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

Purpose: To translate and validate the Adult Strabismus 20 (AS-20) questionnaire, a health-related quality of life questionnaire specifically devised for patients with strabismus.

Methods: The AS-20 was translated in accordance with the principles of good practice for the translation and cultural adaptation process for patient-related outcomes (PRO) according to the methodology recommended by the International Society for Pharmacoeconomics and Outcome Research (ISPOR). The translation, evaluation, and validation were performed in several steps. The study used both qualitative and quantitative methods and engaged 31 final-year orthoptic students in workshops, as well as 19 experts (experienced clinical orthoptists), 17 laymen (members of the public), and 17 patients from national eye clinics. The final translated questionnaire was tested for reliability and validity in 68 adults with strabismus by internal consistency using Cronbach´s alpha and content and construct validity using the Rasch analysis.

Results: The Swedish AS-20 showed a high level of internal consistency. Cronbach´s alpha was 0.95 for the psychosocial subscale and 0.92 for the functional subscale. However, the Rasch analysis indicated that both items and responses should be condensed to achieve content and construct validity.

Conclusion: The thorough translation and evaluation process resulted in a validated AS-20 questionnaire for use in the Swedish language, and shows reliability as an instrument to measure health-related quality of life (HRQoL) in adults with strabismus in a clinical setting.

Background: This study aims to describe the epidemiology and clinical features of patients with intraocular foreign bodies (IOFBs) and analyze the prognostic factors influencing final vision.

Methods: We retrospectively reviewed medical records of patients with IOFBs admitted to Qingdao Eye Hospital of Shandong First Medical University between January 1, 2014, and December 31, 2021. Inclusion criteria involved complete clinical data details of patients diagnosed with intraocular foreign bodies in our hospital who were treated with concurrent surgery and based on IOFB position and characteristics, different surgical methods were employed. The minimum follow-up duration was 6 months. Exclusion criteria were foreign bodies retained in the orbit, organ failure, surgical contraindications, coagulation abnormalities, autoimmune diseases, history of ocular surgery, and ocular space-occupying lesions. Based on IOFB position and characteristics, different surgical methods were employed. Multivariate logistic regression analysis was performed to predict independent factors influencing final visual acuity after IOFBs.

Results: This study analyzed 159 patients (159 eyes) with IOFBs. Based on discharge and follow-up results, IOFB removal was performed through pars plana incision in 105 (67.9%) eyes, corneoscleral limbus incision in 24 (15.1%) eyes, and original wound in 27 (17.0%) eyes. Of these, 44 eyes underwent IOFB removal without vitrectomy, while 55 (34.6%) eyes were treated with silicone oil. Post-vitrectomy, three cases showed secondary macular membrane, five cases exhibited retinal detachment, and enucleation was necessary in three cases. The final best corrected visual acuity (BCVA, logMAR) was 1.06 ±0.88, significantly better than preoperative visual acuity of 1.65 ±0.87 (t = 8.21, p < 0.01). Multi-factor logistic regression analysis revealed that the length of corneal/scleral wound (OR=0.6 P < 0.05), maximum size of IOFB (OR=0.585 P < 0.05), initial presenting VA (OR=0.900 P < 0.05), and macular lesions(OR=0.400 P < 0.05) were risk factors for postoperative vision prognosis after intraocular foreign body surgery.

Conclusion: In a tertiary eye center in northern China, IOFBs predominantly affected the working-age group, particularly males. Factors such as wound length, IOFB size, initial presenting VA, and macular lesions might impact the final visual outcome.

Background: To evaluate the one-year safety and effectiveness of bio-interventional cyclodialysis and scleral reinforcement in open-angle glaucoma (OAG) patients undergoing cataract surgery.

Methods: An ab-interno approach was used to create a sectoral cyclodialysis in OAG patients who were prospectively followed in a consecutive case series. Subsequent visco-cycloplasty with scleral reinforcement using homologous minimally modified allograft scaffold was completed to maintain patency of the cyclodialysis reservoir and increase uveoscleral outflow. Outcomes were mean medicated IOP and mean number of IOP-lowering medications. Safety outcomes were adverse events (AEs) and best-corrected visual acuity (BCVA) changes.

Results: Successful cyclodialysis and allograft bio-scaffold reinforcement was achieved in 117 eyes. There was minimal intraoperatie bleeding and few post-operative adverse events. At baseline, mean BCVA was 0.48 (95% CI: 0.42‒0.54; 20/40 Snellen) and mean ± SD medicated IOP was 20.2 ± 6.0 mmHg on 1.4 ± 1.3 IOP-lowering medications. At 12 months, there was a 27.1% reduction from baseline mean medicated IOP. In eyes with medicated baseline IOP > 21 mmHg (n = 45), there was a 39.7% paired IOP reduction at 12 months with a concurrent reduction in the mean number of IOP lowering medications to 0.8 ± 0.9 which were statistically significant (p < 0.01). For all eyes, 81.9% achieved a medicated IOP ≤ 18 mmHg with no increase in medications at 12 months. To achieve target IOP control, secondary glaucoma surgery was performed in 3.2% of the cases.

