Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献_第10页

Trends in medico-legal cases against Canadian ophthalmologists: a 10-year retrospective review (2013–2022) 针对加拿大眼科医生的医疗法律案件趋势：一项10年回顾性审查（2013-2022）。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.05.003

Derek M. Waldner , Gary Garber , Anne Steen , P.J. Finestone , Richard Liu , Donna Perron , Qian Yang , Anna MacIntyre , Natalie Gagné , Tricia Savoy , Kevin Warrian , Alex Ragan

Objective

To investigate trends in medico-legal complaints against Canadian ophthalmologists over a ten-year period (2013–2022).

Methods

Retrospective review of closed legal, hospital, and regulatory cases involving ophthalmologists was conducted using data from the Canadian Medical Protective Association (CMPA). Cases were systematically coded by nurse analysts using the Canadian Classification of Health Interventions, ICD-10-CA, and a specific schema for contributing factors. Data analyses utilized SAS software (9.4) and Prism GraphPad (9.4.1).

Results

A total of 970 closed cases with sufficient data for analysis were identified, including 584 college complaints, 340 legal complaints, and 46 hospital complaints. Complainants were predominantly female (55.4%) and mostly aged 30–64. Of the 1021 ophthalmologists named, 210 faced multiple complaints, with 82% of complaints against those with over ten years of practice. The most common clinical presentations generating complaints were disorders of the lens (37.1%), disorders of the choroid and retina (17.3%), and disorders of refraction (14.9%). The most common complications cited in complaints included visual disturbances (22.0%) and retinal complications (13.8%). Peer expert concerns were noted in 540 cases (55.7%), with common issues being inadequate documentation (31.5%), consent processes (25.9%), and communication (20.6%). Approximately 50.9% of cases had unfavorable outcomes for CMPA members, though the most frequent unfavourable college outcome was “dismissed with concern”.

Conclusion

This review highlights gaps in Canadian ophthalmic care, empowering ophthalmologists to address these concerns. Future work will focus on detailed assessments of cases with peer expert concerns and developing specific recommendations for clinical practice.

目的：调查十年间（2013-2022年）加拿大眼科医生的医疗法律投诉趋势。方法：使用加拿大医疗保护协会（CMPA）的数据，对涉及眼科医生的法律、医院和监管案件进行回顾性分析。护士分析人员使用加拿大健康干预分类（ICD-10-CA）和特定的促成因素模式对病例进行系统编码。数据分析采用SAS软件（9.4）和Prism GraphPad软件（9.4.1）。结果：共收集到970例有足够数据可供分析的结案案例，其中高校投诉584例，法律投诉340例，医院投诉46例。投诉人以女性为主（55.4%），大部分年龄在30至64岁之间。在被点名的1021名眼科医生中，210名面临多重投诉，其中82%的投诉对象是从业10年以上的医生。最常见的临床表现是晶状体疾病（37.1%）、脉络膜和视网膜疾病（17.3%）和屈光疾病（14.9%）。最常见的并发症包括视力障碍（22.0%）和视网膜并发症（13.8%）。540例病例（55.7%）注意到同行专家的担忧，常见的问题是文件不足（31.5%），同意程序（25.9%）和沟通（20.6%）。大约50.9%的案例对CMPA会员有不利的结果，尽管最常见的不利的大学结果是“担忧地忽视”。结论：本综述突出了加拿大眼科护理的差距，使眼科医生能够解决这些问题。未来的工作将集中于对病例的详细评估和同行专家的关注，并为临床实践提出具体建议。

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引用次数: 0

Artificial intelligence in the classification and segmentation of fundus images with choroidal nevi 人工智能在脉络膜痣眼底图像分类和分割中的应用。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2024.07.009

R. Trafford Crump , Emad Mohammed , Mehregan Biglarbeiki , Mohammadmahdi Eshragh , Esmaeil Shakeri , Gunnar Joakim Siljedal , Behrouz Far , Ezekiel Weis

Objective

The purpose of this study is to summarize the results from 3 experimental studies into the use of artificial intelligence to classify and segment colour fundus images with choroidal nevi.

Study Design

This study is based on a secondary analysis of colour fundus images taken of patients receiving usual clinical care from the Alberta Ocular Brachytherapy Program.

