RESUMO
BACKGROUND: Selective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational study evaluates real-world outcomes of SLT comparing optometrist-treated to ophthalmologist-treated eyes. METHODS: Adults aged ≥40 years receiving first SLT treatment at three UK hospital eye units (Aintree, Manchester, Macclesfield) between 1 August 2018 and 1 August 2021 were analysed using anonymised local audit data. Outcomes included intraocular pressure (IOP), visual acuity (VA), drop burden, complications including post-SLT IOP spikes, and composite treatment failures including repeat laser or glaucoma surgery, evaluated at 6-monthly intervals up to 24 months. Groups were compared with parametric and non-parametric tests, accounting for intereye correlation, and Kaplan-Meier survival analysis using composite treatment failure endpoints was conducted. RESULTS: 207 eyes (131 patients) were analysed, 84 (56 patients) optometrist-treated eyes compared with 123 ophthalmologist-treated eyes (75 patients). No statistically significant differences (p>0.05) were found in change in VA, IOP or glaucoma drops from pre-SLT baseline between optometrist and ophthalmologist-treated eyes, at all time points. More cataracts were detected in optometrist-treated eyes, however, this did not affect differences in VA or cataract surgery frequency. More optometrist-treated eyes underwent glaucoma surgery, however, ophthalmologist-treated eyes had higher drop burden and chance of composite treatment failure up to month 18. CONCLUSION: Outcomes of SLT treatment by optometrists and ophthalmologists are comparable up to 24 months post-treatment. Ophthalmologist-treated eyes may have had more aggressive eye-drop treatment, preventing the need for surgery.
Assuntos
Glaucoma de Ângulo Aberto , Pressão Intraocular , Terapia a Laser , Oftalmologistas , Optometristas , Trabeculectomia , Acuidade Visual , Humanos , Trabeculectomia/métodos , Feminino , Masculino , Estudos Retrospectivos , Idoso , Pressão Intraocular/fisiologia , Glaucoma de Ângulo Aberto/cirurgia , Reino Unido , Terapia a Laser/métodos , Acuidade Visual/fisiologia , Pessoa de Meia-Idade , Resultado do Tratamento , Hipertensão Ocular , Idoso de 80 Anos ou mais , AdultoRESUMO
Purpose: To investigate if split-spectrum amplitude-decorrelation optoretinography (SSADOR) can detect and measure macular cone dysfunction in inherited retinal dystrophies (IRDs). Methods: This study was a case series of participants presenting with various IRD pathologies. Participants were recruited from the Ophthalmic Genetics clinic at the Casey Eye Institute from February to August 2023. Multimodal and SSADOR imaging was obtained in all cases. Results: We recruited nine participants, including four with macular dystrophy, one with fundus flavimaculatus, one with cone dystrophy, and three with retinitis pigmentosa. SSADOR decorrelation maps identified areas of cone functional impairment consistent with disease phenotypes. A correlation between the SSADOR signal and retinal sensitivity measured by microperimetry within the central 20° diameter area was observed. Additionally, SSADOR was able to demonstrate a decreased signal in mild cases when microperimetry measurements were still normal but subtle changes were also apparent on structural OCT. Conclusions: SSADOR is sensitive at detecting functional changes in macular cones, even prior to abnormalities in perimetry testing. We highlight the potential benefits of this innovative technology for the early detection of cone dysfunction and their potential contributions to earlier diagnosis and more accurate monitoring of progression. Translational Relevance: SSADOR is an innovative technology that detects early macular cone function changes, allowing for early diagnosis and precise monitoring of cone dysfunction progression. By serving as a potential clinical trial endpoint, SSADOR facilitates the translation of scientific findings into practical applications, ultimately improving patient care and outcomes.
