+2.6 weeks (p<0.001), and CST decreased to 262+63 µm (p<0.001). Multiple linear regression analysis revealed that higher number of different anti-VEGF drugs used at baseline was associated with a lower decrease in CST on faricimab (p=0.04) while total number of anti-VEGF injections at baseline (p=0.56) and time on faricimab (p=0.68) were not associated. Faricimab was discontinued in 23 eyes (26.1%), including 8 eyes for poor response, 2 eyes for persistent new floaters and 4 eyes for new vision decrease which reversed after stopping faricimab.

Conclusion: In previously treated nAMD eyes, intravitreal faricimab was associated with increased mean treatment interval and decreased CST but no improvement in mean BCVA. The benefit of faricimab on CST reduction may be diminished in eyes previously treated with multiple different types of anti-VEGF therapy.

In the dynamic field of ophthalmology, artificial intelligence (AI) is emerging as a transformative tool in managing complex conditions like uveitis. Characterized by diverse inflammatory responses, uveitis presents significant diagnostic and therapeutic challenges. This systematic review explores the role of AI in advancing diagnostic precision, optimizing therapeutic approaches, and improving patient outcomes in uveitis care. A comprehensive search of PubMed, Scopus, Google Scholar, Web of Science, and Embase identified over 10,000 articles using primary and secondary keywords related to AI and uveitis. Rigorous screening based on predefined criteria reduced the pool to 52 high-quality studies, categorized into six themes: diagnostic support algorithms, screening algorithms, standardization of Uveitis Nomenclature (SUN), AI applications in management, systemic implications of AI, and limitations with future directions. AI technologies, including machine learning (ML) and deep learning (DL), demonstrated proficiency in anterior chamber inflammation detection, vitreous haze grading, and screening for conditions like ocular toxoplasmosis. Despite these advancements, challenges such as dataset quality, algorithmic transparency, and ethical concerns persist. Future research should focus on developing robust, multimodal AI systems and fostering collaboration among academia and industry to ensure equitable, ethical, and effective AI applications. The integration of AI heralds a new era in uveitis management, emphasizing precision medicine and enhanced care delivery.

Background: Geographic atrophy (GA) is an advanced form of age-related macular degeneration leading to irreversible vision loss and negative impacts on quality of life.

Methods: To assess the experiences of living with GA, the Geographic Atrophy Insights Survey (GAINS) was conducted between October 12, 2021, and December 10, 2021, captured the responses of individuals ≥60 years with a self-reported GA diagnosis residing in the United States, Canada, Australia, and six European countries. Survey questions focused on the perceptions of individuals living with GA and covered six themes: speed of disease progression, effect on independence, impact on quality of life, emotional toll of GA, misconceptions and need for further education about GA, and clinician interactions. An exploratory comparison between participants with unilateral and bilateral GA was conducted.

Results: The survey included 203 individuals with a mean age of 70 years; 42% had bilateral GA. Most respondents (77%) agreed ("strongly" or "somewhat agreed") that GA impacted their vision faster than expected, and 68% agreed that it is hard to enjoy life fully the way they did before GA diagnosis. Regarding comparisons between individuals with bilateral and unilateral GA, both groups reported similar "major" or "moderate" negative impacts on their ability to drive (73% vs 75%, respectively), followed by the ability to read (66% vs 71%), and ability to travel as much as they would prefer (62% vs 62%). Among participants, 49% and 56% of respondents with bilateral and unilateral GA, respectively, reported major/moderate negative impacts on self-confidence and 40% of both cohorts reported major/moderate negative impacts on mental health.

Conclusion: Our survey provides further insight on the burden experienced by individuals living with GA. We find similar responses between unilateral and bilateral GA groups, highlighting the impact GA may have on an individual's quality of life even when only one eye is affected.

Objective: To assess the short-term effects of Multiwavelength Photobiomodulation (LumiThera Valeda Light Delivery System) on retinal functional behavior in patients with retinitis pigmentosa (RP).

