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

Objective: The swinging-flashlight test for relative afferent pupillary defect (RAPD) detection is an important clinical tool in ophthalmology that may be incorrectly performed by general healthcare providers. We designed an affordable, accessible, and easy-to-use cellphone application to screen patients for RAPD.

Methods: We created machine-learning software that locates, segments, tracks, and quantifies the kinetic response of the pupils with the goal of identifying RAPD. We tested our application on recordings of 547 participants and compared the software performance against evaluations made by a neuro-ophthalmologist, enabling us to determine the specificity and sensitivity of our software.

Results: We identified a RAPD prevalence of 5.84% in our specific population. When comparing videos that were classified as having a RAPD (RAPD+) and having no RAPD (RAPD-), we found a clear difference in kinetic response of the pupil (RAPD+: mean 0.40 ± 0.17; RAPD-: mean 0.76 ± 0.17; p < 0.001). Our method has a sensitivity of 93% and a specificity of 85%. Given a RAPD prevalence of 5.84% in our group, the software yields a positive predictive value of 28% and a negative predictive value of 99.5%.

Conclusions: We created an efficient screening tool to assist clinicians and medical staff, who may not be accustomed to performing swinging-flashlight tests, in detecting RAPD by using a readily available cellphone application.

Objective: To compare the efficacy of levobupivacaine versus bupivacaine for peribulbar block in ophthalmic surgery.

Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Publications in MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) that compared levobupivacaine and bupivacaine for peribulbar block in ophthalmic surgery were screened for eligibility from inception through December 22, 2023. Our analyses were summarized by calculating mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous variables, using either fixed-effects or random-effects meta-analysis based on the level of heterogeneity.

Results: Eight randomized control trials enrolling 800 patients were identified in the English literature published between 1998 and 2023. There was no statistically significant difference in akinesia score at 2 minutes (MD = 0.17; p = 0.12) or 10 minutes postinjection (MD = 0.02; p = 0.89). Similarly, there was no statistically significant difference between the 2 groups in terms of time of onset of the anesthetic effect (MD = 0.38; p = 0.36), postoperative diplopia (OR = 0.62; p = 0.17), incidence of systemic hypotension (OR = 1.00; p = 1.00) or verbal pain scales during the block (MD = 0.04; p = 0.66), at the end of surgery (MD = -0.01; p = 0.94) or 4 hours postoperatively (MD = -0.00; p = 0.98).

Conclusions: As a result of conducting this meta-analysis, we conclude that there is no significant difference between levobupivacaine and bupivacaine in terms of akinesia score, time to onset of anesthetic effect, verbal pain scales, postoperative diplopia, or incidence of systemic hypotension.

Objective: To investigate the prevalence of non-person-first language (PFL) in neuro-ophthalmology referrals to a single tertiary ophthalmology clinic.

Design: Retrospective cross-sectional study.

Methods: Participants included neuro-ophthalmology patients seen for their initial visit from July 2018 to December 2022. Ten randomly selected referrals from each day were screened. Non-PFL was further categorized as per American Medical Association and American Psychological Association guidelines. Associations between non-PFL and patient age and gender, referring provider gender and specialty, and year and length of referral, were evaluated using the χ² test.

Results: A total of 2105 referrals were included in the study and 81 (3.8%) used non-PFL, such as referring to a person with glaucoma as a "glaucoma patient". Error types included general (38.3%), stigma (25.9%), diabetes (19.8%), disability (13.6%), and obesity (2.5%). Non-PFL was significantly more likely in long referrals compared with medium and short referrals (9.9% vs 3.1% vs 1.3%; p < 0.001). Referral year was predictive of non-PFL (p = 0.0006), with a significant increase from 2018 (1.7%) to 2021 (6.1%) and decrease in 2022 (2.6%). Patient age was also predictive of non-PFL (p = 0.0359), with the highest prevalence among patients 40-69 years old (5.4%). Patient gender (p = 0.3350), referring provider gender (p = 0.3571), and referring provider specialty (p = 0.1280) were not predictive of non-PFL.

Conclusions: The highest proportions of non-PFL errors made were general and stigma errors. Non-PFL use was most prevalent in 2021, most commonly in referrals for patients aged 40-69 years. There exists a need for ongoing education and awareness around PFL use in physician-physician communication to enhance inclusive, nonstigmatizing care for neuro-ophthalmology patients.

Objective: Immune checkpoint inhibitors (ICIs) reportedly have a potential risk of general ocular complications; however, whether ICIs have a risk of uveitis remains unclear. Therefore, we assessed whether ICI use has a higher risk of uveitis than chemotherapy alone.

Methods: Using a large administrative claims database in Japan, we identified 26 474 patients with lung cancer, renal cell carcinoma, or malignant melanoma, who initiated ICI or chemotherapy between April 2014 and November 2022. The patients were divided into 2 groups: those receiving ICI with and without chemotherapy (ICI group: n = 8103) and those receiving chemotherapy alone (non-ICI group: n = 18 371). After propensity score-overlap weighting to adjust for background factors, we estimated the incidence of uveitis and performed Cox regression analyses. We also conducted subgroup analyses stratified by age (<75 and ≥75 years).

Results: The overlap-weighted incidence of uveitis in the ICI group was higher than that in the non-ICI group (85.1 vs 55.9/10,000 person-years; number needed to harm: 343). The hazard ratio (HR) for uveitis in the ICI group was 1.49 (95% confidence interval, 1.11 to 2.01) in comparison with the non-ICI group. The age-stratified analysis showed that the ICI group had an increased risk among individuals aged <75 years (HR 1.65 [1.15 to 2.41]), while the risk did not differ among individuals aged ≥75 years (HR 1.35 [0.84 to 2.18]).

Conclusions: ICI use was associated with a higher risk of uveitis compared to non-ICI use, particularly among patients aged <75 years.

Objective: To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) arterial injury on temporal artery biopsy (TAB).

Design: Single-centre, retrospective cohort study.

Participants: One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.

Methods: Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.

Results: Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (p = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (p = 0.050) and with earlier relapse rates (p = 0.007). Aortitis (HR 7.96; p = 0.007) and jaw claudication (HR 5.08; p = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (p = 0.044 and p = 0.047, respectively) and were associated with disease relapses on univariable analysis (p = 0.044 and p = 0.047, respectively) but not on multivariable analysis.

Conclusions: The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.

Objective: To review the literature on safety of magnetic resonance imaging (MRI) in patients with preseptal ferromagnetic foreign bodies.

Methods: We describe 3 cases of MRI in patients with preseptal ferromagnetic foreign bodies (FFBs) from our institution.

Results: The FFBs were all preseptal, adjacent to the medial canthus (n = 2) and lateral canthus (n = 1). None of the patients had any ocular complications post-MRI. The literature review identified an additional 7 cases with intraocular and preseptal FFBs that underwent MRI. The FFBs ranged in size from 1.0 mm to 3.5 mm. The FFBs were intraocular (n = 6), or preseptal (n = 1). The MRI field strength ranged from 0.35 T to 1.5 T. Five (83.3%) of the patients with intraocular FFBs had ocular complications, which included hyphema (n = 2), cataract (n = 3), vitreous haemorrhage (n = 1), and corneal scar (n = 1). The patient with preseptal FFB did not have post-MRI complications.

Conclusions: There is some evidence to suggest that patients with preseptal FFBs may be less likely to experience complications post-MRI compared to intraocular FFBs. Various factors affect the safety of MRIs, including FFB location, size, proximity to visually-significant structures, and MRI field strength.