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

Objective: To examine whether the number of relapses is associated with visual outcomes in patients with optic neuritis.

Design: A post hoc analysis using data from the Optic Neuritis Treatment Trial, a multicenter randomized controlled trial conducted to explore the efficacy of corticosteroids on optic neuritis.

Methods: Multivariate linear mixed effect models were used to estimate the associations of the number of ipsilateral relapses in the baseline affected eye with visual outcomes. The modeling accounted for the number of ipsilateral relapses and adjusted for time to follow-up visit, baseline visual function, treatment groups, the number of contralateral relapses, the interaction between the number of relapses and time to follow-up, as well as demographic covariates of age, sex, race/ethnicity.

Results: Among the 449 included patients, 71 (15.8%) had one ipsilateral relapse, and 24 (5.3%) had ≥2 ipsilateral relapses. The mean age of the patients was 31.9 years, with 345 (76.8%) females and 384 (85.5%) Whites. The median follow-up time was 15.9 years. In the adjusted mixed model, higher number of ipsilateral relapses was associated with poorer visual outcomes, including visual acuity (mean difference [MD], 0.20 logarithm of the minimal angle of resolution unit; 95% confidence interval [CI], 0.15 to 0.25 for ≥2 vs no ipsilateral relapse), contrast sensitivity (MD, -1.14 lines; 95% CI, -1.54 to -0.73 for ≥2 vs no ipsilateral relapse), visual field mean deviation (MD, -3.57 decibels; 95% CI, -4.38 to -2.76 for ≥2 vs no ipsilateral relapse), and color vision (MD, 1.94 error scores; 95% CI, 0.74 to 3.14 for ≥2 vs no ipsilateral relapse).

Conclusions: Increasing number of relapses was associated with worse visual outcomes. More aggressive management following an initial episode is imperative to prevent relapse.

Objective: To compare sex and medical school graduate type differences in cataract surgical training volumes at Canada's largest residency program, the University of Toronto (UoT).

Design: Retrospective cohort study PARTICIPANTS: Ophthalmology residents completing cataract surgical training from 2015 to 2020.

Methods: Data collected from surgical logbooks at the main cataract surgical teaching site at UoT were analyzed from July 1, 2015, to June 30, 2020. Data collected included stage of resident training and degree of participation for each case. The main outcome measure was mean number of complete cataract cases as a function of resident sex, medical school graduate type, and level of training.

Results: Thirty-five (19, 54.3% female) residents completed cataract surgical training during the study period. There were 24 (68.6%) Canadian medical graduates (CMGs) and 11 (31.4%) international medical graduates (IMGs). Female residents performed a lower mean number of complete cataract cases compared to males (464.2 versus 504.8, respectively). IMGs completed on average 110.0 (22.8%) fewer cataract cases compared to CMGs. Compared to all residents, female IMGs had the lowest number of complete cataract cases (mean of 380.8 versus 465.7, respectively). The greatest difference occurred between male CMGs and female IMGs, with male CMGs performing 153.8 (40.4%) more complete cases (534.6 vs 380.8, respectively).

Conclusion: The greatest difference in surgical volumes occurred between CMGs and IMGs. Female IMGs had the lowest complete cataract case volumes compared to all residents. Our study highlights novel medical school graduate type disparities in cataract surgical training warranting further exploration.

Objective: To assess the prevalence of unintended placement of intraocular lens (IOL) haptics in the sulcus and its association with posterior capsular opacification (PCO).

Design: Cross-sectional study.

Participants: 428 post-mortem pseudophakic human eyes.

Methods: Eyes were obtained from the Lions Gift of Sight and imaged in Miyake-Apple view (MAV). IOL haptic placement (bag-bag, bag-sulcus, sulcus-sulcus) was determined from the MAV images. IOL-capsular bag complexes were extracted and analyzed via Automated Detector Opacification Software to quantify PCO and Soemmering's Ring (SR). SR distribution was categorized as focal, diffuse, or none. Mean differences in PCO and SR between haptic groups were assessed via Welch's t-test. Odds ratios were used to compare the risk of SR distribution patterns between both haptic groups. Sex, clinical history (diabetes, smoking, hypertension, glaucoma, cancer, age-related macular degeneration [AMD], hypercholesterolemia, cardiovascular disease), and IOL model and specifications were collected.

Results: 20 eyes (4.67%) had unintended sulcus placement of haptics. Mean PCO (p = 0.0367) and SR (p = 0.0414) were significantly higher in sulcus eyes. Sulcus eyes were significantly more at risk of focal SR distribution (OR 8.715; p < 0.0001) and significantly less at risk of diffuse SR distribution (OR 0.168; p = .0007). Sulcus eyes had significantly higher frequencies of glaucoma (p < 0.0001) and AMD (p = 0.0023) on clinical history.

Conclusions: This study demonstrates that unintended sulcus placement of IOL haptics may be associated with an increased risk of PCO and SR formation. This study offers clinical signs of sulcus haptic placement that may prompt physicians to seek earlier appropriate intervention.

Purpose: This study aims to identify clinical similarities and differences between males and females presenting with orbital fracture.

Methods: Patient charts of adult orbital fracture cases diagnosed via computed tomography and referred by a level 1 trauma center to the McGill University Health Centre between August 2015 to January 2018 were examined and analyzed. Clinical parameters included age, sex, mechanism of injury, morphology of orbital fracture, symptoms and examination features, and rates of ocular pathology. Comparative analyses were performed via Student's t-test and chi-square to assess for sex-related differences.

