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

Purpose: Drug-induced uveitis is an uncommon but clinically important cause of intraocular inflammation across diverse systemic and ophthalmic therapies. As the use of biologics, targeted agents, and chronic ocular medications expands, clinicians need drug class-specific data on risk, phenotype, and clinical course. In this study, we synthesize and review the published literature on drug-induced uveitis, summarizing reported incidence, clinical phenotypes, latency to onset, and time to resolution by medication class, route of administration, and patient-level factors.

Methods: A systematic literature search was conducted with PubMed, Scopus, and the Cochrane Library in September 2025 using terms related to drug-induced and medication-associated uveitis. Articles were included if they discussed human cases of noninfectious uveitis attributed to a specific medication or drug class and were written in English. Data analysis was performed to assess relationships between medication class, medication exposure time, uveitis location, uveitis treatment, and uveitis resolution time.

Results: 317 articles with 690 unique patient cases met inclusion criteria for case-level data analysis. The mean age at drug-induced uveitis onset was 54.4 years; most patients were female, 63.4% had bilateral disease, and 74.8% had anterior uveitis. Mean exposure time from first dose to uveitis onset was 197.2 days (SD 497.6; range, 0-6205), and mean resolution time was 61.0 days (SD 157.4; range, 1-2520). Antineoplastics (29.1%), vaccines (15.8%), antibiotics (13.0%), intraocular pressure-lowering drops (11.9%), bisphosphonates (9.7%), vascular endothelial growth factor (VEGF) inhibitors (6.4%), antivirals (5.1%), and disease-modifying antirheumatic drugs (4.3%) were the most frequently implicated classes.

Conclusion: Drug-induced uveitis, although rare, represents a broad array of presentations, mechanisms, and clinical course. As systemic and targeted therapeutic use continues to expand, understanding the clinical presenation and course will help patient outcomes and minimize vision-threatening risks.

The hallmark of acute corneal hydrops (CH) is Descemet membrane (DM) rupture that leads to the influx of fluid into the cornea causing corneal edema. Multiple risk factors have been related to an increased incidence of CH in keratoconus (KC) patients, such as Down's syndrome, atopy, vernal keratoconjunctivitis, eye rubbing, and an earlier age of KC onset. Penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), compression sutures, cyanoacrylate tissue adhesive with bandage contact lens (BCL), intracameral gas injection, and amniotic membrane transplant (AMT) are some of the conservative and surgical methods used to treat CH. Compared to KC without a history of CH, the need for PKP in patients with healed hydrops is higher due to preexisting DM rupture. Thus, the majority of surgeons conduct PKP after CH. On the other hand, some corneal surgeons choose to perform DALK over PKP as it spares the host endothelium. In this narrative review, we compare DALK to PKP for corneal hydrops in KC, evaluating the challenges, advantages, and visual and refractive outcomes.

Purpose: To quantitatively assess light sensitivity thresholds and ocular surface parameters in patients with thyroid eye disease (TED) compared to sex- and age-matched patients with dry eye disease (DED) and healthy controls, and to further investigate differences between moderate-to-severe active and mild non-active TED.

Patients and methods: This cross-sectional, controlled study included patients with TED, patients with DED, and healthy controls. Light sensitivity was evaluated using the Lumiz 100 device (Essilor International, Paris, France) under three lighting conditions: continuous warm, continuous cold and flashing warm. TED patients were further stratified into moderate-to-severe active and mild non-active subgroups. In addition, ocular surface parameters were assessed using the Keratograph 5M (Oculus, Wetzlar, Germany). Correlations between light sensitivity thresholds and clinical parameters were analyzed.

Results: Out of 93 included patients, 39 had TED (14 moderate-to-severe active, 25 mild non-active), 25 had DED, and 29 were healthy controls. TED patients demonstrated significantly lower total light sensitivity thresholds compared to healthy controls (3.17 ± 0.52 vs 3.47 ± 0.42 log10[lux], p = 0.040) but higher thresholds compared to DED patients (2.71 ± 0.52 log10[lux], p = 0.003). Among TED patients, those with moderate-to-severe active disease exhibited significantly lower light sensitivity thresholds than those with mild non-active disease (2.85 ± 0.48 vs 3.35 ± 0.47 log10[lux], p = 0.004). A significant negative correlation was found between total light sensitivity threshold and ocular discomfort symptoms in both subgroups of TED patients (r =-0.623, p = 0.017 for moderate-to-severe active TED and r = -0.405, p = 0.045 for mild non-active TED, respectively). Conversely, no significant correlation was found between light thresholds and tear film or thyroid function parameters.

