Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Objective: To analyze the pathological composition ratio of orbital space-occupying lesions in a large single-center cohort and to assess differences across age groups and decades.

Design: A retrospective observational study.

Participants: A total of 7 515 patients with histopathologically confirmed orbital space-occupying lesions who underwent surgical excision at Zhongshan Ophthalmic Center from January 2000 to March 2021.

Methods: Demographic and histopathological data were reviewed. Lesions were classified by biological behavior (benign/borderline vs malignant), tissue origin, and age group (0-14, 15-59, and ≥60 years). Temporal trends were compared between 2000-2009 and 2010-2021.

Results: Among 7 515 patients, 3 717 (49.5%) were male. Benign or borderline lesions comprised 78.0%, and malignant lesions comprised 22.0%, with mean ages of 36 and 49 years, respectively (p < 0.05). The leading histopathologic types were vasculogenic (22.3%), lymphoproliferative (16.4%), inflammatory (16.0%), and cystic (11.9%) lesions. Idiopathic orbital inflammatory pseudotumour was the most common benign entity, and MALT lymphoma was the most frequent malignancy. Malignancy increases with age, reaching 43.6% in the elderly. Over 2 decades, vasculogenic lesions declined, while lymphoproliferative and malignant lesions rose.

Conclusions: The pathological spectrum of orbital space-occupying lesions in southern China is dominated by inflammatory and vascular lesions in younger patients and by lymphoproliferative malignancies in the elderly. Over the past two decades, vascular lesions have decreased, whereas lymphoproliferative and malignant lesions have become more prevalent, reflecting demographic aging and advances in diagnostic pathology. These findings provide updated epidemiologic evidence to guide the differential diagnosis and management of orbital tumours.

Objective: Amid growing adoption of AI in ophthalmology, Hill-Radial Basis Function (Hill-RBF) 3.0 formula may improve refractive target prediction across diverse populations, transforming patient care. This systematic review and meta-analysis (PROSPERO: CRD42021231150) evaluated the predictive performance of the Hill-RBF 3.0 against other traditional and AI-based intraocular lens (IOL) power calculation formulas.

Design: Systematic review and meta-analysis.

Methods: EMBASE, MEDLINE, CINAHL, and Web of Science were searched on March 17, 2025. Eligible studies reported refractive or cataract surgeries using Hill-RBF 3.0 and at least 1 comparable formula (Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Hoffer QST, Holladay I, Ladas Super Formula AI, Kane, Olsen, Pearl-DGS, or SRK/T). Standardized mean difference (SMD) in mean absolute error (MAE) and odds ratio (OR) of achieving postoperative refraction within ±0.25, ±0.50, and ±1.00 diopters (D) were assessed. Meta-analyses were performed.

Results: Of 130 records screened, 31 studies were included qualitatively and 28 quantitatively. Hill-RBF 3.0 showed significantly lower MAE (SMD [95% CI]) compared to Haigis (-0.12 [-0.21 to -0.02]; p = 0.01), Holladay-1 (-0.08 [-0.15 to -0.01]; p = 0.04), and SRK/T (-0.07 [-0.14 to 0.00]; p = 0.04). Odds (odds ratio [OR; 95% CI]) of achieving ±0.50 D were higher versus Haigis (1.09 [1.01-1.19]; p = 0.03), Hoffer Q (1.11 [1.04-1.19]; p = 0.002), Holladay-1 (1.10 [1.02-1.18]; p = 0.02), and SRK/T (1.08 [1.01-1.16]; p = 0.02). Similarly, Hill-RBF outperformed these formulas within ±0.25 D, except in comparison with Holladay-1.

Conclusions: Hill-RBF 3.0 achieved comparable or superior predictive accuracy over traditional and AI-based formulas, enhancing clinical workflows, refractive outcomes, and patient care.

Objective: To evaluate the real-world effectiveness and safety of topical insulin (25 IU/mL) in patients with neurotrophic keratopathy (NK) across multiple etiologies.

Methods: We retrospectively reviewed 29 consecutive eyes of 28 patients with neurotrophic keratopathy treated with topical insulin at a single center. The primary outcome was complete epithelial healing for stages 2 and 3 NK; for stage 1, success was prespecified as improvement in corneal staining and epithelial integrity. Statistical analysis included survival analysis and multivariable logistic regression with Firth penalization.