Results: The study included 176 males (mean age: 46.2 years) and 68 females (mean age: 58.5 years). The most common etiology of orbital fracture was assault among males (32%) and fall from own or standing height among females (38%). Males had a higher prevalence of bilateral fractures than females (17% vs 6%; p = 0.02) and had more orbital walls fractured per orbit than females (2.0 vs 1.5; p < 0.01). Males were more likely to have their orbital roof fractured (28% vs 15%; p = 0.03) and were more likely to be intubated after their trauma (22% vs 7%; p = 0.004). Post-traumatic ocular pathology occurred in 11% of males versus 9% of females (p = 0.56).

Conclusion: In our cohort of adult orbital fractures, males were more prevalent, more likely to have bilateral fractures, more extensive fracture per orbit, and higher prevalence of orbital roof fractures and intubation. Despite these differences, rates of ocular pathology did not differ significantly between males and females, highlighting the importance of a careful assessment in both groups.

Objective: To determine the quality and extent of sociodemographic reporting in the contemporary Canadian ophthalmology literature.

Study design: Cross-sectional study.

Methods: All full-length primary studies involving human participants published in the Canadian Journal of Ophthalmology from January 2020 to December 2022 were included.

Results: A total of 669 studies were screened, and 213 studies were eligible for inclusion. Sociodemographic information reported in eligible studies included age (97.18%), sex (88.26%), comorbidities (25.35%), level of education (5.16%), socioeconomic status (2.82%), and occupation (1.14%). Of the relevant studies, 54 (25.35%) included racial or ethnic data. Canadian studies were 1.84 times less likely than studies conducted outside Canada to report race or ethnicity (p = 0.018), but 13 times more likely to report level of education (p < 0.001). Few articles provided information on how racial or ethnic data were collected (12.96%), why the racial or ethnic classification reported in the study was used (5.56%), why race or ethnicity was assessed in the study (24.07%), whether the classification options used were defined by the investigator or the participant (5.56%) or defined the variable race (1.85%). Some studies reported Indigenous participants (18.52%), and no studies with Indigenous participants reported engagement with Indigenous interest holders in the research process.

Conclusions: Most studies reported age and sex or gender, while the reporting of other equity-relevant sociodemographic data was low. In particular, the reporting of racial or ethnic data was limited. Improved sociodemographic reporting may help stakeholders better identify and address national disparities in ocular health.

Objective: To describe the clinical, imaging characteristics, and treatment of pediatric orbital Langerhans cell histiocytosis (LCH).

Design: Retrospective case series.

Participants: Children with orbital LCH.

Methods: Children with orbital LCH who presented to 4 different centres over the past 10 years. Demographic details, presenting features, imaging, histopathology, immunohistochemistry, and management outcomes were analyzed.

Results: Sixteen patients were reviewed. The mean age of presentation was 6.56 ± 4.38 years (range, 1-18 years). Eyelid swelling was the most common presenting feature (13, 81%), followed by proptosis (1, 5%), eyebrow swelling (1,5%), and temple swelling (1, 5%). Imaging revealed superior orbital lesions with osteolytic defects of the orbital roof in 13 (72.2%) patients. Frontal and zygomatic bones were the most commonly affected. All the orbital lesions were extraconal. All patients in the study were diagnosed with LCH from orbital tissue biopsy. Three patients also demonstrated extra-orbital involvement. Two patients (12.5%) had intraoperative steroid injection with curettage, and 1 patient (6.25%) underwent curettage only. The remainder of the patients (n = 13, 81.25%) received systemic steroids and chemotherapy after undergoing biopsy. All patients had complete remission of disease without any signs of recurrence, except for 1 case of refractory LCH.

Conclusions: LCH is a rare disorder of the orbit and should be considered in the differential diagnosis for osteolytic lesions involving the superior orbit among the pediatric age group. Histopathologic confirmation is mandatory. Although optimal treatment remains controversial, complete removal of unifocal orbital LCH is recommended and may be achieved through excision and curettage.

Background/objectives: Tamoxifen has well-known retinal toxicity, but the epidemiology of this toxicity is poorly defined. This study aims to 1) evaluate the prevalence of tamoxifen retinopathy in a major northeastern metropolitan area based on multimodal retinal imaging and 2) determine whether the additional peripheral retina captured in ultra-widefield (UWF) imaging aids in the diagnosis of tamoxifen retinopathy.

Methods: This retrospective cohort study examined female patients initiated on tamoxifen for at least 12 months prior to their first retinal exam. Two independent graders performed blinded review of spectral-domain optical coherence tomography (OCT) images for evidence of macular toxicity and UWF images for signs of central and peripheral toxicity. A one-tailed two-proportion Z-test determined whether peripheral pigmentary changes were more prevalent in the tamoxifen cohort than age- and gender-matched controls.

Results: 241 eyes from 123 patients were included in the tamoxifen cohort, and 258 eyes from 132 patients were included in the control cohort. Two patients demonstrated definitive tamoxifen retinopathy, for a prevalence of 1.6%. One patient demonstrated crystalline maculopathy on OCT and UWF imaging, while another demonstrated pseudocystic cavitations on OCT imaging. Neither patient had peripheral findings on UWF imaging. Peripheral pigmentary changes were not significantly more prevalent in the tamoxifen cohort.

Conclusions: These findings suggest that UWF imaging does not contribute to diagnosis of tamoxifen retinopathy, and OCT may be the most valuable tool in diagnosing tamoxifen retinopathy. Our prevalence (1.6%) diverges from higher rates in studies screening with similarly advanced retinal imaging. Further large population studies are needed.