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

Purpose: To evaluate the efficacy and safety of a dexamethasone intracanalicular insert (DEX) for treatment of allergic conjunctivitis (AC).

Patients and methods: In this multicenter, randomized, double-masked, placebo-controlled phase 3 study, adults (≥18 years) with AC were randomized 1:1 to DEX or placebo insert (PBO) placed bilaterally. Subjects underwent repetitive conjunctival allergen challenges (CAC) across 30 days and were assessed for changes in AC signs and symptoms. The primary endpoint was ocular itching score at 3, 5, and 7 minutes post-CAC at Day 8 (7 days post-insertion). This trial is registered on ClinicalTrials.gov (NCT04050865).

Results: Ninety-six subjects were randomized (n=48 DEX, n=48 PBO). Compared to PBO, there were statistically significant treatment differences favoring DEX for the primary endpoint of mean ocular itching score at Day 8 (-0.86, -0.98, -0.96 at 3, 5, and 7 minutes post-CAC respectively; P<0.0001 for all). Treatment differences favored DEX for all 24 time points across 6 visits and were statistically significant (P<0.05) except for the first post-insertion (Day 7, 3 minutes). For the 18 time points at which conjunctival redness was assessed, DEX had lower scores than PBO (P<0.05 for all). The most common ocular adverse events (AEs) in DEX subjects were eye discharge and irritation. No serious AEs, elevated intraocular pressure, dacryocanaliculitis, or use of rescue medications were reported.

Conclusion: Results of this study support the potential use of dexamethasone insert as a physician-administered, preservative-free treatment for AC, with significant improvements in ocular itching and conjunctival redness compared with placebo. The dexamethasone insert was generally safe with a favorable safety profile.

Purpose: This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses.

Methods: This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications.

Results: A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66±0.55 logMAR preoperatively and 0.38±0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%).

Conclusion: PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.

Purpose: This study aims to evaluate the outcomes of surgical intervention for infantile esotropia at a tertiary care hospital.

Patients and methods: Medical records of patients with esotropia who underwent surgical correction at our tertiary hospital between January 2013 and June 2023 were retrospectively analyzed. Patient demographics, preoperative and postoperative ocular alignment, surgical techniques employed, complications or reoperations, and factors related to successful surgery were analyzed.

Results: The study included 77 participants with an average age of 9.54 ± 10.87 years at the time of surgery. Postoperatively, 71.4% (55/77) patients achieved successful alignment, which was defined as an ocular deviation of ≤10 prism diopters (PD), at the final follow-up. The average follow-up period was 12 months, during which no complications were noted. Reoperation was required in 15.6% (12/77) patients. Multivariate logistic regression revealed that having a smaller preoperative deviation of <50 PD positively influenced the success of strabismus surgery (adjusted odds ratio, 7.13; 95% CI, 2.04-24.86).

Conclusion: The surgical correction of infantile esotropia in a tertiary care setting yielded favorable alignment outcomes in most cases, with no complications and a low reoperation rate. A preoperative angle of <50 PD emerged as a prognostic factor for successful surgical outcomes in this population. Further studies with longer follow-up periods are recommended to evaluate the long-term stability of these outcomes and identify additional influencing factors.

Purpose: To assess the efficacy and safety of goniotomy using a uniquely shaped trapezoidal, serrated dual blade (TDB), designed to accommodate variability in patient anatomy, in reducing intraocular pressure (IOP) or anti-glaucoma medications (AGM) in adult glaucoma patients when combined with cataract surgery.

Patients and methods: Retrospective consecutive case series of patients with glaucoma who underwent phacoemulsification with TDB-goniotomy were included. Preoperative, intraoperative, and postoperative data were collected over 6 months. The primary outcome measure was surgical success, defined as IOP reduction ≥20% from baseline at 6 months, and/or reduction of at least 1 AGM. Postoperative adverse events were collected as a secondary outcome measure.

Results: Sixty-five eyes of 46 patients were included with data available on 53 eyes at 6 months. Primary open-angle (38%), primary angle-closure (37%), and mixed-mechanism glaucoma (11%) were the most common diagnoses. Most cases were severe (48%) or moderate (32%) stage. At the 6-month mark, surgical success was achieved in 92% of eyes by either or both criteria. Mean preoperative IOP decreased from 18.4 mmHg (SE 0.83) to 13.0 mmHg (SE 0.37) (p<0.001) at postoperative month 6. Mean AGM decreased from 2.46 (SE 0.19) preoperatively to 1.45 (SE 0.17) (p<0.001). The most common postoperative complication was an IOP spike at postoperative week 1 (11%). No serious adverse events occurred related to the goniotomy.

Conclusion: TDB-goniotomy in combination with cataract surgery safely and effectively lowered IOP and reduced AGM burden in adults with various types and severities of glaucoma over 6-months of follow-up.

Purpose: Inherited retinal diseases (IRDs) are a group of degenerative disorders of the retina, that can be potentially associated with changes in the anterior segment, but their prevalence and impact are not known. Exploring these concomitant ophthalmologic changes with biomechanical assessment may help identify other non-retina causes of vision loss in these patients, such as corneal ectasia or susceptibility to glaucoma. This study aimed to measure and compare corneal biomechanics in patients with and without IRDs.