Assuntos
Células Fotorreceptoras Retinianas Cones , Distrofias Retinianas , Tomografia de Coerência Óptica , Testes de Campo Visual , Humanos , Tomografia de Coerência Óptica/métodos , Feminino , Masculino , Adulto , Células Fotorreceptoras Retinianas Cones/patologia , Pessoa de Meia-Idade , Distrofias Retinianas/diagnóstico , Distrofias Retinianas/fisiopatologia , Distrofias Retinianas/diagnóstico por imagem , Testes de Campo Visual/métodos , Adulto Jovem , Idoso , Retinose Pigmentar/fisiopatologia , Retinose Pigmentar/diagnóstico , Retinose Pigmentar/diagnóstico por imagem , Acuidade Visual/fisiologia , AdolescenteRESUMO
AIMS: To identify baseline characteristics that best correlate to treatment interval for naive neovascular age-related macular degeneration patients treated with faricimab in the first year (Y1) of the TENAYA and LUCERNE phase 3 trials, and to further understand how these characteristics may impact treatment intervals. METHODS: This post-hoc analysis of Y1 data from the TENAYA and LUCERNE trials evaluated ocular baseline characteristics associated with Y1 treatment intervals. Patients were categorised into three subgroups based on their Y1 treatment interval: Q16W, Q12W or Q8W. Baseline characteristics (central subfield thickness (CST), best-corrected visual acuity, presence of subretinal fluid in centre 1 mm, presence of retinal fluid in centre 1 mm, macular neovascularisation (MNV) location and MNV type) were inputted into an R package 'rpart' to create a classification tree model. A data-driven tree model based on CST was fitted, producing CST subgroups of low, middle and high ranges. Within each CST subgroup, the model identified the most impactful variables and associated thresholds. RESULTS: After fitting the data to produce data-driven CST ranges, the model chose MNV location, followed by MNV lesion type as the most impactful baseline characteristics with these factors having a p value <0.05 in a multivariate analysis. CONCLUSIONS: Among the selected ocular baseline characteristics from TENAYA and LUCERNE trial, CST, MNV type and MNV location were seen as the most relevant variables to enable extension of treatment intervals during Y1. While this analysis provides insights for treatment intervals during the first year, further analysis incorporating Y2 data from the TENAYA and LUCERNE studies will be needed to assess factors influencing treatment intervals over a longer period.
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Inibidores da Angiogênese , Injeções Intravítreas , Acuidade Visual , Degeneração Macular Exsudativa , Humanos , Masculino , Feminino , Inibidores da Angiogênese/uso terapêutico , Inibidores da Angiogênese/administração & dosagem , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Método Duplo-Cego , Idoso de 80 Anos ou mais , Resultado do Tratamento , Fatores de TempoRESUMO
INTRODUCTION: It remains uncertain whether Descemet membrane endothelial keratoplasty (DMEK) or Descemet stripping only (DSO) yields better outcomes in patients with symptomatic Fuchs endothelial corneal dystrophy (FECD). This paper presents the protocol for the Descemet Endothelial Thickness Comparison Trial II (DETECT II), a multicentre, outcome-masked, randomised, placebo-controlled, clinical trial comparing DMEK to DSO with ripasudil (DSO-R) for this patient population. METHODS AND ANALYSIS: A total of 60 patients with endothelial dysfunction due to symptomatic FECD will be enrolled from seven participating sites in the USA. The patients will be randomly assigned in a 1:1 ratio to one of the following treatment groups: group 1-DMEK plus topical placebo and group 2-DSO plus topical ripasudil 0.4%. The enrolment period is 24 months. The primary outcome is best spectacle-corrected visual acuity at 12 months. Secondary outcomes include peripheral and central endothelial cell density, visual acuity, vision-related quality of life and Pentacam Scheimpflug tomography. Study outcomes will be analysed using mixed effects linear regression. Adverse events, including rebubble procedures, endothelial failure and graft rejection, will be documented and analysed using appropriate statistical methods. DETECT II aims to provide evidence on the comparative effectiveness of DMEK and DSO-R. The results of this trial will contribute to optimising the treatment of FECD, while also exploring the cost-effectiveness of these interventions. Dissemination of findings through peer-reviewed publications and national/international meetings will facilitate knowledge translation and guide clinical practice in the field of corneal transplantation. ETHICS AND DISSEMINATION: A data and safety monitoring committee has been empanelled by the National Eye Institute. All study protocols will be subject to review and approval by WCG IRB as the single IRB of record. This study will comply with the National Institute of Health (NIH) Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Data from the trial will be made available on reasonable request. TRIAL REGISTRATION NUMBER: NCT05275972.
Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Isoquinolinas , Sulfonamidas , Acuidade Visual , Humanos , Distrofia Endotelial de Fuchs/cirurgia , Distrofia Endotelial de Fuchs/tratamento farmacológico , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Acuidade Visual/efeitos dos fármacos , Masculino , Sulfonamidas/uso terapêutico , Sulfonamidas/administração & dosagem , Feminino , Isoquinolinas/uso terapêutico , Isoquinolinas/administração & dosagem , Endotélio Corneano/patologia , Lâmina Limitante Posterior/cirurgia , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso , Soluções Oftálmicas/uso terapêutico , Estudos Multicêntricos como AssuntoRESUMO
BACKGROUND: To investigate the risk factors and prognosis of clinical pseudophakic cystoid macular edema (PCME) after uneventful phacoemulsification surgery in patients without pre-existing fundus diseases. METHODS: This was a retrospective case-control study. Medical records between August 2020 and August 2023 were reviewed for patients who had no previous fundus diseases and developed clinical PCME. A control group was randomly chosen and the risk factors for PCME was analyzed by binary logistic regression. Structure and visual prognosis of the PCME cohort were observed and compared among subgroups undergoing different treatment measures. RESULTS: Forty-seven eyes of 47 patients with PCME were included. The development of PCME was associated with higher systolic blood pressure (OR, 1.048; 95%CI 1.002, 1.097; P = .042), no posterior vitreous detachment (OR, 0.215; 95%CI: 0.553, 0.887; P = .032) and shorter axial lengths (OR, 0.401; 95%CI 0.161, 0.997; P = .049) compared to controls. During a mean follow-up of 8.26 months, 36 eyes (76.6%) showed visual improvement with decreased macular thickness. Different treatment modalities, including observation, topical NSAIDs, and intervention therapy, have no significant differences on the visual prognosis (P = 1.000). However, the intervention group had a shorter recovery time compared to the observation group (28.6 vs. 45.9 days, P = .037). CONCLUSION: PCME remains an encountered morbidity in patients without pre-existing fundus diseases. Shorter axial lengths, absence of posterior vitreous detachment, and higher systolic blood pressure are risk factors of PCME. Active intervention failed to improve the prognosis of PCME but could shorten the recovery time.
Assuntos
Edema Macular , Facoemulsificação , Acuidade Visual , Humanos , Edema Macular/etiologia , Edema Macular/diagnóstico , Masculino , Estudos Retrospectivos , Feminino , Fatores de Risco , Idoso , Prognóstico , Acuidade Visual/fisiologia , Estudos de Casos e Controles , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias , Tomografia de Coerência Óptica , Fundo de Olho , Seguimentos , Pseudofacia/fisiopatologia , Pseudofacia/complicações , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: This Systematic review aims to assess the efficacy of trehalose and hyaluronic acid in enhancing ocular recovery post-cataract surgery, focusing on their impact on tear film stability, ocular surface integrity, and patient-reported outcomes. METHODS: A comprehensive search was conducted across MEDLINE, PubMed, and Cochrane Library databases to identify randomized controlled trials investigating the efficacy of trehalose, hyaluronic acid, or their combination in post-cataract surgery care. The inclusion criteria focused on peer-reviewed studies in English, detailing outcomes relevant to ocular recovery such as tear film stability, ocular surface integrity, patient-reported discomfort, or visual acuity (VA). The quality of the included studies was assessed using the Cochrane Risk of Bias Tool and synthesized the data qualitatively. RESULTS: Four qualitative investigations met the inclusion criteria. The studies collectively assessed the efficacy of a 3% trehalose and 0.15% hyaluronic acid eye drop solution in reducing postoperative eye symptoms compared to various control solutions. Parameters measured included tear break-up time (TBUT), Fluorescein staining, tear production (Schirmer test), and Ocular Surface Disease Index (OSDI) scores. The results indicated significant improvements in tear film stability and ocular surface health for the treatment groups compared to controls, with a notable decrease in patient-reported discomfort. The study showed an improvement of - 18 (± 14.6) in the treatment group compared to - 7 (± 8.0) in the control group for OSDI. For TBUT, the treatment group improved by 3 (± 1.2) s, whereas the control group improved by 0.3 (± 0.71) s. VA, measured on a scale of 0-100, increased to 17 (± 0.7) in the treatment group compared to 15 (± 1.1) in the control group. CONCLUSIONS: Trehalose and hyaluronic acid may be beneficial in the postoperative period by enhancing tear film stability and ocular surface health. While the results are promising, further research is needed to confirm these findings, understand the mechanisms of action, and explore broader applications.
Assuntos
Ácido Hialurônico , Lágrimas , Trealose , Humanos , Trealose/farmacologia , Trealose/uso terapêutico , Lágrimas/metabolismo , Lágrimas/fisiologia , Síndromes do Olho Seco/tratamento farmacológico , Soluções Oftálmicas , Assistência ao Paciente/métodos , Acuidade VisualRESUMO
BACKGROUND: To investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29. METHODS: Preoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed. RESULTS: Fifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted. CONCLUSIONS: The anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.