Conclusion: IOP lowering through uveoscleral outflow enhancement can be achieved by means of a bio-interventional cyclodialysis procedure with allograft scleral reinforcement.

Purpose: This study was designed to determine the frequency of neurotrophic keratopathy (NK) among patients presenting for cataract surgery consultation in a suburban US practice.

Methods: Patients presenting for cataract consultation were evaluated with corneal staining without anesthetic. Those with grade 1 or greater corneal stain and a tear breakup time (TBUT) of ≤10 underwent corneal sensitivity testing with a Cochet Bonnet esthesiometer. The study also evaluated patient SPEED score symptoms, corrected distance visual acuity (CDVA), corneal higher-order aberrations (HOAs), and conjunctival hyperemia.

Results: Among the 31 patients enrolled, mean corneal esthesiometry was 40 ± 9.5 mm (range 13 to 55). Esthesiometry of ≤40 mm, indicating neurotrophic keratopathy, was detected in 18 (58%, 95% CI 39-75%) patients. Corneal higher-order aberrations were significantly worse at 0.83 ± 0.22 µ in the group with NK vs 0.67 ± 0.16 among patients without NK (P < 0.028). A nonsignificant correlation was found between reduced corneal sensitivity and reduced symptoms. Older patients had slightly reduced sensation, but this trend was not statistically significant. No trend was seen between reduced sensation and either CDVA or corneal staining.

Conclusion: More than half of patients presenting for cataract evaluation with dry eye had stage 1 neurotrophic keratopathy. These patients had significantly worse higher-order aberrations than patients with normal sensitivity. Among patients with NK, symptoms were milder and age was higher, but neither trend was statistically significant. No trend was observed between corneal sensation and either corneal staining or CDVA.

Background: The rise of large language models (LLM) promises to widely impact healthcare providers and patients alike. As these tools reflect the biases of currently available data on the internet, there is a risk that increasing LLM use will proliferate these biases and affect information quality. This study aims to characterize the effects of different race, ethnicity, and gender modifiers in question prompts presented to three large language models (LLM) on the length and readability of patient education materials about myopia.

Methods: ChatGPT, Gemini, and Copilot were provided a standardized prompt incorporating demographic modifiers to inquire about myopia. The races and ethnicities evaluated were Asian, Black, Hispanic, Native American, and White. Gender was limited to male or female. The prompt was inserted five times into new chat windows. Responses were analyzed for readability by word count, Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid Grade Level, and Flesch Reading Ease score. Significant differences were analyzed using two-way ANOVA on SPSS.

Results: A total of 150 responses were analyzed. There were no differences in SMOG index, Flesch-Kincaid Grade Level, or Flesch Reading Ease scores between responses generated with prompts containing different gender, race, or ethnicity modifiers using ChatGPT or Copilot. Gemini-generated responses differed significantly in their SMOG Index, Flesch-Kincaid Grade Level, and Flesch Reading Ease based on the race mentioned in the prompt (p<0.05).

Conclusion: Patient demographic information impacts the reading level of educational material generated by Gemini but not by ChatGPT or Copilot. As patients use LLMs to understand ophthalmologic diagnoses like myopia, clinicians and users should be aware of demographic influences on readability. Patient gender, race, and ethnicity may be overlooked variables affecting the readability of LLM-generated education materials, which can impact patient care. Future research could focus on the accuracy of generated information to identify potential risks of misinformation.

Aim: The main indications for Ahmed glaucoma valve (AGV) include neovascular glaucoma, congenital glaucoma, primary open angle glaucoma and patients with failed previous trabeculectomy. This article aims to investigate the complications of AGV in Jordanian glaucoma patients and to justify the main risk factors.

Methods: Retrospectively, we report 87 eyes of 83 patients who underwent AGV implantation for different indications. The database included demographic data, past ocular and medical history, the indication for surgery, the perioperative outcome parameters at different follow-up visits, and the developed complications at each post-operative visit.

Results: More than half of the patients (54%) were males. The mean age of the patients was 47.4 years. Neovascular glaucoma was the most common indication for AGV implantation. Valve encapsulation was the most encountered complication. About one quarter of the eyes at one time underwent valve revision. Younger patients, neovascular glaucoma and congenital glaucoma were associated significantly with AGV failure and for the need for revision surgery.

Conclusion: AGV is the predominant glaucoma surgery performed in Jordan. Valve encapsulation is the most common complication for AGV implant in Jordanian patients which may be related to racial and genetic factors. Neovascular glaucoma has a high burden in Jordan and secondary causes should be controlled adequately.

