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

Background: Ocular pain is a prevalent symptom of dry eye disease (DED), which often accompanies potential psychological issues. The study aimed to explore whether acupuncture could improve ocular pain, mental state, and dry eye parameters in patients with DED.

Methods: The non-randomized pilot study included 48 patients divided into two groups: the acupuncture group (n=27) and the 0.3% sodium hyaluronate (SH) group (n=21). Participants in the acupuncture group underwent treatments on six bilateral acupuncture points (BL1, BL2, ST1, LI 20, SI1 and SI3) 3 times per week for 4 weeks. Patients in the SH group received 0.3% SH 4 times per day for 4 weeks. Ocular pain was assessed using the numerical rating scale (NRS), and mental state was evaluated through the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Ocular surface parameters, concentrations of inflammatory cytokines, and corneal nerve morphological indicators were measured at baseline, the first week, and the fourth week. Randomization procedures were not used in this study, and outcome assessors and statistical analysts were blinded.

Results: Compared with baseline, both NRS scores (from 5.91 ± 1.52 to 1.94 ± 1.57) and ocular surface discomfort index (OSDI) scores (from 49.75 ± 14.92 to 29.64 ± 18.79) were decreased after 1 and 4 weeks of treatment in both groups (all p < 0.05). At 4 weeks, the acupuncture group showed significant improvements, including increased tear break-up time (TBUT) and corneal perception, decreased SAS and SDS scores, and reduced concentrations of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α concentration in tears (all p < 0.05). These changes were not observed in the SH group (all p > 0.05).

Conclusion: Acupuncture treatment could improve ocular surface characteristics in patients with DED, and more importantly, it alleviates their ocular pain and depressive state. The anti-inflammatory effect of acupuncture may be involved in this process. Future research with larger, randomized controlled trials (RCTs) is necessary to confirm these findings and clarify the mechanisms involved.

Purpose: To determine clinical and refractive results after the implantation of EyeCryl Phakic Toric intraocular lens in patients with stable keratoconus.

Methods: The study included all patients diagnosed with keratoconus who underwent implantation of an EyeCryl Phakic Toric intraocular lens (Biotech Healthcare Holding; Ahmedabad, India) in at least one eye and had a follow-up of at least 12 months. Visual and refractive data were collected for all patients, along with corneal tomography measurements using Pentacam, and vault measurement using optical coherence tomography. This retrospective study was conducted at a high-volume private refractive surgery center in Medellín, Colombia.

Results: A total of 83 eyes from 47 patients were included in the study. The majority (71.1%) were female, with a mean age of 31.2 ± 5.1 years. After 12 months of follow-up post-surgery, the spherical equivalent improved significantly from -8.19 ± 4.04 D to -0.06 ± 0.48 D (p < 0.001). Furthermore, 77% of eyes had a post-surgical spherical equivalent within ±0.50 D, while 92% had residual astigmatism ≤0.50 D. Twelve months after surgery, mean manifest astigmatism was -0.28 ± 0.27 D. Uncorrected visual acuity also showed improvement, from 1.11 ± 0.35 LogMAR to 0.14 ± 0.11 LogMAR. Moreover, 52.4% of eyes demonstrated an improvement of at least one line in best-corrected visual acuity. Notably, no intraoperative or postoperative complications were observed in the study population.

Conclusion: The implantation of EyeCryl Phakic Toric intraocular lenses represents a highly effective and safe option for correcting refractive errors in patients with a history of keratoconus. Refractive accuracy is excellent, and a significant proportion of patients experienced an improvement in their best-corrected vision by at least one line.

Purpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.

Patients and methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson's Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.

Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (-17.26, p < 0.001), CFS OD (-0.50, p < 0.001), and CFS OS (-0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.

Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.

Background: Glaucoma, a leading cause of irreversible vision loss, is characterized by progressive degeneration of retinal ganglion cells. Intraocular pressure (IOP) remains a well-established risk factor, but recent research suggests environmental and lifestyle factors may also play a role.

Objective: This review aimed to evaluate the current evidence on the impact of environmental factors on glaucoma progression.

Methods: We conducted a systematic review following PRISMA guidelines, searching various databases for studies on environmental factors and glaucoma progression.

Results: Our review identified several key findings. IOP remains the most crucial modifiable risk factor. Aerobic exercise and mindfulness practices may lower IOP and provide neuroprotection. Lifestyle modifications like smoking cessation and balanced diets were also emphasized. Studies suggest air pollution exposure, particularly PM2.5, may be associated with an increased risk of glaucoma. However, the studies were primarily observational, and more research is needed to establish causality and elucidate underlying mechanisms.

Conclusion: This review highlights the multifaceted nature of glaucoma, emphasizing the interplay between established risk factors (IOP) and emerging environmental influences (air pollution). Environmental factors hold promise as potential targets for glaucoma prevention and management strategies. Future research should focus on well-designed studies to investigate causal relationships and biological mechanisms.

Purpose: The objective of this research was to assess the effectiveness and safety of using Conbercept injection and dexamethasone implant (DEX I) in sequence for treating refractory macular edema (ME) caused by central retinal vein occlusion (CRVO) in patients.

Methods: A study was conducted on 34 patients with persistent macular edema caused by central retinal vein occlusion, reviewing their medical history and interventions performed. Sequential implantation of DEX I was performed 1 week after the Conbercept injection. OCTA images were used to measure central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and pre- and post-treatment vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), with a 1-year follow-up period.

Results: At the 12-month follow-up, participants demonstrated notable improvements in central retinal thickness and intraocular pressure (p < 0.05). Throughout the monitoring period, no significant differences were found in BCVA improvement or vessel density reduction (p > 0.05). Two patients required topical treatment to lower their intraocular pressure during the study period.