Methods

High-resolution colour fundus images were labeled by experienced ocular oncologists. In experimental study 1, four pre-trained models (ResNet 50, VGG-19, VGG-16, and AlexNet) were evaluated for their ability to classify images based on the presence of choroidal nevi. In experimental study 2, the performance of 3 patch-based models to classify images based on the presence of choroidal nevi were compared. In experimental study 3, four convolutional neural network models were developed to segment the images. In experimental studies 1 and 2, performance was measured using accuracy, precision, recall, F1 score, and AUC. In experimental study 3, IoU and Dice measures were used to evaluate performance.

Results

A total of 591 labelled colour fundus images were used for analysis. In experimental study 1, VGG-16 showed the best accuracy, AUC, and recall, but lower precision in classifying images. In experimental study 2, the patched approached enhanced with artifact and contrast outperformed the others in classifying images. In experimental study 3, a voting-based Ensemble model excelled in segmenting the part of images with nevi.

Conclusions

It is feasible to train AI models to identify choroidal nevi in colour fundus images.

研究目的本研究旨在总结利用人工智能对带有脉络膜痣的彩色眼底图像进行分类和分割的 3 项实验研究的结果：方法：由经验丰富的眼部肿瘤专家对高分辨率彩色眼底图像进行标注。在实验研究 1 中，评估了四个预训练模型（ResNet 50、VGG-19、VGG-16 和 AlexNet）根据脉络膜痣的存在对图像进行分类的能力。在实验研究 2 中，比较了 3 个基于补丁的模型根据脉络膜痣的存在对图像进行分类的性能。在实验研究 3 中，开发了 4 个卷积神经网络模型来分割图像。在实验研究 1 和 2 中，使用准确率、精确度、召回率、F1 分数和 AUC 来衡量性能。在实验研究 3 中，使用 IoU 和 Dice 度量来评估性能：共有 591 张标注了颜色的眼底图像被用于分析。在实验研究 1 中，VGG-16 显示出最佳的准确率、AUC 和召回率，但图像分类精度较低。在实验研究 2 中，用人工痕迹和对比度增强的修补方法在图像分类方面优于其他方法。在实验研究 3 中，基于投票的集合模型在分割有痣的图像部分方面表现出色：训练人工智能模型来识别彩色眼底图像中的脉络膜痣是可行的。

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引用次数: 0

Impact of 11 years of glaucoma research funding: Glaucoma Research Society of Canada (2010–2020) 11年青光眼研究经费的影响：加拿大青光眼研究协会（2010-2020）。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.05.022

William J. Herspiegel , Melina Moeinkhah , Anastasiya Vinokurtseva , Graham Trope , Cindy M.L. Hutnik

Objective

The Glaucoma Research Society of Canada (GRSC) is Canada’s only nonprofit organization dedicated to funding peer-reviewed glaucoma research. This study evaluates the impact of GRSC-funded projects using established research productivity metrics.

Design

Retrospective study.

Methods

GRSC-funded grants from 2010 to 2020 were analyzed, including project details and funding amounts. Research productivity was assessed by (1) the number of peer-reviewed publications and (2) the number of conference presentations at major North American meetings. Publications were identified via PubMed searches of grant recipients, ensuring alignment with GRSC-funded topics. Conference presentations were determined by reviewing accepted abstracts from 5 key ophthalmology meetings: the Canadian Ophthalmological Society, American Society of Cataract and Refractive Surgery, American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology. Research output was analyzed in relation to funding costs.

Results

Of 135 grants totaling $2,220,822, 84 (62%) led to at least one publication (92 total), while 67 (50%) resulted in conference presentations (85 total). The average research output per grant was 1.3, with costs of $12,547 per research output and $24,139 per publication. Research costs increased over time, with a slight decrease in 2019.

Conclusions

GRSC-funded research consistently generates peer-reviewed knowledge, with over half of projects producing publications or presentations. Despite rising research costs, the high success rate in knowledge dissemination underscores GRSC’s critical role in sustaining and advancing glaucoma research in Canada.

