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

Objective: This study aimed to evaluate the association between optical coherence tomography (OCT)-derived biomarkers and disease severity in patients with choroideremia (CHM) and CHM carriers.

Methods: We retrospectively reviewed consecutive CHM patients and female carriers who underwent comprehensive ophthalmic imaging. Evaluated OCT biomarkers included central macular thickness (CMT), cystoid space (CS), outer retinal tubulation (ORT), and hyperreflective foci (HF). Disease severity in CHM patients was assessed using the preserved islet area (PIA) on fundus autofluorescence images, while a pre-existing grading system was applied for carriers. Linear mixed models were used to assess the associations.

Results: Thirty-one affected males (62 eyes) and nine female carriers (18 eyes) were included. In CHM patients, the total number of HF showed a significant negative correlation with PIA (β = -0.449, 95% CI: -0.853 to -0.045; p = 0.043). Subgroup analysis revealed that choroidal HF in the fovea was significantly associated with reduced PIA (β = -0.221, 95% CI: -0.379 to -0.063; p = 0.015). Other OCT biomarkers, including CMT, CS, and ORT, were not significantly correlated with disease severity. In female carriers, none of the OCT biomarkers differed significantly across the stages of fundus severity.

Conclusions: The total number of HF and choroidal HF in the fovea showed significant associations with disease severity measures in CHM, suggesting potential utility as structural biomarkers alongside established OCT parameters. No OCT-derived biomarkers were significantly associated with disease severity among the CHM carriers.

Purpose: 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: Vitreomacular traction is a common presentation that can benefit from surgical intervention. The decision to peel the internal limiting membrane (ILM) is made at the discretion of the operating surgeon. We describe a large cohort of eyes that had surgery with or without ILM peeling to give more evidence for the decision-making process.

Design: A retrospective cohort study.

Participants: Eyes with the diagnosis of vitreomacular traction (VMT) that underwent surgery between January 1, 2016, and January 1, 2025, at a group retina practice in Edmonton, Canada.

Methods: Eyes at a single center underwent vitrectomy surgery for the treatment of VMT with or without peeling of the ILM. Baseline visual and anatomic measures were captured and compared to postoperative findings. The main outcome measures were visual acuity and anatomic outcomes postsurgery. Complication rates were also captured.

Results: A total of 250 surgeries were performed during the study period. There was a significant improvement in vision in all eyes (0.19 logMAR). There was no difference in visual improvement when comparing ILM peeling versus ILM sparing. There was better anatomical resolution in cases that had sparing of the ILM. Complication rates were low with no difference in secondary macular hole formation when comparing ILM peeling to ILM sparing.

Conclusions: Pars plana vitrectomy with or without peeling of the ILM is an effective treatment for symptomatic VMT. There may be better anatomic preservation with sparing of the ILM secondary to less surgical manipulation. Complication rates are low regardless of surgical technique.