Conclusion: In conclusion, patients experiencing persistent ME due to secondary CRVO may benefit from transitioning to a treatment regimen involving Conbercept and DEX I, potentially resulting in a reduction in CRT. However, no significant improvement was observed in BCVA or deep and superficial capillary plexus vessel density.

Objective: To explore the distribution and influence factors of non-invasive tear film break-up time (NIBUT) in children.

Methods: This is a hospital-based cross-sectional study. Spherical equivalent error (SER) was measured with cycloplegia. NIBUT was measured by an ocular surface integrated analyzer.

Results: A total of 1269 children (1269 eyes) were included in this study. Participants' median age was 11 (range 6-18) years. 47.1% (598/1269) of participants were boys. The median NIBUT of myopic children and non-myopic children were 9.9 seconds (s) (Inter-quartile range, IQR: 6.4 to 16.1) and 10.9 s (IQR: 8.8 to 17.9), respectively, which was statistically significant (p = 0.004). In myopic children, 49.9% (573/1148) were able to achieve NIBUT of 10 s or more, compared to 67.8% (82/121) in non-myopic children, which was statistically significant (p < 0.001). There were 41 (3.57%) children in the myopic group and none (0%) in the non-myopic group with dry eye disease (p = 0.028). There was a positive correlation between NIBUT and age: NIBUT = 9.256 + 0.352*Age. 71.8% (824/1148) of myopic children used electronic products almost every day, compared to 37.2% (45/121) of non-myopic children, which was statistically significant (p < 0.001).

Conclusion: The NIBUT of myopic children was significantly shorter than that of non-myopic children. Children with myopia are more likely to have dry eyes. NIBUT increases with age. High frequency of electronic product use may be an important cause to NIBUT shortening in children.

Purpose: To compare the intra-operative surgical performance of Quatera 700 with Centurion and Signature Pro phacoemulsification systems.

Setting: Nethradhama Superspeciality Eye Hospital, Bangalore, India.

Study design: Prospective, interventional, 3-arm, randomized comparison study.

Methods: A total of 180 non-consecutive eyes satisfying the eligibility criteria were recruited. N = 60 eyes were operated using each of the above systems, of which n = 30 eyes had LOCS III grade 1-2, and n = 30 eyes had grade 3-4 nuclear density. Phacoemulsification with foldable IOL implantation was performed by a single experienced surgeon. Chamber stability scores (1-4, 4 being the worst), fluid turnover per case, surge incidence and intra-operative complications were assessed.

Results: Intra-operatively, the mean chamber stability score was significantly better for the Quatera 700 in both the soft and dense cataract groups compared to the other two machines (p < 0.001). Total Phaco Time (TPT) with Quatera 700 was significantly lower compared to Signature Pro, while it was comparable with Centurion for both the soft and dense cataract groups. The mean fluid turnover was significantly lower for the Quatera 700 in the dense cataract group (p = 0.04) and so was the combined phaco and I/A time (p = 0.01) when compared with Signature Pro. One eye operated with Signature Pro and 2 eyes operated with Centurion had PCR due to surge. The mean corneal clarity scores on POD-1 and specular counts at 2 weeks and 6 months were comparable.

Conclusion: The new Quatera 700 system resulted in lesser TPT, fluid turnover and phaco + I/A time than Signature Pro, while its performance was comparable to Centurion for these parameters. Moreover, the surgeon graded intra-operative chamber stability scoring was highest, when compared to the other two systems.

Ctri registration number: CTRI/2022/01/039296.

Objective: This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis.

Methods: Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias.

Results: Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P < 0.00001, I2 = 47%), 5 minutes (P < 0.00001, I2 = 46%), and 7 minutes (P < 0.00001, I2 = 41%). Additionally, the meta-analysis found a statistically significant increase in the mean CAC change for conjunctival redness with low heterogeneity (P < 0.00001, I2 = 15%). The pooled analysis showed no significant difference (P = 0.57, I2 = 0%) between the DEXTENZA and placebo groups in the frequency of adverse events.

Conclusion: DEXTENZA has emerged as a promising and viable treatment option for patients with seasonal/perennial allergic conjunctivitis and is an effective alternative to current therapeutic modalities.

Purpose: To compare the accuracy and readability of responses to oculoplastics patient questions provided by Google and ChatGPT. Additionally, to assess the ability of ChatGPT to create customized patient education materials.

Methods: We executed a Google search to identify the 3 most frequently asked patient questions (FAQs) related to 10 oculoplastics conditions. FAQs were entered into both the Google search engine and the ChatGPT tool and responses were recorded. Responses were graded for readability using five validated readability indices and for accuracy by six oculoplastics surgeons. ChatGPT was instructed to create patient education materials at various reading levels for 8 oculoplastics procedures. The accuracy and readability of ChatGPT-generated procedural explanations were assessed.

Results: ChatGPT responses to patient FAQs were written at a significantly higher average grade level than Google responses (grade 15.6 vs 10.0, p < 0.001). ChatGPT responses (93% accuracy) were significantly more accurate (p < 0.001) than Google responses (78% accuracy) and were preferred by expert panelists (79%). ChatGPT accurately explained oculoplastics procedures at an above average reading level. When instructed to rewrite patient education materials at a lower reading level, grade level was reduced by approximately 4 (15.7 vs 11.7, respectively, p < 0.001) without sacrificing accuracy.

Conclusion: ChatGPT has the potential to provide patients with accurate information regarding their oculoplastics conditions. ChatGPT may also be utilized by oculoplastic surgeons as an accurate tool to provide customizable patient education for patients with varying health literacy. A better understanding of oculoplastics conditions and procedures amongst patients can lead to informed eye care decisions.