目的：加拿大青光眼研究协会（GRSC）是加拿大唯一致力于资助同行评议青光眼研究的非营利组织。本研究使用已建立的研究生产力指标评估grsc资助项目的影响。研究设计：回顾性研究。方法：对2010 - 2020年grsc资助项目进行分析，包括项目明细和资助金额。研究生产力是通过(1)同行评议的出版物数量和(2)在北美主要会议上的会议发言数量来评估的。通过PubMed对资助接受者的搜索确定出版物，确保与grsc资助的主题保持一致。会议报告是通过审查5个主要眼科会议的接受摘要来确定的：加拿大眼科学会、美国白内障和屈光手术学会、美国眼科学会、美国青光眼学会和视觉和眼科研究协会。研究产出与资金成本的关系进行了分析。结果：在135项资助中，总计2,220,822美元，84项（62%）导致至少一篇论文发表（总共92篇），67项（50%）导致会议报告（总共85篇）。每笔赠款的平均研究产出为1.3，每项研究产出费用为12 547美元，每本出版物费用为24 139美元。研究成本随着时间的推移而增加，2019年略有下降。结论：grsc资助的研究始终产生同行评审的知识，超过一半的项目产生出版物或演示文稿。尽管研究成本不断上升，但知识传播的高成功率强调了GRSC在维持和推进加拿大青光眼研究方面的关键作用。

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引用次数: 0

Prevalence of ocular manifestations in cutaneous rosacea: systematic review and meta-analysis 皮肤酒渣鼻眼部表现的患病率：一项系统回顾和荟萃分析。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.04.005

Ryan H. Kirkpatrick , Kristina Nazzicone , Aleksandar Biorac , Anneke R. Froentjes , Sarah M. Simpson , Sonja Molin

Objective

Ocular rosacea (OR) is a rosacea subtype, typically presenting as dry eye, foreign body sensation, and photophobia. Prevalence estimates of OR in cutaneous rosacea (CR) range from 0.03% to 65%. This systematic review and meta-analysis consolidate the prevalence of diagnosed OR within CR and ocular involvement of CR.

Methods

Primary research studies reporting the prevalence of OR in adults with CR were eligible for inclusion. Embase, MEDLINE, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. The Joanna Briggs Institute Critical Appraisal tool for Prevalence Studies and a Peters’ regression test assessed risk of bias. Results were analyzed through random intercept logistic regression models using R. Studies reporting diagnosed OR were analyzed separately from those reporting ocular involvement.

Results

28 studies were identified, 11 reported on diagnosed OR, and 17 reported on ocular involvement in CR. Prevalence of diagnosed OR (N = 124 093) was 10.3%, whereas the prevalence of ocular involvement in CR (N = 1 747) was 44.3%. In diagnosed OR, publication year significantly contributed to variations in reported OR prevalence, with more recent studies reporting a lower prevalence of diagnosed OR compared to older studies.

Discussion

This study highlights the variability in reported prevalences of OR and ocular involvement in CR. This might be explained by a lack of clear guidelines on how to diagnose and refer patients with CR and co-occurring ocular signs and symptoms. Greater clinician awareness and clear referral guidelines are warranted.

目的：眼酒渣鼻（OR）是一种酒渣鼻亚型，典型表现为干眼、异物感和畏光。OR在皮肤酒渣鼻（CR）中的患病率估计在0.03%到65%之间。本系统综述和荟萃分析巩固了CR中诊断的OR的患病率和CR的眼部受累。方法：报告成人CR中OR患病率的初步研究符合纳入条件。检索了Embase、MEDLINE、Web of Science、ProQuest和Cochrane Central Register of Controlled Trials （Central）。乔安娜布里格斯研究所流行病学研究关键评估工具和彼得斯回归测试评估了偏倚风险。结果通过随机截距logistic回归模型进行分析。报告诊断为OR的研究与报告眼部受累的研究分开分析。结果：共纳入28项研究，其中11项报告了诊断为OR， 17项报告了CR的眼部受累。诊断为OR的患病率（N = 124,093）为10.3%，而CR的眼部受累患病率（N = 1 747）为44.3%。在诊断性OR中，发表年份对报告的OR患病率差异有显著影响，与较早的研究相比，最近的研究报告诊断性OR的患病率较低。讨论：本研究强调了报道的CR中OR患病率和眼部受累的差异，这可能是由于缺乏关于如何诊断和转诊CR患者并同时出现眼部体征和症状的明确指南。提高临床医生的认识和明确的转诊指南是必要的。

