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

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.

Purpose: To describe the clinical outcomes of combined Descemet stripping automated endothelial keratoplasty (DSAEK) and intraocular lens (IOL) exchange using the Yamane technique, and a review of the literature.

Methods: This is a retrospective interventional case series. Included were patients with decompensated cornea and dislocated IOL, anterior-chamber IOL, or iris-claw IOL that underwent IOL exchange using the Yamane technique combined with suture pull-through DSAEK. Best-corrected visual acuity (BCVA), graft survival, and complications were evaluated at year 1.

Results: Twenty-four eyes from 24 patients were included. Mean age was 71 ± 14.2 years. All except 1 patient (95.8%) had concomitant issues that could limit visual outcome or success of surgery, such as glaucoma (62.5%, of which 47.0% had previously undergone glaucoma tube surgery). Mean BCVA improved from 20/590 to 20/93 1 year after surgery (p = 0.0001). Rebubbling was performed in 4 eyes (16.7%), and 2 eyes (8.3%) had graft failure requiring repeat DSAEK. None had graft rejection. Two eyes (8.3%) developed IOL issues (1 haptic-optic junction dislocation and 1 haptic-optic junction rotation), 6 eyes (25.0%) had ocular hypertension requiring topical treatment, and 1 eye had suprachoroidal hemorrhage.

Conclusions: Combined DSAEK and IOL exchange using the Yamane technique was shown to be a safe and effective method for visual rehabilitation in patients with decompensated cornea and anterior chamber/iris-claw/dislocated IOL. Further studies are required to evaluate the long-term stability of the graft and the IOL.

Objective: To compare in detail the clinical outcome and safety of PreserFlo MicroShunt implantation versus trabeculectomy in patients with secondary open-angle glaucoma (SOAG).

Design/participants: A retrospective study of patients with SOAG and uncontrolled intraocular pressure (IOP) who underwent PreserFlo MicroShunt implantation (PreserFlo) or trabeculectomy (TRAB) at the Medical University of Innsbruck.

Methods: We analyzed changes in IOP, use of IOP-lowering medications, complete surgical success (IOP ≤21 to ≤12 mm Hg and >6 mm Hg without medication), best-corrected visual acuity, and visual field outcomes up to 12 months postoperatively.

Results: Between 2014 and 2023, PreserFlo was performed in 85 eyes and TRAB in 55 eyes. Mean IOP decreased from 26.8 to 10.8 mm Hg (mean reduction 56%, 95% confidence interval 52-61%; p < 0.001) in the PreserFlo group and from 27.3 to 10.9 mm Hg (mean reduction 55%, 46-65%; p < 0.001) in the TRAB group. IOP was significantly lower in the PreserFlo group at 1-3 days and 1 week (p < 0.001 and p = 0.007, respectively). At 12 months, both groups showed similar rates of medication use (18.8% vs 11.4%; p = 0.334) and complete surgical success (e.g., ≤18 mm Hg: 76.8% vs 75.7%; p = 0.864). PreserFlo was associated with fewer needlings (hazard ratio 0.33; 0.12-0.90; p = 0.0031) and worse BCVA at month 12 (p = 0.036).

Conclusions: Both PreserFlo and trabeculectomy significantly lowered IOP and reduced medication use over 12 months. PreserFlo was associated with fewer postoperative interventions, while TRAB yielded better visual acuity outcomes. Both procedures appear comparably safe and effective for treating SOAG.

Objective: To evaluate whether semaglutide use is associated with thyroid eye disease (TED)-related outcomes among patients with autoimmune thyroiditis and type II diabetes mellitus (T2DM).

Methods: Adults with thyrotoxicosis (International Classification of Diseases [ICD-10]: E05) and T2DM were identified from the TriNetX US Collaborative Network. T2DM was defined by ICD-10 (E11) or laboratory criteria. The exposed cohort included individuals prescribed semaglutide on or after its Foood and Drug Administration approval (December 5, 2017). The control cohort included patients treated with non-glucogon-like peptide-1 receptor agonist antihyperglycemic agents without prior glucagon-like peptide-1 receptor agonist exposure. Propensity score matching (1:1) was performed using demographics, comorbidities, medications, and health care utilization variables. Five-year outcomes included: (1) TED-related diagnoses; (2) systemic corticosteroid use; (3) TED-related surgical interventions; (4) radiation treatment; and (5) teprotumumab use. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