Conclusion: Light sensitivity represents a significant and quantifiable manifestation of TED, particularly in patients with active disease. Quantitative assessment of light sensitivity might be incorporated into clinical evaluation of TED patients to better characterize disease burden and guide management strategies.

This narrative review provides a comprehensive overview of current evidence on the use of the Amsler grid as a simple and cost-effective tool for detecting central visual field defects, particularly in macular disorders such as age-related macular degeneration (AMD). Despite the availability of advanced imaging techniques like optical coherence tomography (OCT), the grid remains valuable in primary care and home monitoring due to its accessibility and ease of use. This review includes studies evaluating its diagnostic performance, clinical applications, and recent digital adaptations, with a focus on early detection and patient self-monitoring. It facilitates early detection of visual disturbances, enabling timely diagnosis and intervention. The test is applicable in various retinal conditions, including AMD, diabetic macular edema, central serous chorioretinopathy, and epiretinal membrane. Although its diagnostic accuracy varies depending on the condition and stage, clinical studies support its reliability as an adjunctive tool in everyday practice. Recent developments include mobile and web-based platforms, as well as integration with artificial intelligence, which may enhance diagnostic accuracy, enable longitudinal monitoring, and improve patient adherence. Early detection is crucial for preserving vision and reducing the global burden of visual impairment.

Background: Uveitis pattern varies according to regional, demographic, and racial factors. Therefore, an epidemiological study of the distribution of uveitis in various regions in India is likely to provide valuable information. There is no study available on the pattern of uveitis from Haryana.

Aim: To report the pattern of uveitis in a secondary eye care center in Panipat, Haryana.

Material and methods: A retrospective study was conducted on 65,126 new patients who attended the Ophthalmology outpatient department of a secondary eye care hospital in Panipat from April 2015 to October 2023. The data of all the subjects is taken from electronic medical records analyzed.

Results: Minimum age of the patients was 8 years, the maximum was 95 years and the mean age was 42.28 years. Out of 65,126 cases, 377 were found to have uveitis. The cumulative incidence proportion of uveitis among new patients attending our institute during the study period was 0.58%. The majority of patients were of anterior uveitis 158 (41.8%) and the minimum belonged to intermediate uveitis 39 (10.3%). It was also seen that the maximum cases were unilateral. Tailored laboratory investigations were done in all the cases. The most common cause was found to be idiopathic.

Conclusion: Anterior uveitis is the most common entity in secondary care and the most common etiology found to be idiopathic.

Purpose: To demonstrate intraocular pressure (IOP) control using the UNITY^® Vitreoretinal Cataract System (UVCS) during cataract surgery based on bench testing and initial clinical experience.

Patients and methods: Bench testing using an eye model and calibrated pressure sensor measured IOP control error by evaluating the pressure difference between the IOP setpoint and the measured IOP under continuous irrigation for approximately 10 seconds followed by aspiration for approximately 15 seconds. To examine the system at its limits, 30 phacoemulsification (phaco) handpieces were tested at 20 mmHg IOP and 60 cc/min aspiration flow rate, and 15 irrigation/aspiration (I/A) handpieces were tested at 20 mmHg IOP and 30 cc/min aspiration flow rate. In addition, a prospective, single-arm clinical study evaluated the safety and performance of UVCS in adults presenting for routine cataract surgery (clinicaltrials.gov, NCT06071104, Registered October 2, 2023).

Results: The expected IOP variation at an IOP setpoint of 20 mmHg was 2.36 ± 2.13 at an aspiration flow rate of 60 cc/min during phaco and 4.19 ± 1.97 mmHg at an aspiration flow rate of 30 cc/min during I/A. These results compare favorably to physiologic IOP diurnal variation in normal patients (5.0 ± 2.7 mmHg) and demonstrate that IOP would be expected to be maintained approximately within 18 to 22 mmHg when the IOP is set to 20 mmHg during the phacoemulsification step. This is supported by results from the clinical study where 68 subjects underwent cataract surgery using UVCS, with exceptional anterior chamber stability observed during all cases.

Conclusion: UNITY VCS/CS demonstrates excellent IOP control in bench testing and was reported to provide exceptional AC stability clinically. Maintaining IOP at the desired surgeon setpoint with minimal fluctuation throughout surgery may reduce intraoperative and postoperative complications, especially in more complex cases.

Purpose: To evaluate 3-month postoperative outcomes for bilateral implantation of a next generation presbyopia correcting intraocular lens (IOL).