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引用次数: 0

An atypical case of thyroid-related orbitopathy presenting as bilateral infiltrative mass lesions 一个不典型的甲状腺相关眼病病例，表现为双侧浸润性肿块病变。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.08.013

Nishanth S. Iyengar, Edward Xie, Casey Bunge, Tahmeena Ahmed, Nariman S. Boyle

引用次数: 0

Visual Abstract 视觉文摘

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.11.007

引用次数: 0

ETDRS-style distance visual acuity charts for Indigenous Canadians: development and validation using Canadian Aboriginal syllabics 加拿大原住民etdrs风格的距离视力表：使用加拿大原住民音节的发展与验证。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.04.004

Brendan K. Tao , Sidrat Rahman , Dana Toameh , Edsel Ing , Christian El-Hadad

Objective

To develop and validate a logMAR Early Treatment Diabetic Retinopathy Study (ETDRS)-style visual acuity chart imprinted with Canadian Aboriginal Syllabics (CAS) optotypes.

Design

Prospective, nonrandomized, within-subject analysis.

Participants

22 Indigenous patients from the Ullivik residence (Montreal, QC) for Inuit patients who were able to interpret Latin and CAS characteristics.

Methods

Python and LaTeX scripts were created to generate PDFs of standard ETDRS charts, which could be readily modified for alphabet (CAS or Latin), font, and optotype sizing. We used CAS characters that were preserved across Cree, Ojibwe, and Inuktitut languages. A 60" television screen (4K resolution) was used to display the eye charts to scale. For each subject, the best-corrected visual acuity (BCVA) of each eye was assessed on each chart (4 measurements per patient).

Results

The median difference between visual acuities (logMAR) acquired by the Latin and CAS charts was 0 (Q1: –0.08; Q3: 0). Band–Altman analysis revealed a bias of −0.01 (SD: 0.03), which was near zero (indicating favourable agreement), and one outlier (of 22 patients), whose deviation was attributed to random error. The visual acuity differences between eye charts were not statistically significant (p = 0.1).

Conclusions

We developed and validated the first CAS-imprinted ETDRS chart for measuring visual acuity. Given its use of preserved characters across Cree, Ojibwe, and Inuktitut languages, this chart has additional applicability to several Indigenous populations in Canada. Future work should develop near reading cards and other methods of optimizing culturally competent eye care for Indigenous patients.

目的：开发并验证一种带有加拿大原住民音节（CAS）视力表的logMAR早期治疗糖尿病视网膜病变研究（ETDRS）式视力表。设计：前瞻性、非随机、受试者内分析。参与者：来自Ullivik住所（蒙特利尔，QC）的22名土著患者，其中因纽特人能够解释拉丁语和CAS特征。方法：编写Python和LaTeX脚本，生成标准ETDRS图表的pdf格式，该格式可以方便地修改字母（CAS或Latin）、字体和视字大小。我们使用了保存在克里语、奥吉布语和因纽特语中的CAS字符。使用60英寸的电视屏幕（4K分辨率）按比例显示视力表。每位受试者在每张图表上评估每只眼睛的最佳矫正视力（BCVA）（每位患者4次测量）。结果：拉丁图和CAS图获得的视力（logMAR）中位数差值为0 (Q1: -0.08；问题3:0)。Band-Altman分析显示偏差为-0.01 (SD: 0.03)，接近于零（表明有利的一致性），并且有一个异常值（22例患者），其偏差归因于随机误差。两组视力表视力差异无统计学意义（p = 0.1）。结论：我们开发并验证了第一个用于测量视力的cas印迹ETDRS表。考虑到它使用了克里语、奥吉布语和因纽特语中保留的字符，这个图表对加拿大的几个土著人口有额外的适用性。未来的工作应该开发近阅读卡和其他方法，以优化土著患者的文化主管眼保健。