Methods: A total of 77 patients (154 eyes) with IRD were recruited as the study group. The control group consisted of 77 healthy adults (154 eyes) with matched age and sphere equivalents. All participants underwent a comprehensive assessment including corneal tomography (Pentacam^®) and biomechanical assessment (Corvis ST^®). A total of 4 second-generation biomechanical parameters and 3 indexes were collected: Ambrosio Relational Thickness (ARTh), Deflection Amplitude Ratio Max (DARM), Integrated Radius (IR) and Stiffness Parameter at Applanation (SP-A1), the final deviation value D of the Belin/Ambrosio Enhanced Ectasia Display (BAD-D), Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI).

Results: For IRD patients, there was a higher DARM (p < 0.001), lower ARTh (p < 0.001), higher CBI (p < 0.001), higher TBI (p<0.001), and higher BAD-D (p < 0.001) compared to the control group. Regarding discrimination of healthy subjects and IRD patients, ARTh was the most sensitive parameter.

Conclusion: The results showed that IRD patients tend to have softer corneal behaviour, compared to eyes without pathology, which may predispose patients to corneal ectasia or glaucoma development. ARTh could be used to screen IRD patients if a non-retina cause of vision loss is suspected.

Purpose: To evaluate the efficacy of a cloud-based surgical planning platform with regards to refractive target accuracy.

Methods: This was a retrospective chart review of consecutive cases from January 2022 through December 2023. Surgical planning was performed using the SMARTCataract platform, eyes were implanted with Clareon monofocal IOLs, and power calculations were done using the Barrett Universal II formula. Data were collected for the percentage of eyes within ±0.5 D of target refraction, mean absolute error (MAE), and postoperative visual acuity.

Results: A total of 148 eyes were identified that met the inclusion/exclusion criteria. The percentage of eyes within ±0.5 D of the planned target was 94%. The MAE was 0.25 ± 0.17 D. In addition, 57%, 93%, 98%, and 100% of eyes had MAE ≤ 0.25 D, ≤ 0.5 D, ≤ 0.75 D, and ≤ 1.0 D, respectively.

Conclusion: The results of this study suggest high refractive accuracy when using the SMARTCataract planning platform with the Barrett Universal II formula and excellent distance visual acuity.

Purpose: To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG).

Methods: A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student's t-tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded.

Results: Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, -23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, -22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (-30.8%; p=0.0005) and 2.2 ± 1.4 (-25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP.

Conclusion: Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery.

Purpose: Age-related macular degeneration (AMD) presents a multifaceted etiopathogenesis involving ischemic, inflammatory, and genetic components. This study investigates the correlation between ocular hemodynamics, scleral rigidity (SR), and plasma endothelin-1 (ET1) levels in treatment-naive patients with asymmetrical AMD.

Patients and methods: This study included 20 treatment-naive patients (12 females and 8 males) with an average age of 76.4 ± 3.7 years, who presented with AMD with neovascular membrane formation (nAMD) in one eye, and intermediate grade 2 AMD (iAMD) in the other eye. The control group consisted of 20 healthy subjects (13 females and 7 males) with a mean age of 74.7 ± 3.9 years. All patients and healthy controls underwent color Doppler imaging (i) of the ophthalmic artery (OA), short posterior ciliary arteries (SPCAs), and central retinal artery (CRA); Plasma ET-1 levels were measured for all patients and healthy subjects. Corneal biomechanics were assessed using an Ocular Response Analyzer and two indices were obtained: corneal hysteresis (CH) and corneal resistance factor (CRF).

Results: Results showed reduced blood flow velocities and increased resistance indices in AMD eyes, particularly affecting the short posterior ciliary arteries. According to mechanical theory, ARMD eyes exhibited elevated scleral rigidity and corneal resistance factor compared to controls, with a notable rise in SR in neovascular AMD (nAMD) eyes. As per the chronic subacute inflammation theory, plasma ET-1 levels were significantly higher in AMD patients, correlating with abnormal SPCAs blood flow and increased resistance indices.

Conclusion: Findings suggest a multifactorial etiology of AMD involving an increase of ET-1 plasma levels with biomechanic damages of corneal and scleral tissue in nAMD.

Background: We have previously studied the physiological and mechanical responses of the eye to blunt trauma in various situations using finite element analysis (FEA). In this study, we evaluated the volume kinetics of an airbag impact on the eye using FEA to sequentially determine the volume change rates of intraocular segments at various airbag deployment velocities.

Methods: The human eye model we created was used in simulations with the FEA program PAM-GENERIS^TM (Nihon ESI, Tokyo, Japan). Different airbag deployment velocities, 30, 40, 50, 60 and 70 m/s, were applied in the forward direction. The volume of the deformed eye impacted by the airbag was calculated as the integrated value of all meshes in each segment, and the decrease rate was calculated as the ratio of the decreased volume of each segment at particular timepoints to the value before the airbag impact.

Results: The minimum volume of the anterior chamber was 63%, 69% and 50% at 50, 60 and 70 m/s airbag impact velocity, respectively, showing a curve with a sharp decline followed by gradual recovery. In contrast to the anterior chamber, the volume of the lens recovered promptly, reaching 80-90% at the end of observation, except for the case of 60 m/s. Following the decrease, the volume increased to more than that of baseline at 60 m/s. The rate of volume change of the vitreous was distributed in a narrow range, 99.2-100.4%.

Conclusion: In this study, we found a large, prolonged decrease of volume in the anterior chamber, a similar large decrease followed by prompt recovery of volume in the lens, and a time-lag in the volume decrease between these tissues. These novel findings may provide an important insight into the pathophysiological mechanism of airbag ocular injuries through this further evaluation, employing a refined FEA model representing cuboidal deformation, to develop a more safe airbag system.