Assuntos
Câmara Anterior , Catarata , Facoemulsificação , Acuidade Visual , Humanos , Feminino , Masculino , Câmara Anterior/diagnóstico por imagem , Idoso , Pessoa de Meia-Idade , Acuidade Visual/fisiologia , Facoemulsificação/métodos , Microscopia Acústica , Ar , Capsulorrexe/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso de 80 Anos ou mais , Cápsula do Cristalino/cirurgia , Cápsula do Cristalino/diagnóstico por imagemRESUMO
BACKGROUND: Optical coherence tomography angiography (OCTA) is a relatively new extension of Optical coherence tomography (OCT) that generates non-invasive, depth-resolved images of the retinal microvasculature which allows for the detection of various features of diabetic retinopathy. OBJECTIVES: This study aimed to detect biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal ranibizumab (IVR) by means of OCTA. PATIENTS AND METHODS: This prospective interventional study was undertaken on 111 eyes of 102 naïve participants who had diabetic macular edema; enrolled patients were evaluated by taking a complete ophthalmologic history, examination and investigations by use of a pre-designed checklist involving Optical Coherence Tomography Angiography. RESULTS: Regarding the best corrected visual acuity (BCVA) the Mean ± SD was 0.704 ± 0.158 preoperatively and 0.305 ± 0.131 postoperatively in good responder patients; and was 0.661 ± 0.164 preoperatively and 0.54 ± 0.178 postoperatively in poor responders. The central macular thickness (CMT) was 436.22 ± 54.66 µm preoperatively and 308.12 ± 33.09 µm postoperatively in good responder patients; and was 387.74 ± 44.05 µm preoperatively and 372.09 ± 52.86 µm postoperatively in poor responders. By comparing the pre injection size of the foveal avascular zone area (FAZ-A) in both groups, it found that the mean ± SD of FAZ-A was 0.297 ± 0.038 mm in good responder patients compared to 0.407 ± 0.05 mm in non-responder patients. The preoperative superficial capillary plexus (SCP) foveal vascular density (VD) was 24.02 ± 3.01% in good responder patients versus 17.89 ± 3.19% um in poor responders. The preoperative SCP parafoveal VD was 43.06 ± 2.67% in good responder patients versus 37.96 ± 1.82% um in poor responders. The preoperative deep capillary plexus (DCP) foveal VD was 30.58 ± 2.89% in good responder patients versus 25.45 ± 3.14% in poor responders. The preoperative DCP parafoveal VD was 45.66 ± 2.21% in good responder patients versus 43.26 ± 2.35% um in poor responders, this was statistically significant. CONCLUSION: OCTA offers an accurate measurement for VD in the macula as well as the FAZ-A which could be used to predict an early anatomical response of anti-VEGF treatment in DME.
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Inibidores da Angiogênese , Retinopatia Diabética , Angiofluoresceinografia , Injeções Intravítreas , Edema Macular , Ranibizumab , Tomografia de Coerência Óptica , Acuidade Visual , Humanos , Tomografia de Coerência Óptica/métodos , Edema Macular/tratamento farmacológico , Edema Macular/diagnóstico , Edema Macular/diagnóstico por imagem , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Estudos Prospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Angiofluoresceinografia/métodos , Acuidade Visual/fisiologia , Inibidores da Angiogênese/uso terapêutico , Ranibizumab/uso terapêutico , Ranibizumab/administração & dosagem , Idoso , Valor Preditivo dos Testes , Adulto , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fundo de Olho , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologiaRESUMO
Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. Methods: A retrospective review of patients aged 38 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 38 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), postoperative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 38). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.0393.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %)... (AU)
Assuntos
Humanos , Criança , Supressão , Visão Binocular , Esotropia , Acuidade Visual , TerapêuticaRESUMO
Purpose: To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups. Methods: 12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white. Results: The DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p = 0.012) and -0.11±0.12 D (YG, p = 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p = 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance. Conclusion: Both age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.(AU)
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Humanos , Masculino , Feminino , Adulto Jovem , Idoso , Visão Ocular , Acuidade Visual , Fundo de Olho , Lentes de Contato , Testes VisuaisRESUMO