{"title":"ETDRS-style distance visual acuity charts for Indigenous Canadians: development and validation using Canadian Aboriginal syllabics","authors":"Brendan K. Tao , Sidrat Rahman , Dana Toameh , Edsel Ing , Christian El-Hadad","doi":"10.1016/j.jcjo.2025.04.004","DOIUrl":"10.1016/j.jcjo.2025.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and validate a logMAR Early Treatment Diabetic Retinopathy Study (ETDRS)-style visual acuity chart imprinted with Canadian Aboriginal Syllabics (CAS) optotypes.</div></div><div><h3>Design</h3><div>Prospective, nonrandomized, within-subject analysis.</div></div><div><h3>Participants</h3><div>22 Indigenous patients from the Ullivik residence (Montreal, QC) for Inuit patients who were able to interpret Latin and CAS characteristics.</div></div><div><h3>Methods</h3><div>Python and LaTeX scripts were created to generate PDFs of standard ETDRS charts, which could be readily modified for alphabet (CAS or Latin), font, and optotype sizing. We used CAS characters that were preserved across Cree, Ojibwe, and Inuktitut languages. A 60\" television screen (4K resolution) was used to display the eye charts to scale. For each subject, the best-corrected visual acuity (BCVA) of each eye was assessed on each chart (4 measurements per patient).</div></div><div><h3>Results</h3><div>The median difference between visual acuities (logMAR) acquired by the Latin and CAS charts was 0 (Q1: –0.08; Q3: 0). Band–Altman analysis revealed a bias of −0.01 (SD: 0.03), which was near zero (indicating favourable agreement), and one outlier (of 22 patients), whose deviation was attributed to random error. The visual acuity differences between eye charts were not statistically significant (<em>p</em> = 0.1).</div></div><div><h3>Conclusions</h3><div>We developed and validated the first CAS-imprinted ETDRS chart for measuring visual acuity. Given its use of preserved characters across Cree, Ojibwe, and Inuktitut languages, this chart has additional applicability to several Indigenous populations in Canada. Future work should develop near reading cards and other methods of optimizing culturally competent eye care for Indigenous patients.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"60 6","pages":"Pages e807-e813"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost analysis of immediate versus delayed bilateral cataract surgery in seniors in community-based ambulatory surgical centers in a post-COVID-19 era 后covid -19时代社区门诊中心老年人即刻与延迟双侧白内障手术的成本分析

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.04.010

Francesca Lee , Zaynab Somani , Eric S. Tam , Hannah H Chiu , Lili Tong , Steve Arshinoff , Sohel Somani

Objective

To evaluate the cost-savings of immediately sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery among seniors at a Canadian community-based ambulatory surgical center in the post-COVID-19 era.

Design

Prospective chart review.

Participants

Seniors aged 60 and older undergoing cataract extraction surgery at a community-based ambulatory surgical center in Ontario.

Methods

Direct and indirect cost metrics were collected from 202 patients who underwent either delayed sequential bilateral cataract surgery (DSBCS) or immediately sequential bilateral cataract surgery (ISBCS) at 1 of 2 community-based ambulatory surgical center (ASCs) between January 2022 and January 2023. Direct cost measures included preoperative, intraoperative, and postoperative surgical expenses. Preoperative measures included diagnostic and consultation fees. Intraoperative metrics consisted of medical and nonmedical labor, anesthesia fees, and consumables (including amortized cost of equipment and sterilization). Postoperative surgical costs included the first postoperative follow-up visit and a postoperative visit at week 1 (POW1). Indirect costs were measured by the cost of travel and additional postoperative visits (any visits other than required for the first postoperative visit and POW1). Additional economic factors included total time spent travelling and total duration of travel.

Results

The average costs were reduced by $375.22 CAD when performing ISBCS (p < 0.001), totaling to $1260.33 versus DSCBS’s total cost of $1635.55. Specifically, direct surgical costs were $1487.95 for DSBCS and $1176.93 for ISBCS (p < 0.001), whereas indirect costs were $147.60 for DSBCS versus $83.40 for ISBCS (p < 0.001).

Conclusions

The average costs of cataract extraction among senior patients in ambulatory surgical centers were significantly lower for ISBCS compared to DSBCS.

