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

Objective: To measure the incidence and risk factors of rhegmatogenous retinal detachment (RRD) in a Canadian population from 2010 to 2023.

Design: A retrospective cohort study.

Participants: Patients with ICD-10 diagnostic code H33.0 (retinal detachment with retinal break) and controls who had cataract surgery but no prior history of detachment, age (±2 years) and sex-matched.

Methods: Patients reporting to the QEII Health Sciences Centre between January 1, 2010, to December 31, 2023, were included. The primary outcome was the incidence rate of RRD estimated using negative binomial regression. Generalized linear model was used to compare the risk of RRD and Cox-proportional hazards to model time to RRD following cataract surgery.

Results: Annual RRD incidence rates increased from 15.2 to 27.5 cases per 100,000 between 2010 and 2023. Mean axial length of RRD patients with prior cataract surgery was 25.0 (1.55) mm compared with the control population of 24.1 (1.60) mm. An increased risk of RRD was associated with each 1-mm increase in axial length (hazard ratio [HR] 1.31), male sex (HR 1.29), and per 1 year age increase (HR 1.03) post-cataract surgery. Time-to-event analyses identified that the mean time from cataract surgery to RRD was 9.43 years.

Conclusions: Increases in RRD cases have been seen over the last 14 years. While the total risk for RRD is still small, male sex and a 1-2 mm increase in axial length can significantly change a patient's risk. Furthermore, the increased risk of RRD after cataract surgery is not only an early event.

Purpose: Proliferative diabetic retinopathy causes severe vision loss. Although anti-vascular endothelial growth factor (VEGF) injections aid surgery outcomes, optimal timing is unclear. We evaluated the efficacy and safety of anti-VEGF injections at various perioperative time points.

Method: This network meta-analysis comprehensively searched PubMed, Cochrane Library, Web of Science, Embase, ClinicalTrials.gov, and WHO ICTRP from inception to November 2024 for randomized controlled trials examining perioperative anti-VEGF injection. Two authors independently screened the studies, collected the data, and assessed the risk of bias. The protocol was registered with PROSPERO (CRD42024614758).

Results: Thirty studies involving 2 646 eyes were analyzed. Perioperative anti-VEGF treatment significantly improved postoperative best-corrected visual acuity (preoperatively >7 days: standardized mean difference [SMD] = 0.57, 95% CI: 0.01-1.13; preoperatively 3-7 days: SMD = 0.50, 95% CI: 0.29-0.70; intraoperative: SMD = 0.34, 95% CI: 0.10-0.66). It also reduced recurrent vitreous hemorrhage (intraoperative: odds ratio [OR] = 0.28, 95% CI: 0.09-0.87), and intraoperative bleeding (preoperatively >7 days: OR = 0.11, 95% CI: 0.03-0.39; preoperatively 3-7 days: OR = 0.22, 95% CI: 0.04-1.13). Additionally, it shortened surgical time (preoperatively >7 days vs preoperatively 1-3 days: WMD = -17.90, 95% CI: -29.99 to -5.81). No significant effects on silicone oil use or recurrent retinal detachment were observed. The safety profile of anti-VEGF has been found to be favourable.

Conclusions: The combination of perioperative anti-VEGF injections provides several advantages. Clinicians may select the optimal timing based on individualized treatment objectives. However, because of the variability in evidence quality and the heterogeneity among the included studies, these conclusions should be approached with caution.

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 examine the incidence and clinical characteristics of concurrent thyroid eye disease (TED) and myasthenia gravis (MG) and identify potential diagnostic clues for this rare coexistence.

Methods: A retrospective observational study included 15 patients diagnosed with both TED and MG between May 2013 and July 2025. The diagnosis of TED was based on Bartley's criteria, and MG was diagnosed using criteria from the Japanese Ministry of Health, Labour, and Welfare. Clinical data, including ocular alignment, eyelid position, thyroid function, antibody profiles, imaging findings, treatment, and outcomes, were reviewed.