Results: After matching, 23,279 patients were included per group (mean age: 60.1 years; 75% female). At 5-year, semaglutide users had lower rates of TED-related diagnoses (2.16% vs 2.82%; RR: 0.76; 95% CI: 0.68-0.86), systemic corticosteroid use (22.71% vs 26.39%; RR: 0.86; 95% CI: 0.82-0.90), TED-related surgical interventions (0.30% vs 0.42%; RR: 0.70; 95% CI: 0.51-0.96), and radiation treatment (1.17% vs 2.05%; RR: 0.57; 95% CI: 0.49-0.67). Teprotumumab use was rare and similar between groups (0.08% vs 0.08%; RR: 1.00; 95% CI: 0.52-1.92).

Conclusions: Semaglutide use was associated with fewer TED-related diagnoses and treatments over 5 years, supporting a potential protective role. Further studies are warranted to confirm these associations and clarify underlying mechanisms.

Objective: Eye care providers have a responsibility to accommodate patients with visual impairment; however, few studies have explored the accessibility of eye clinics. It is critical to involve stakeholders in these discussions to design spaces with thoughtfulness and intentionality. This study aimed to identify challenges and practical solutions for the accessibility of eye clinic design.

Design: An observational, qualitative study.

Participants: Participants with visual impairment and blindness were recruited for interviews through "Get Together with Technology", an initiative through the Canadian Council of the Blind that brings together people with vision impairment to use adaptive technology.

Methods: Participants completed 45-minute semi-structured interviews using video conferencing. Audio recordings were transcribed, de-identified, coded, and analyzed for themes.

Results: Twenty adult participants were interviewed from across Canada. Eleven participants had a self-reported visual acuity of counting fingers or less. The most common self-reported primary diagnoses were retinitis pigmentosa (5/20) and glaucoma (3/20). Three major themes were intentionality of accommodations, confidence, and design features. Most participants with early-onset vision loss reported greater confidence in navigating eye care clinics. Participants with late-onset vision loss endorsed barriers to adapting to new skills and technologies. Participants identified challenges and practical solutions for specific clinic features, including paperwork, staff interactions, signage, obstructions, lighting, and transportation.

Conclusions: This study highlighted the diverse needs and lived experiences of patients with visual impairment and blindness who access eye care services with respect to accessibility in clinic design. Through a solutions-focused worldview, this study identifies practical suggestions and modifications for health services to meaningfully accommodate patients with visual impairment.

Objective: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN).

Design: A retrospective cohort study.

Participants: Patients followed for OSSN at the Centre Hospitalier de l'Université de Montréal in Quebec between 2013 and 2024.

Methods: Baseline characteristics were extracted alongside pathologic grades, treatment modalities, and recurrences.

Results: In total, 67 eyes from 66 patients with a median age at diagnosis of 71 years (range 43-92) were identified. Of the patients, 67.2% (n = 45) were male, and 25.5% (n = 13/51) had a history of skin cancer. Lesions most frequently presented on the bulbar conjunctiva (41%, n = 57), the limbus (25.9%, n = 36), and/or the cornea (13.7%, n = 18). Lesions were papillomatous (31.6%, n = 30), gelatinous (29.5%, n = 28), and leukoplakic (23.2%, n = 22). Of the 80.6% (n = 54) of patients who underwent surgery, 36 received combination therapy with topical drops preoperatively (n = 5), postoperatively (n = 24), or both (n = 7). A total of 19.4% (13) had topical chemotherapy alone: 5-fluorouracil 1% (n = 3), and interferon α2b (n = 10). In cases in which histopathology was available (n = 52), conjunctival intraepithelial neoplasia (CIN) was seen in 87% (n = 45) (CIN1: 4% [n = 2], CIN2: 13% [n = 7], and CIN3: 69% [n = 36]) whereas 13% (n = 7) were squamous cell carcinoma. Recurrence occurred in 23.9% (n = 16). On Cox regression, recurrences were not associated with specific treatment approaches (all hazard ratio CIs crossing 1; P > 0.639) but were associated with positive margins (hazard ratio 3.892; P = 0.04).

Conclusions: OSSN in Quebec predominantly presents as papillomatous bulbar conjunctival lesions in the older White men. In total, 83% of biopsied lesions are of a higher grade (CIN3 and SCC), warranting efforts for earlier detection and referral.