BACKGROUND: In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation. METHODS: This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years' post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated. RESULTS: The mean age was 6.52 ± 4.61 years, with an age range of 1-15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of - 0.29 (P = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of - 1.05 (P = 0.009) and - 1.81 (P = 0.009), respectively. CONCLUSION: High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Refração Ocular , Erros de Refração , Acuidade Visual , Humanos , Estudos Retrospectivos , Criança , Masculino , Feminino , Refração Ocular/fisiologia , Adolescente , Estudos Transversais , Pré-Escolar , Lactente , Acuidade Visual/fisiologia , Erros de Refração/fisiopatologia , Erros de Refração/etiologia , Erros de Refração/diagnóstico , Implante de Lente Intraocular/métodos , Catarata/congênito , Catarata/fisiopatologia , Seguimentos , Extração de Catarata/métodos , Extração de Catarata/efeitos adversos , Período Pós-OperatórioRESUMO
BACKGROUND: The inner segments and outer segments (IS/OS) of the retinal photoreceptors are the areas that receive light signals and are the most initial sites for generating visual impulses, and the integrity of the IS/OS has a direct impact on visual sensitivity. METHODS: We performed OCT on a 6-year-old child with vision loss and found that the cause of his vision loss was a retinal IS/OS fracture, and the child underwent some treatments to improve microcirculation and nourish the retina at a higher-level hospital, but his vision never improved. Our examination of this child revealed that this child not only had decreased visual acuity, but also hypermetropia, but his near stereopsis was normal. The symptoms were similar to those of amblyopia, so we tried to use visual training as a treatment. RESULTS: First, 6 sessions of fine visual stimulation were given, followed by 3 sessions of accommodation training, and we followed the 4 stages of accommodation training: perception of accommodation, amplitude of accommodation, sensitivity of accommodation, and autonomic accommodation. After 9 consecutive visual training sessions, the child's visual acuity was stabilized at 0.6, and then we added eye movement training, and after the child's visual acuity was improved to 0.7, we suppressed the visual acuity of the left eye to 0.6, so as to make the visual acuity of both eyes similar, which would promote the establishment of binocular stereo vision, and then we carried out 9 more visual training sessions, and the patient's visual acuity was stabilized at 0.8 gradually. OCT review showed that the child's retinal IS/OS fracture was basically closed. CONCLUSION SUBSECTIONS: In conclusion, our study found that visual training can restore visual acuity in children with monocular IS/OS fracture and also promote repair of IS/OS fracture, which increases our understanding and knowledge of the treatment of retinal IS/OS fracture, and this case may provide some lessons for the treatment of retinal IS/OS fracture in children. We hope to have more samples of retinal IS/OS fracture in the future to evaluate the efficacy of visual training for retinal IS/OS fracture.
Assuntos
Acuidade Visual , Humanos , Criança , Masculino , Tomografia de Coerência Óptica , Acomodação Ocular/fisiologia , Segmento Externo das Células Fotorreceptoras da RetinaRESUMO
BACKGROUND: We aimed to evaluate microaneurysms (MAs) after treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy to understand causes of chronic edema and anti-VEGF resistance. METHODS: Patients with non-proliferative diabetic retinopathy, with or without macular edema were recruited. Optical coherence tomography angiography (OCTA) MAs-related parameters were observed, including the maximum diameter of overall dimensions, material presence, and flow signal within the lumen. OCTA parameters also included central macular thickness (CMT), foveal avascular zone, superficial and deep capillary plexuses, and non-flow area measurements on the superficial retinal slab. RESULTS: Overall, 48 eyes from 43 patients were evaluated. CMT differed significantly between the diabetic macular edema (DME ) and non-DME (NDME) groups at 1st, 2nd, 3rd, and 6th months of follow-up (P < 0.001; <0.001; 0.003; <0.001, respectively). A total of 55 and 59 MAs were observed in the DME (mean = 99.40 ± 3.18 µm) and NDME (mean maximum diameter = 74.70 ± 2.86 µm) groups at baseline, respectively (significant between-group difference: P < 0.001). Blood flow signal was measurable for 46 (83.6%) and 34 (59.3%) eyes in the DME and NDME groups, respectively (significant between-group difference: P < 0.001). CONCLUSIONS: Compared to the NDME group, the DME group had larger MAs and a higher blood-flow signal ratio. Following anti-VEGF therapy, changes in the diameter of MAs were observed before changes in CMT thickness.
