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

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.

Purpose: To describe the "Ridge Sign" as a conclusive indicator for differentiating the anterior and posterior lenticular planes in Small Incision Lenticule Extraction (SMILE).

Methods: Femtosecond laser application for SMILE was performed. Anterior and posterior planes were dissected. "Ridge sign" was elucidated prior to proceeding with the final dissection of the anterior plane. Our sign helps to identify anterior and posterior lenticular planes in SMILE. This sign describes a lenticular ridge noted at the junction between the dissected and undissected halves of both planes. This ridge is formed as the lenticule is attached to the cap on one side and to the stromal bed on the other side. Here, the cap is lifted with the blunt dissector's arm at the junction of the anterior and posterior dissected planes prior to the final dissection of the anterior plane. This maneuver enhances the visibility of the ridge sign and confirms correct initial anterior plane dissection, thereby preventing inadvertent cap lenticular adhesion.

Results: In our study, 400 eyes undergoing SMILE procedures using the VisuMax femtosecond laser were included. In 96% of cases, the cap interface was separated first with ridge sign observed in all. In 4% of cases with wrong initial separation of the lenticule interface, the ridge sign was absent. Successful lenticule extraction was achieved in 100% of cases.

Conclusion: This confirmatory sign helps to dissect the anterior plane ahead of the posterior plane, thereby ensuring smooth lenticule extraction and preventing inadvertent cap lenticular adhesion, lenticule tears, or partial lenticular dissection.

Purpose: To develop a selection pathway to facilitate the use of multifocal intraocular lenses (mfIOLs) in cataract surgery in a public hospital setting.

Methods: A single-surgeon prospective cohort study in an Australian tertiary referral public hospital was conducted. A mfIOL selection pathway was designed and assessed. Outcomes measured included unaided distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA), dysphotopsia, spectacle dependence and satisfaction. Patient-reported outcome measures (PROMs) were assessed using Catquest-9SF (CQ) and Near Visual Acuity Questionnaire (NAVQ). A cost-analysis was performed.

Results: Fifty-four eyes from 27 patients underwent cataract surgery with mfIOL implantation. The monocular UDVA (mean ± standard deviation) was 0.05 ± 0.12 logMAR; UIVA 0.19 ± 0.05 logMAR; UNVA 0.28 ± 0.14 logMAR; 87% and 98% of eyes achieved within 0.5D and 1.0D of target refraction respectively. Spectacle independence was 85% at distance, 81% at intermediate, 59% at near vision. High satisfaction was reported with CQ (>85%) and NAVQ (100%). The cost difference between bilateral monofocal and mfIOLs is comparable to a pair of spectacles. Projected annual cost to the health system for a 5%-10% eligibility rate is 1.1-2.3 million Australian dollars.

Conclusion: The selection pathway presented overcomes the challenges in patient selection inherent to a public hospital setting and was implemented by a senior trainee with excellent vision and PROMs. The pathway ensures the cost-effectiveness of mfOL implantation. There are several funding models that can be applied to support equitable access and improved visual outcomes with mfIOLs within the government funded health system.