Methods: This was a single center, ambispective study of visual outcomes after successful bilateral cataract surgery (with presbyopia-correcting intent) and TECNIS Odyssey implantation. Subjects were assessed 3 months postoperatively during a single visit. Clinical evaluations included measurement of visual acuities at distance, intermediate, near, and extreme near, and administration of the assessment of intraocular lens implant symptoms (AIOLIS) and ocular surface disease index (OSDI) questionnaires.

Results: A total of 40 subjects completed the study. Mean photopic binocular uncorrected visual acuities at 6 m, 66 cm, 40 cm, and 33 cm were -0.05 ± 0.06, 0.02 ± 0.12, 0.04 ± 0.10, and -0.02 ± 0.07 logMAR, respectively. The most commonly reported dysphotopsias (percentage of subjects experiencing them "Always") were halos at 32% (13/40), glare at night at 30% (12/40), and rings or spiderwebs at 18% (7/40). However, only 0% (0/40), 5% (2/40), and 2% (1/40) of subjects were "Extremely" bothered by halos, glare at night, and rings or spiderwebs, respectively. In addition, 80% (36/40) of subjects reported needing glasses "Not at all" or "A little of the time", and 100% (40/40) of subjects were satisfied with their vision.

Conclusion: The results of this study suggest excellent visual outcomes at distance, intermediate, near, and extreme near, high spectacle independence, and high patient satisfaction with bilateral Odyssey implantation.

Purpose: To evaluate the effects of selective laser trabeculoplasty (SLT) on 24-hour intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) with well-controlled IOP but who exhibit glaucoma progression.

Methods: This retrospective study included all POAG patients with disease progression despite a well-controlled IOP in the clinic (≤14 mmHg) after antiglaucoma eye drops administration (mean number of medications = 3.93 ± 0.96). All patients underwent 24-hour IOP measurement before and after SLT. Using the iCare HOME tonometer, IOP was self-measured at several intervals for over 10 days at home in a sitting position. The analysis calculated the 24-hour IOP data after dividing it into eight time periods, while the average IOP values were calculated over each 3-hour period. The average, maximum, minimum, and fluctuation (maximum-minimum) were compared before and after SLT.

Results: In 16 eyes of the 13 enrolled patients, the mean 24-hour IOP was significantly reduced after SLT (11.3 (10.2-13.4) (median (interquartile range) mmHg before vs 10.5 (9.4-11.8) mmHg after, p=0.029). Significant IOP reductions were observed between 3 to 6 AM and 6 to 9 PM after SLT (p=0.004 and p=0.043, respectively). Although there was a significant reduction in the maximum 24-hour IOP (p=0.039), the minimum IOP did not significantly change after SLT (p=0.083). There were also no changes after SLT in the 24-hour, diurnal and nocturnal IOP fluctuations.

Conclusion: SLT significantly reduced nocturnal and maximum IOP in POAG patients whose IOP was already well-controlled in the clinic.

Purpose: This study was conducted to investigate the associations between specific genetic variation in VEGF and the prevalence of strabismus, with particular focus on VEGF polymorphism rs2010963 and whether presence of GG phenotype increases the odds of strabismus compared to GC or CC allele in a Pakistani cohort.

Patients and methods: Blood samples from 43 strabismus patients and 170 non-diabetic healthy normal controls from a previously published study from our group were used for comparison. Genotyping of the selected single nucleotide polymorphism (SNP) was carried out using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) for 43 samples of strabismus. Genotype and allele frequencies were then computed for all patients. Logistic regression was used to evaluate the association between the rs2010963 genotype and the risk of strabismus. A p-value of < 0.05 was considered statistically significant.

Results: Of the 43 strabismus patients, 27 (66%) had exotropia, followed by esotropia in 14 patients (34%). Their genotype frequency included 24 (56%) patients with the GG genotype, 14 (33%) with the GC genotype, and 5 (12%) with the CC genotype. Among the 170 normal controls, 50 (29%) had the GG genotype, 60 (35%) had the GC genotype, and 60 (35%) had the CC genotype. Individuals with the GG phenotype had significantly higher odds of having strabismus compared to those with CC genotype (OR = 5.76, 95% CI [2.05-16.20], p = 0.0009). GG phenotype was also associated with higher odds to those with GC phenotype, but the result was not statistically significant (OR = 2.06 [0.96-4.39], p = 0.062).

Conclusion: This study explored the association of VEGFA polymorphism rs2010963 and strabismus in a Pakistani cohort. The GG genotype was more frequent in strabismus cases than in controls (56% vs 29%), and a significant association was found between rs2010963 and strabismus which should be confirmed in larger, preferably age-matched cohorts.