Materials and methods: Twelve RP patients (24 eyes) underwent treatment involving nine photobiomodulation (PBM) sessions using the Valeda system, which emits three distinct wavelengths within the yellow (590 nm; 4 mW/cm2), red (660 nm; 65 mW/cm2), and near-infrared (NIR) (850 nm; 0.6 mW/cm2) spectrum. All evaluations were conducted four weeks post-therapy. The treated eye was compared with baseline (pre-therapy). Following nine PBM sessions, assessments included best-corrected visual acuity (BCVA), retinal sensitivity, and characteristics of the correction area via fundus automated perimetry using the Compass system. Additionally, a functional and structural assessment of the retina was performed using multifocal electroretinography (ERG), optical coherence tomography (OCT), fluorescence retinography (FR), and autofluorescence (AF). Statistical analysis employed the Student's t-test for paired samples at a 95% confidence level (p-value ≤ 0.05).

Results: LogMAR-based visual acuity assessment demonstrated an improvement in mean value from 0.62 to 0.53 logMAR, with a statistically significant p-value of 0.001. Visual field examination, based on mean deviation (MD), pattern standard deviation (PSD), and fundal perimeter deviation index (FPDI) parameters, showed improvement from -19.87 dB to -19.45 dB, 9.77 dB to 9.76 dB, and 37% to 39%, respectively, although with non-significant p-values of 0.366, 0.446, and 0.245, respectively. No adverse effects or abnormalities in optical coherence tomography (OCT) and electroretinogram (ERG) were observed during the follow-up period.

Conclusion: In this short-term study, PBM appeared to have the potential to enhance BCVA and fundus automated perimeter in RP patients without causing significant adverse events. However, further assessment with a larger patient cohort and longer follow-up is warranted to ascertain the efficacy of this technique in these patients.

Purpose: To explore the significance of changes in anterior chamber depth (ΔACD) and astigmatism between 4 and 8 weeks following uneventful phacoemulsification.

Patients and methods: Anterior chamber depth (ACD, mm), autorefractometry and subjective refraction were monitored in pseudophakic eyes implanted with non-toric IOLs (group 1, SA60AT, n=36; group 2, SN60WF, n=34; group 3, ICBOO, n=16) and phakic control group (n=30, group 4a, for ACD and autorefractometry) over four weeks. Changes in subjective refractions were compared with repeatability in normal phakic eyes (n=30, group 4b).

Results: Reporting key results (p<0.01), mean (±sd 95% CI) ΔACD values (ACD at start minus ACD at four weeks) were +0.02 (±0.37, -0.16 to 0.08), +0.22 (±0.51,0.05 to 0.39), -0.33 (±0.51, -0.58 to -0.08), -0.02 (±0.07, -0.04 to 0.01) in groups 1-4a respectively. Differences were significant (1-way ANOVA, F=7.02). Pooling data from the pseudophakic eyes (n=86) induced astigmatism (IA) by autorefractometry was significantly greater in comparison with group 4a [-0.78D (±0.67, -0.92 to -0.64) and -0.19D (±0.16, -0.25 to - 0.13)]. IA power correlated with the initial power of refractive astigmatism at 4 weeks (A), [IA = 0.36A-0.30 (r²=0.207) and IA = 0.39A-0.29 (r²=0.232) by autorefractometry and subjective refraction, respectively]. In groups 1-3, vector analysis revealed i) the change in refraction in over 55% of eyes was beyond the 95% confidence interval limits observed in groups 4a and 4b, ii) some significant associations between changes in vectors describing astigmatism with ΔACD and IOL labelled power.

Conclusion: Changes in ACD and refraction still occur four weeks after unremarkable phacoemulsification and the inter-relationship depends on IOL design/type. Other factors, such as tilt or dislocation of the IOL along the X-Y axes parallel to Listing's plane, accompanying changes in ACD are expected to affect the postop astigmatism.