Assuntos
Inibidores da Angiogênese , Retinopatia Diabética , Angiofluoresceinografia , Injeções Intravítreas , Edema Macular , Microaneurisma , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Humanos , Tomografia de Coerência Óptica/métodos , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Edema Macular/diagnóstico por imagem , Edema Macular/diagnóstico , Masculino , Microaneurisma/diagnóstico , Feminino , Pessoa de Meia-Idade , Inibidores da Angiogênese/uso terapêutico , Angiofluoresceinografia/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Ranibizumab/uso terapêutico , Ranibizumab/administração & dosagem , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/patologia , Fundo de Olho , SeguimentosRESUMO
BACKGROUND: Leber congenital amaurosis 1 (LCA1), caused by mutations in GUCY2D, is a rare inherited retinal disease that typically causes blindness in early childhood. The aim of this study was to evaluate the safety and preliminary efficacy of ascending doses of ATSN-101, a subretinal AAV5 gene therapy for LCA1. METHODS: 15 patients with genetically confirmed biallelic mutations in GUCY2D were included in this phase 1/2 study. All patients received unilateral subretinal injections of ATSN-101. In the dose-escalation phase, three adult cohorts (n=3 each) were treated with three ascending doses: 1·0â×â1010 vg/eye (low dose), 3·0â×â1010 vg/eye (middle dose), and 1·0â×â1011 vg/eye (high dose). In the dose-expansion phase, one adult cohort (n=3) and one paediatric cohort (n=3) were treated at the high dose. The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs), and secondary endpoints included full-field stimulus test (FST) and best-corrected visual acuity (BCVA). A multi-luminance mobility test (MLMT) was also done. Data through the 12-month main study period are reported. FINDINGS: Patients were enrolled between Sept 12, 2019, and May 5, 2022. A total of 68 TEAEs were observed, 56 of which were related to the surgical procedure. No serious TEAE was related to the study drug. Ocular inflammation was mild and reversible with steroid treatment. For patients who received the high dose, mean change in dark-adapted FST was 20·3 decibels (dB; 95% CI 6·6 to 34·0) for treated eyes and 1·1 dB (-3·7 to 5·9) for untreated eyes at month 12 (white stimulus); improvements were first observed at day 28 and persisted over 12 months (p=0·012). Modest improvements in BCVA were also observed (p=0·10). Three of six patients who received the high dose and did the MLMT achieved the maximum score in the treated eye. INTERPRETATION: ATSN-101 is well tolerated 12 months after treatment, with no drug-related serious adverse events. Clinically significant improvements in retinal sensitivity were sustained in patients receiving the high dose. FUNDING: Atsena Therapeutics.
Assuntos
Terapia Genética , Guanilato Ciclase , Amaurose Congênita de Leber , Receptores de Superfície Celular , Adolescente , Adulto , Criança , Humanos , Terapia Genética/métodos , Guanilato Ciclase/genética , Injeções Intraoculares , Amaurose Congênita de Leber/genética , Mutação , Receptores de Superfície Celular/genética , Resultado do Tratamento , Acuidade VisualRESUMO
Purpose: Crowding is the inability to distinguish objects in the periphery in the presence of clutter. Previous studies showed that crowding is elevated in patients with glaucoma. This could serve as an indicator of the functional visual performance of patients with glaucoma but at present appears too time-consuming and attentionally demanding. We examined visual crowding in individuals with preperimetric glaucoma to compare the potential effectiveness of eye movement-based and manual response paradigms. Methods: We assessed crowding magnitude in 10 participants with preperimetric glaucoma and 10 age-matched controls. Crowding magnitudes were assessed using four different paradigms: a conventional two-alternative forced choice (2AFC) manual, a 2AFC and a six-alternative forced choice (6AFC) eye movement, and a serial search paradigm. All paradigms measured crowding magnitude by comparing participants' orientation discrimination thresholds in isolated and flanked stimulus conditions. Moreover, assessment times and participant preferences were compared across paradigms. Results: Patients with preperimetric glaucoma exhibited elevated crowding, which was most evident in the manual-response paradigm. The serial search paradigm emerged as the fastest method for assessing thresholds, yet it could not effectively distinguish between glaucoma and control groups. The 6AFC paradigm proved challenging for both groups. Conclusions: We conclude that patients with preperimetric glaucoma demonstrate heightened binocular visual crowding. This is most effectively demonstrated via the 2AFC manual response paradigm. The additional attentional demand in eye movement paradigms rendered them less effective in the elderly population of the present study. Translational Relevance: Our findings underscore both the value and the complexity of efficiently evaluating crowding in elderly participants, including those with preperimetric glaucoma.