Results: Of 6 576 TED patients, 15 (0.23%) were diagnosed with concurrent MG, and 12 (0.18%) had isolated ocular MG (OMG). Ptosis was observed in 9 patients (60.0%), and vertical strabismus was the most common pattern (53.3%). Exotropia, an unusual presentation in TED, was seen in 6 patients (40.0%). Extraocular muscle inflammation was confirmed on magnetic resonance images in 11 patients (73.3%). Steroid pulse therapy, administered to 8 patients (53.3%) for active TED, also improved MG symptoms. At a mean follow-up of 43.8 ± 36.6 months, 10 patients (66.7%) showed significant improvement in ptosis and/or diplopia.

Conclusions: Concurrent TED and MG, while rare, present overlapping features that can complicate diagnosis. Atypical signs, such as ptosis with diurnal variability and exotropia with vertical misalignment in TED patients, should raise suspicion for MG.

Objective: To evaluate whether age ≥80 years independently influences outcomes after endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (NLDO).

Design: A retrospective cohort study.

Participants: Three hundred forty-six consecutive adults underwent standardized endonasal DCR between 2011 and 2023; 31 were ≥80 years.

Methods: Preoperative comorbidities, intraoperative variables and postoperative course were prospectively recorded. Outcomes-ostium patency, symptom relief, complications and revision-were assessed at a median of 12 months (IQR 6-24). Kaplan-Meier curves and multivariable Cox proportional-hazards models identified independent predictors.

Results: Octogenarians had more hypertension (64.5% vs 26.0%; p < 0.001) and hypothyroidism (25.8% vs 7.3%; p = 0.003). Silicone intubation was less common in this group (32.3% vs 54.0%, p = 0.021) but did not affect outcomes. Anatomical success was 83.9% in octogenarians versus 84.1% in younger adults (p = 0.97); functional success was 74.2 % versus 76.2% (p = 0.81). Complication (12.9 % vs 16.2 %; p = 0.64) and revision (3.2 % vs 4.1 %; p = 0.78) rates, as well as 24-month event-free survival, did not differ. Age ≥80 years was not an independent predictor of failure (Hazard Ratio: 0.93, 95% CI: 0.44-1.98).

Conclusions: Despite greater systemic morbidity, very elderly patients achieved safety and efficacy equivalent to younger adults. Chronological age alone should not preclude endoscopic DCR; these real-world data support offering minimally invasive lacrimal surgery and -evidence-based counseling to an aging population.

Objective: To evaluate longitudinal trends and determinants of diabetic retinopathy (DR) screening uptake over 10 years among adults with newly diagnosed diabetes in Ontario, Canada.

Methods: A population-based cohort study using linked ICES (formerly the Institute for Clinical Evaluative Sciences) administrative data, including adults aged ≥19 years with newly diagnosed diabetes between April 1, 2011, and March 31, 2020. The primary outcome was DR screening within 2 years of diagnosis. Predictors included age, sex, socioeconomic status, comorbidities, rurality, immigration status, and health system factors. Logistic regression evaluated the associations. Five-year rates and ocular complications were assessed.

Results: Among 691,557 individuals, 396,073 (57.3%) received DR screening within 2 years of diagnosis. Screening was more common among older adults, females, and individuals with higher comorbidity or rural residence, and less common among younger patients (OR [odds ratio]: 0.22 for age 20-39 vs ≥65; p < 0.0001), males (OR: 1.10 for females vs males; p < 0.0001), immigrants (OR: 0.98; p < 0.0001), and those in the lowest income quintile. One-year rates declined from 44.9% (2011/12) to 35.2% (2019/20), and 5-year rates from 76.8% (2011/12) to 72.4% (2017/18). DR and other ocular conditions were more often diagnosed among screened individuals. Screening dropped sharply during COVID-19, especially among younger adults.

Conclusions: Despite universal health care, substantial disparities in DR screening persist across age, sex, immigration status, and socioeconomic strata. Screening rates declined over time and were further exacerbated by COVID-19. These findings underscore the urgent need for targeted, equity-oriented strategies, such as teleophthalmology and primary care integration, to improve uptake and prevent vision loss in the growing diabetic population.