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

Purpose: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness worldwide. While choroidal involution has been described in animal models, choroidal perfusion in premature infants remains poorly characterized because of limited use of intravenous fluorescein angiography (IVFA).

Methods: This retrospective study systematically analyzed IVFAs performed post-treatment in patients with ROP at the Hospital for Sick Children between 2011 and 2020. Eligible patients had received intravitreal bevacizumab or laser photocoagulation, and only transiting eyes were included to allow complete IVFA phase analysis. Three independent experts graded each IVFA for image quality, presence of delayed choroidal perfusion during the arteriovenous phase, and its location (central, peripheral, or multifocal). Inter-rater reliability was assessed using Fleiss's κ.

Results: Of 79 IVFAs reviewed, 74 met quality criteria. The cohort had an average birth weight of 602.6 g and a gestational age of 24.0 weeks. Most (63.5%) had zone I, stage 3+ ROP. IVFAs were conducted at a corrected age of 7.5 months. Delayed choroidal perfusion was found in 64 eyes (86.5%), predominantly multifocal. Only 2 eyes had normal perfusion. Inter-rater agreement was high (κ = 0.85).

Conclusions: Delayed choroidal perfusion is common and persistent in treated ROP patients. To our knowledge, this is the largest IVFA series that systematically describes this underrecognized feature with implications for long-term vision.

Purpose: To systematically review the extant literature on pediatric endoscopic dacryocystorhinostomy (endoDCR) and to perform a meta-analysis of the pooled success rate and complication profile.

Methods: A comprehensive literature search was conducted using PubMed, Cochrane Library, and Web of Science databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported the pediatric endoDCR success rate with a minimum follow-up of 3 months and at least 10 patients. Data on success rates, complications, age, follow-up time, and silicone stent removal time were extracted. Statistical analyses were performed using comprehensive meta-analysis software.

Results: Twenty-nine studies comprising 1502 pediatric eyes were included. The pooled success rate was 87% (95% CI: 0.83-0.90). The I² statistic was 58.47%, indicating moderate to substantial heterogeneity. Egger's test indicated significant publication bias (p < 0.00001). Complication rates varied considerably: while some studies reported minor complications in up to 60% of cases, others documented serious, but rare, events such as cerebrospinal fluid rhinorrhea (0.28%). The most common complications included bleeding/epistaxis, tube prolapse, adhesions/synechiae, and granulation tissue.

Conclusion: EndoDCR is an effective and generally safe surgical option for pediatric nasolacrimal duct obstruction, with a high pooled success rate and acceptable variability in outcomes. However, variation in complication reporting and methodological heterogeneity across studies highlights the need for standardization in future research.

Objective: 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: To develop a surgical assessment tool to evaluate the breadth of surgical procedures in which ophthalmology residents are required to gain competence and to validate this tool for cataract surgery.

Design: A questionnaire development study.

Participants: Ophthalmology residents and faculty at the University of Ottawa.

Methods: The Canadian Ophthalmology Assessment Tool for Surgery (COATS) was developed by a group of experts by modifying a previously validated assessment tool, the Ottawa Surgical Competency Operating Room Evaluation, and consists of 6 Likert scale items, 1 yes or no question assessing independence and 2 open-ended questions for narrative feedback. During a 2-year period, residents were evaluated on the performance of cataract surgery using the COATS. The primary outcome was the total COATS score, defined as the sum of the Likert scale items.

Results: A total of 165 COATS assessments were collected across 5 residents. Mean total COATS scores were lower for the first 2 months of training compared with the last 3 months of training (4.33 ± 0.25 vs 4.81 ± 0.03; p = 0.01; Cohen's d = 0.25) and for procedures where the resident was rated as "not independent" versus "independent" (4.26 ± 0.13 vs 4.74 ± 0.06; p = 0.006; Cohen's d = 0.13). There was a significant correlation between the number of cataract surgeries performed and the mean total COATS score (Pearson r = 0.20; p = 0.02). Forty-five COATS assessments per resident were required to obtain an overall reliability of 0.70, the accepted threshold for low-stakes assessments.

Conclusions: The COATS is a valid tool for the assessment of surgical competence in cataract surgery. There is also evidence that it is a reliable tool when completed multiple times per resident over the course of training.

Objective: To synthesize and critically appraise the available evidence on choroidal vitiligo, integrating clinical presentation, multimodal imaging characteristics, and diagnostic differentiation from mimics, while proposing a set of diagnostic criteria based on literature synthesis and authors' expert consensus.

Methods: A systematic search of PubMed, Embase, and Cochrane Reviews through July 2025 identified English-language studies reporting on choroidal vitiligo. Two reviewers independently screened, extracted data, and assessed methodological quality for case reports and case series. Narrative synthesis and descriptive statistics were used to summarize the findings.

Results: Eight studies met inclusion criteria, comprising 16 patients (28 eyes) from 5 countries. The majority of patients (75%) were asymptomatic, middle-aged females, with bilateral involvement in 88% of cases and preserved visual acuity (≥20/25 in 81% of eyes). Multimodal imaging consistently revealed well-demarcated choroidal hypopigmentation with intact retinal architecture and no intraocular inflammation. OCT demonstrated preserved retinal layers with occasional mild choroidal thinning. Fundus autofluorescence often showed scleral hyper-autofluorescence; FA/indocyanine green angiography showed mild window defects without leakage. Cutaneous vitiligo was present in 63% of patients, with no systemic autoimmune disease reported.

Conclusions: Choroidal vitiligo is a rare, benign, and often incidental finding, best recognized through multimodal imaging. This review proposes clinical diagnostic criteria for primary choroidal vitiligo and highlights its key imaging signature to aid differentiation from neoplastic and inflammatory mimics. We recommend baseline multimodal imaging and follow-up at 6-12 months to confirm stability. Standardized imaging criteria and prospective studies are needed to better define prevalence, natural history, and systemic associations. Given that most included studies were single-case reports, the overall level of evidence is low.