目的：评估后covid -19时代加拿大社区门诊中心老年人立即顺序双侧白内障手术与延迟顺序双侧白内障手术的成本节约。设计：前瞻性图表回顾。参与者：在安大略省社区流动外科中心接受白内障摘除手术的60岁及以上老年人。方法：收集2022年1月至2023年1月期间在2个社区流动手术中心（ASCs）中的1个接受延迟顺序双侧白内障手术（DSBCS）或立即顺序双侧白内障手术（ISBCS）的202例患者的直接和间接成本指标。直接成本措施包括术前、术中和术后手术费用。术前措施包括诊断费和咨询费。术中指标包括医疗和非医疗人工、麻醉费用和消耗品（包括设备和灭菌的摊销成本）。术后手术费用包括术后第一次随访和术后第1周随访（POW1）。间接成本是通过差旅费和术后额外访问（除术后第一次访问和POW1所需的任何访问）的成本来衡量的。其他经济因素包括总旅行时间和总旅行时间。结果：执行ISBCS时，平均成本降低了375.22加元（p < 0.001），总计为1260.33美元，而DSCBS的总成本为1635.55美元。具体来说，DSBCS的直接手术费用为1487.95美元，ISBCS为1176.93美元（p < 0.001），而DSBCS的间接费用为147.60美元，ISBCS为83.40美元（p < 0.001）。结论：在门诊手术中心进行ISBCS的老年患者白内障摘出的平均费用明显低于DSBCS。

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引用次数: 0

Association between intravitreal anti-vascular endothelial growth factor agents and hypertension: a meta-analysis 玻璃体内抗血管内皮生长因子与高血压之间的关系：一项荟萃分析。

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.05.014

Michael Balas , Aaditeya Jhaveri , Faran Khalid , Ahmed Abdelaal , Marko M. Popovic , Peter J. Kertes , Rajeev H. Muni

Objective

To compare the risk of hypertension between intravitreal anti-vascular endothelial growth factor (VEGF) agents and sham injections, and between different anti-VEGF agents.

Methods

A systematic search was performed on OVID MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials from January 2005 to August 2023. Inclusion criteria included published randomized clinical trials (RCTs) reporting on cases of hypertension as an adverse event for standard dose intravitreal anti-VEGF agents. Using random-effects modeling, risk ratios (RR) and 95% confidence intervals (CI) were used to estimate the frequency of hypertension between patients who received anti-VEGF agents versus sham injections.

Results

Twenty RCTs with 11 196 patients were included. There were 189/2873 (6.6%) new cases of hypertension in the ranibizumab 0.5-mg group, 61/1448 (4.2%) in the bevacizumab 1.25-mg group, 287/3450 (8.3%) in the aflibercept 2-mg group, 32/412 (7.8%) in the brolucizumab 6-mg group, 99/2063 (4.8%) in the faricimab 6-mg group, and 73/950 (7.7%) new cases of hypertension in patients receiving sham injections. There was no significant difference in the risk of developing hypertension between any of the included anti-VEGF agents. Compared to sham injection, ranibizumab (RR = 1.02, 95% CI: [0.74 to 1.40]; p = 0.92) and aflibercept (RR = 0.77, 95% CI: [0.54 to 1.11]; p = 0.17) did not significantly increase the risk of developing hypertension.

Conclusion

This meta-analysis found no significant difference in hypertension risk between different intravitreal anti-VEGF agents or sham injection. These results reinforce the notion that these agents have similar and safe side effect profiles, and that the choice of agent should not be based on the risk of hypertension.

目的：比较玻璃体内注射抗血管内皮生长因子（VEGF）与假注射抗血管内皮生长因子（VEGF）以及不同抗VEGF药物之间的高血压风险。方法：系统检索2005年1月至2023年8月的OVID MEDLINE、EMBASE和Cochrane Controlled Register of Trials。纳入标准包括已发表的随机临床试验（rct），这些试验报告了标准剂量玻璃体内抗vegf药物的不良事件高血压病例。使用随机效应模型，使用风险比（RR）和95%置信区间（CI）来估计接受抗vegf药物和假注射的患者之间高血压的频率。结果：纳入20项随机对照试验，共11196例患者。雷尼单抗0.5 mg组高血压新发病例数为181 /2873例（6.6%），贝伐单抗1.25 mg组为61/1448例（4.2%），阿非利西普2 mg组为287/3450例（8.3%），博鲁单抗6 mg组为32/412例（7.8%），法利西单抗6 mg组为99/2063例（4.8%），假注射患者高血压新发病例数为73/950例（7.7%）。在任何抗vegf药物之间，发生高血压的风险没有显著差异。与假注射相比，雷尼单抗(RR = 1.02,95% CI: [0.74 ~ 1.40]；p = 0.92)和afliberept (RR = 0.77,95% CI: [0.54 ~ 1.11]；P = 0.17)没有显著增加患高血压的风险。结论：本荟萃分析发现，不同玻璃体内抗vegf药物或假注射之间高血压风险无显著差异。这些结果强化了这些药物具有相似且安全的副作用概况的概念，并且药物的选择不应基于高血压的风险。