Results: Twenty-nine eyes with a mean follow-up of 32.7 weeks were included. Most common etiologies were infectious (51.7%), including herpes simplex virus (24.1%) and varicella zoster virus (20.7%). Twenty-three eyes had stages 2 or 3 NK. Among eyes with stages 2 and 3 NK, complete epithelial healing occurred in 18/23 (78.3%, 95%; CI: 58.1-90.3%), with a median healing time of 33.5 days (IQR: 15.8-81.8). The cumulative healing rate at 8 weeks was 43.5%. Healing success was not significantly associated with defect size or etiology. Among 8 patients who discontinued insulin after healing, recurrence occurred in 1 case (12.5%) and resolved upon treatment resumption. One patient developed mild punctate keratopathy that resolved with continued therapy.

Conclusions: Topical insulin demonstrated substantial healing efficacy for neurotrophic keratopathy across diverse etiologies, with a favourable safety profile and low recurrence rate. Although healing may be slower than FDA-approved alternatives, the dramatic cost difference suggests insulin may be a cost-effective first-line therapy for refractory cases. This represents one of the largest multietiological case series of insulin therapy for neurotrophic keratopathy reported to date.

Objective: To develop a surgical assessment tool to evaluate the breadth of surgical procedures in which ophthalmology residents are required to gain competence and to validate this tool for cataract surgery.

Design: A questionnaire development study.

Participants: Ophthalmology residents and faculty at the University of Ottawa.

Methods: The Canadian Ophthalmology Assessment Tool for Surgery (COATS) was developed by a group of experts by modifying a previously validated assessment tool, the Ottawa Surgical Competency Operating Room Evaluation, and consists of 6 Likert scale items, 1 yes or no question assessing independence and 2 open-ended questions for narrative feedback. During a 2-year period, residents were evaluated on the performance of cataract surgery using the COATS. The primary outcome was the total COATS score, defined as the sum of the Likert scale items.

Results: A total of 165 COATS assessments were collected across 5 residents. Mean total COATS scores were lower for the first 2 months of training compared with the last 3 months of training (4.33 ± 0.25 vs 4.81 ± 0.03; p = 0.01; Cohen's d = 0.25) and for procedures where the resident was rated as "not independent" versus "independent" (4.26 ± 0.13 vs 4.74 ± 0.06; p = 0.006; Cohen's d = 0.13). There was a significant correlation between the number of cataract surgeries performed and the mean total COATS score (Pearson r = 0.20; p = 0.02). Forty-five COATS assessments per resident were required to obtain an overall reliability of 0.70, the accepted threshold for low-stakes assessments.

Conclusions: The COATS is a valid tool for the assessment of surgical competence in cataract surgery. There is also evidence that it is a reliable tool when completed multiple times per resident over the course of training.

Objective: To synthesize and critically appraise the available evidence on choroidal vitiligo, integrating clinical presentation, multimodal imaging characteristics, and diagnostic differentiation from mimics, while proposing a set of diagnostic criteria based on literature synthesis and authors' expert consensus.

Methods: A systematic search of PubMed, Embase, and Cochrane Reviews through July 2025 identified English-language studies reporting on choroidal vitiligo. Two reviewers independently screened, extracted data, and assessed methodological quality for case reports and case series. Narrative synthesis and descriptive statistics were used to summarize the findings.

Results: Eight studies met inclusion criteria, comprising 16 patients (28 eyes) from 5 countries. The majority of patients (75%) were asymptomatic, middle-aged females, with bilateral involvement in 88% of cases and preserved visual acuity (≥20/25 in 81% of eyes). Multimodal imaging consistently revealed well-demarcated choroidal hypopigmentation with intact retinal architecture and no intraocular inflammation. OCT demonstrated preserved retinal layers with occasional mild choroidal thinning. Fundus autofluorescence often showed scleral hyper-autofluorescence; FA/indocyanine green angiography showed mild window defects without leakage. Cutaneous vitiligo was present in 63% of patients, with no systemic autoimmune disease reported.

Conclusions: Choroidal vitiligo is a rare, benign, and often incidental finding, best recognized through multimodal imaging. This review proposes clinical diagnostic criteria for primary choroidal vitiligo and highlights its key imaging signature to aid differentiation from neoplastic and inflammatory mimics. We recommend baseline multimodal imaging and follow-up at 6-12 months to confirm stability. Standardized imaging criteria and prospective studies are needed to better define prevalence, natural history, and systemic associations. Given that most included studies were single-case reports, the overall level of evidence is low.