Assuntos
Movimentos Oculares , Glaucoma , Campos Visuais , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Movimentos Oculares/fisiologia , Idoso , Glaucoma/fisiopatologia , Glaucoma/diagnóstico , Campos Visuais/fisiologia , Testes de Campo Visual/métodos , Acuidade Visual/fisiologia , Limiar Sensorial/fisiologiaRESUMO
Purpose: To develop a novel classification of highly myopic eyes using artificial intelligence (AI) and investigate its relationship with contrast sensitivity function (CSF) and fundus features. Methods: We enrolled 616 highly myopic eyes of 616 patients. CSF was measured using the quantitative CSF method. Myopic macular degeneration (MMD) was graded according to the International META-PM Classification. Thickness of the macula and peripapillary retinal nerve fiber layer (p-RNFL) were assessed by fundus photography and optical coherence tomography, respectively. Classification was performed by combining CSF and fundus features with principal component analysis and k-means clustering. Results: With 83.35% total variance explained, highly myopic eyes were classified into four AI categories. The percentages of AI categories 1 to 4 were 14.9%, 37.5%, 36.2%, and 11.4%, respectively. Contrast acuity of the eyes in AI category 1 was the highest, which decreased by half in AI category 2. For AI categories 2 to 4, every increase in category led to a decrease of 0.23 logarithm of the minimum angle of resolution in contrast acuity. Compared with those in AI category 1, eyes in AI category 2 presented a higher percentage of MMD2 and thinner temporal p-RNFL. Eyes in AI categories 3 and 4 presented significantly higher percentage of MMD ≥ 3, thinner nasal macular thickness and p-RNFL (P < 0.05). Multivariate regression showed AI category 4 had higher MMD grades and thinner macular compared with AI category 3. Conclusions: We proposed an AI-based classification of highly myopic eyes with clear relevance to visual function and fundus features. Translational Relevance: This classification helps to discover the early hidden visual deficits of highly myopic patients, becoming a useful tool to evaluate the disease comprehensively.
Assuntos
Inteligência Artificial , Sensibilidades de Contraste , Fundo de Olho , Tomografia de Coerência Óptica , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Idoso , Sensibilidades de Contraste/fisiologia , Acuidade Visual/fisiologia , Adulto , Miopia Degenerativa/fisiopatologia , Miopia Degenerativa/diagnóstico por imagem , Miopia Degenerativa/diagnóstico , Miopia Degenerativa/classificação , Miopia Degenerativa/patologia , Degeneração Macular/classificação , Degeneração Macular/fisiopatologia , Degeneração Macular/diagnóstico , Degeneração Macular/patologia , Degeneração Macular/diagnóstico por imagem , Macula Lutea/patologia , Macula Lutea/diagnóstico por imagem , Macula Lutea/fisiopatologia , Fibras Nervosas/patologiaRESUMO
PURPOSE: To present our clinical experience using femtosecond laser-assisted cataract surgery (FLACS) and cortical cleavage hydrodissection in eyes with posterior polar cataract. METHODS: Medical records of consecutive10 eyes of 6 patients with clinical diagnosis of posterior polar cataract (PPC), were retrospectively reviewed. All surgeries were done by using femtosecond laser-assisted cataract surgery. In all cases careful hydrodissection was done to separate the lens material from the posterior capsule. RESULTS: There were 3 males and 3 females, ages 39-73 years (average 52.5 years), two of them were implanted with toric lenses. In all eyes hydrodissection was successfully performed and the lens material was separated from the lens capsule. The posterior capsule remained intact during nucleus removal in all cases. In one eye the posterior capsule broke during cortical cleaning and the tear was converted to posterior capsulorhexis (PCCC). No postoperative complications were recorded during follow-up in all eyes. CONCLUSIONS: Hydrodissection can be safely performed in combination (but not exclusively) with FLACS, in eyes with posterior polar cataract with no evidence of a preexisting posterior capsule rent. Hydrodissection is regarded by most surgeons as contraindicated in these eyes however apparently it is more gentile to the capsule than any other surgical maneuver and allows clean and efficient separation of the lens material from the thinned posterior capsule. Femtosecond laser capsulotomy and lens fragmentation is effective and may further assist surgery by pneumo-separation of the lens material. Anterior chamber maintainer may further aid to the stability of the chamber and safety of surgery.