Purpose: To evaluate the effectiveness and safety of ab-interno canaloplasty (ABiC) for managing intraocular pressure (IOP) in patients following keratoplasty over a three-year period.

Methods: This retrospective analysis focused on post-keratoplasty patients treated with ABiC with the iTrack microcatheter (Nova Eye Medical, Fremont, CA, USA) at a single institution. The study assessed the procedure's impact on IOP control, graft survival, and reliance on topical hypotensive medications, with additional observation for any postoperative complications. Surgical success criteria included the percentage of eyes with IOP ≤15 mmHg, IOP ≤18 mmHg, ≥20% IOP reduction, medication-free eyes, and eyes with concurrent IOP and medication reductions.

Results: ABiC was performed successfully in a cohort of 16 post-keratoplasty (7 penetrating keratoplasty and 9 endothelial keratoplasty (EK)) eyes. Preoperative mean IOP of 25.8±7.2 mmHg was significantly reduced to 13.4±2.9 mmHg (p<0.001) at 1 year postoperatively and maintained at 13.1±3.9 mmHg (p=0.009) at 3 years postoperatively. The mean number of glaucoma medications was 3.5±1.7 at baseline, 2.8±1.3 at 1 year (p=0.107), and 2.5±1.2 at 3 years postoperatively (p=0.088). Eight eyes (66.7%) maintained IOP ≤ 15 mmHg, and 10 eyes (83.3%) maintained ≥ 20% IOP reduction at 3 years. The mean IOP and medication reductions from baseline at 3 years were -49.2% and -28.6%, respectively. Graft clarity was preserved in all patients except for one case of late graft failure that necessitated a repeat EK procedure. Post-ABiC complications included transient hyphema in two patients, neither of which led to long-term adverse outcomes.

Conclusion: ABiC appears to be an effective and safe surgical intervention for sustained IOP reduction in post-keratoplasty patients. Graft survival trends are encouraging, and there was a low incidence of complications over a three-year follow-up period.

Purpose: To evaluate the visual outcomes of keratorefractive lenticule extraction using a new version of a femtosecond laser platform with semi-automated cyclotorsion compensation in comparison to the previous generation without cyclotorsion control.

Methods: This was an ambispective study of consecutive eyes treated by SMILE with the VisuMax and VISUMAX 800 femtosecond lasers at the Uma Eye clinic, Chennai, India between June 2022 and July 2023. Inclusion criteria were myopia up to -10 D and astigmatism between 1.5 D and 5 D. Data was retrospectively collected from patients that underwent SMILE using the VisuMax without cyclotorsion compensation and prospectively collected from patients undergoing SMILE using the VISUMAX 800 with Oculign and Centralign software aids.

Results: Data was collected from a total of 220 eyes that underwent routine SMILE; 115 eyes with VisuMax (VM500 group) and 105 eyes with VISUMAX 800 (VM800 group). The mean attempted spherical equivalent was -4.82±2.16 D in the VM500 group and -4.80±2.24 in the VM800 group. At the 3-month postoperative visit, 94% of eyes in the VM500 group and 98% of eyes in the VM800 group had an UDVA of 20/20 or better. Accuracy of the SEQ showed that 71% of eyes were within ±0.50 D and 100% were within ±1.00 D of target in the VM500 group and 96% of eyes were within ±0.50 D and 100% were within ±1.00 D of target in the VM800 group. There were no reported cases of suction loss or any other intraoperative complication in either group.

Conclusion: SMILE with the VisuMax and VISUMAX 800 provided excellent visual and refractive outcomes for subjects with myopic astigmatism. The VISUMAX 800, using Oculign and Centralign aids, demonstrated better accuracy when correcting cylinder greater than 2 D compared to the VisuMax without using manual cyclotorsion compensation.

Cannabis is the most used drug worldwide with an estimated 219 million users. This narrative review aims to explore the adverse effects and therapeutic applications of cannabis and cannabinoids on the eye, given its growing clinical and non-clinical uses. The current literature reports several adverse ocular effects of cannabis and cannabinoids, including eyelid tremor, ptosis, reduced corneal endothelial cell density, dry eyes, red eyes, and neuro-retinal dysfunction. Cannabinoids may transiently impair night vision, depth perception, binocular and monocular contrast sensitivity, and dynamic visual acuity. Cannabinoids are not currently considered a first-line treatment option for any ocular conditions. Δ-9-tetrahydrocannabinol been shown to result in short-term intraocular pressure reduction, but insufficient evidence to support its use in treating glaucoma exists. Potential therapeutic applications of cannabinoids include their use as a second-line agent for treatment-refractory blepharospasm, for dry eye disease given corneal anti-inflammatory properties, and for suppression of pendular nystagmus in individuals with multiple sclerosis, which all necessitate further research for informed clinical practices.