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引用次数: 0

Temporal trends and risk factors for retinopathy of prematurity: insights from a population-based study (1995–2021) 早产儿视网膜病变的时间趋势和危险因素：一项基于人群的研究（1995-2021）

IF 2.8 4区医学 Q1 OPHTHALMOLOGY

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

Pub Date : 2025-12-01 DOI: 10.1016/j.jcjo.2025.04.016

Rachel Shemesh , Brian Reichman , Tzipora Strauss , Inna Zaslavsky-Paltiel , Liat Lerner-Geva , Tamara Wygnanski-Jaffe , Israel Neonatal Network

Objective

The aim of this population-based study was to evaluate the temporal trends in the incidence of retinopathy of prematurity (ROP) and the demographic and clinical factors associated with ROP.

Methods

In this population-based observational cohort study data from the Israel national very low birthweight infant database were used. Following exclusions, the final study population comprised 16,257 infants born at 23–29 weeks. The independent effect of variables associated with ROP was assessed using multivariable logistic regression. P values for trend were determined by applying the Cochran-Armitage Trend Test.

Results

The rates of ROP decreased from 32.9% in the years 1995–2000 to 16.0% in 2017–2021 (p < 0.0001). In comparison to the reference epoch (1995–2000), the adjusted odds ratio (OR) [95% confidence interval] for ROP, were significantly lower in 2001–2006 (OR 0.68 [0.59–0.77]), in 2007–2011 (OR 0.36 [0.31–0.42]), in 2012–2016 (OR 0.31 [0.26–0.36]), and in 2017–2021 (OR 0.32 [0.27–0.39]). Sepsis (OR 1.67 [1.52–1.83]), surgically treated necrotizing enterocolitis (NEC) (OR 1.86 [1.49–2.32]) and surgically treated patent ductus arteriosus (PDA) (OR 1.88 [1.56–2.27]) were associated with ROP. Among the infants with sepsis, surgically treated PDA or surgically treated NEC, the rates of ROP increased in the 2017–2021 epoch.

Conclusions

The odds for ROP decreased by over two-thirds throughout the period 1995–2021, although the decline was attenuated in the recent decade. In view of the independent association found between surgically treated PDA or NEC and ROP, and the increasing rates of ROP in these infants, further studies may elucidate whether earlier ROP screening and possibly earlier therapeutic interventions may be appropriate for these infants.

目的：这项基于人群的研究旨在评估早产儿视网膜病变（ROP）发病率的时间趋势以及与ROP相关的人口统计学和临床因素。方法：在这项以人群为基础的观察队列研究中，数据来自以色列国家极低出生体重婴儿数据库。排除后，最终的研究人群包括16257名在23-29周出生的婴儿。使用多变量逻辑回归评估与ROP相关的变量的独立效应。趋势P值采用Cochran-Armitage趋势检验。结果：ROP由1995-2000年的32.9%下降到2017-2021年的16.0% （p < 0.0001）。与参考时期（1995-2000年）相比，2001-2006年（OR 0.68[0.59-0.77]）、2007-2011年（OR 0.36[0.31-0.42]）、2012-2016年（OR 0.31[0.26-0.36]）和2017-2021年（OR 0.32 [0.27-0.39]） ROP的校正优势比（OR）[95%置信区间]显著降低。脓毒症（OR 1.67[1.52-1.83]）、手术治疗的坏死性小肠结肠炎（NEC）（OR 1.86[1.49-2.32]）和手术治疗的动脉导管未闭（PDA）（OR 1.88[1.56-2.27]）与ROP相关。在脓毒症、手术治疗PDA或手术治疗NEC的婴儿中，2017-2021时期ROP发生率增加。结论：在1995年至2021年期间，ROP的几率下降了三分之二以上，尽管近十年来下降幅度有所减弱。鉴于手术治疗的PDA或NEC与ROP之间的独立关联，以及这些婴儿ROP发生率的增加，进一步的研究可能会阐明早期ROP筛查和早期治疗干预是否适合这些婴儿。

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