Assuntos
Catarata , Terapia a Laser , Acuidade Visual , Humanos , Pessoa de Meia-Idade , Feminino , Masculino , Idoso , Estudos Retrospectivos , Adulto , Catarata/complicações , Terapia a Laser/métodos , Extração de Catarata/métodos , Seguimentos , Cápsula do Cristalino/cirurgiaRESUMO
PURPOSE: To investigate the efficacy and outcomes of switching neovascular age-related macular degeneration (nAMD) patients from aflibercept to faricimab, focusing on visual acuity, retinal fluid management, and treatment intervals. The primary aim was to assess the early outcomes in nAMD patients refractory to aflibercept and explore faricimab's potential as a longer-lasting therapeutic alternative. METHODS: A single-center retrospective study was conducted on 50 refractory nAMD patients at Cleveland Clinic Abu Dhabi from September 2022-May 2023. Patients were switched from aflibercept to faricimab, having met specific criteria for refractory nAMD. The study analyzed best-corrected visual acuity (BCVA), central subfield thickness (CST), and fluid changes post-switch, using Optical Coherence Tomography (OCT). RESULTS: After three faricimab injections, significant reductions in CST were observed, with a notable decrease in retinal fluid. The mean BCVA remained stable throughout the study period. Although there was a decrease in the maximum pigment epithelial detachment (PED) height, it was not statistically significant. Treatment intervals post-switch showed that the majority of patients maintained or extended their treatment intervals, with a significant proportion achieving resolution of intraretinal fluid (IRF) and subretinal fluid (SRF). CONCLUSIONS: Switching to faricimab from aflibercept in refractory nAMD patients led to significant improvements in retinal fluid management and CST, with stable BCVA outcomes. Faricimab presents a promising alternative for patients requiring frequent aflibercept injections, potentially offering a more manageable treatment regimen with extended dosing intervals. This study highlights the need for personalized therapeutic strategies in nAMD treatment, though further research is necessary to optimize treatment switches.
Assuntos
Inibidores da Angiogênese , Injeções Intravítreas , Receptores de Fatores de Crescimento do Endotélio Vascular , Proteínas Recombinantes de Fusão , Tomografia de Coerência Óptica , Acuidade Visual , Degeneração Macular Exsudativa , Humanos , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Masculino , Feminino , Tomografia de Coerência Óptica/métodos , Idoso , Degeneração Macular Exsudativa/tratamento farmacológico , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/fisiopatologia , Inibidores da Angiogênese/administração & dosagem , Idoso de 80 Anos ou mais , Substituição de Medicamentos/métodos , Resultado do Tratamento , Seguimentos , Angiofluoresceinografia/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fundo de OlhoRESUMO
BACKGROUND: Pars Plana Vitrectomy (PPV) combined with subretinal injection of low-dose recombinant tissue plasminogen activator (rt-PA) and intravitreal injection of Conbercept as a novel therapy for submacular hemorrhage (SMH) requires evaluation. METHODS: In a retrospective interventional clinical study, 14 eyes of 14 patients with SMH underwent PPV along with rt-PA (subretinal) and Conbercept (intravitreal) injections. The main outcomes included best-corrected visual acuities (BCVAs), degrees of blood displacement, and adverse events. All patients completed at least 6-month follow-up visits. RESULTS: Mean BCVAs significantly improved at 7 days (22.29 ± 15.35), 1 month (30.71 ± 16.42), 3 months (38.29 ± 13.72), 4 months (38.86 ± 14.15), and 6 months (41.21 ± 14.91) post-treatment compared to baseline (16.36 ± 13.97) (F = 12.89, P = 0.004). The peak improvement in BCVAs occurred at 6 months postoperatively. The procedure effectively eliminated subfoveal hemorrhages in all eyes, with clots removal and absorption occurring within one month and complete regression by 3-month follow-up visits. Postoperatively, two cases of AMD resulted in discoid scars on the fundus. No instances of rt-PA-related retinal toxicity were observed during the follow-up period. CONCLUSION: The combined approach of PPV with low-dose rt-PA and anti-VEGF shows promise in enhancing both vision and anatomical structure in SMH therapy. Individualized treatment plans tailored to the primary disease should be developed to optimize visual prognoses. TRIAL REGISTRATION: Retrospectively registered No.ChiCTR2100053034. Registration date: 10/11/2021.
Assuntos
Injeções Intravítreas , Proteínas Recombinantes de Fusão , Hemorragia Retiniana , Ativador de Plasminogênio Tecidual , Acuidade Visual , Vitrectomia , Humanos , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêutico , Estudos Retrospectivos , Masculino , Feminino , Hemorragia Retiniana/tratamento farmacológico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/diagnóstico , Acuidade Visual/fisiologia , Pessoa de Meia-Idade , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/uso terapêutico , Idoso , Vitrectomia/métodos , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Terapia Combinada , Tomografia de Coerência Óptica , Seguimentos , Quimioterapia Combinada , AngiofluoresceinografiaRESUMO
BACKGROUND: This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades. METHODS: Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated. RESULTS: The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05). CONCLUSION: The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression.