Graefe's Archive for Clinical and Experimental Ophthalmology

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a Inferior corneal fluorescein staining in a patient with moderate Sjögren syndrome (SS) related dry eye disease (DED). b Diffuse conjunctival and corneal interpalpebral fluorescein staining in a patient with severe SS-related DED
a Conjunctival hyperaemia (Efron’s scale grade 3 in a patient with moderate dry eye disease (DED) before starting treatment with hydrocortisone sodium phosphate 0.335%. b Meibomian gland dysfunction in a patient with severe Sjögren syndrome-related DED. c Severe lid inflammation with telangiectasias and Meibomian glands obstruction
  • Martina MenchiniMartina Menchini
  • Francesco SartiniFrancesco Sartini
  • Michele FigusMichele Figus
  • Giovanna GabbrielliniGiovanna Gabbriellini
Background We investigated the safety and efficacy of short-term treatment with topical low-dose hydrocortisone sodium phosphate 0.335% (PFH) in patients with moderate to severe primary Sjögren syndrome (SS)-related dry eye disease (DED).MethodsA retrospective single-centre interventional study. All patients received PFH for 6 days with a pulsed posology: three times daily for 2 days, twice daily for 2 days, and once daily for 2 days. This scheme was repeated for 3 consecutive months and then alternated for 3 months. Data were collected at baseline, 3 months, and 6 months of follow-up.ResultsA total of 40 SS patients were enrolled. Conjunctival hyperaemia and corneal-conjunctival stain significantly improved (p < 0.001). Ocular Surface Disease Index score reduced significantly between baseline and 3 months and between baseline and 6 months (p < 0.001). The tear film osmolarity lowered significantly in each eye from baseline to 3 months and from baseline to 6 months (p = 0.002 and p = 0.037, respectively).Comparing results at 3 and 6 months, the Ocular Surface Disease Index score (p = 1.000), the frequency of lacrimal substitutes installation (p = 0.632), and tear film osmolarity (right eye p = 0.518, left eye p = 1.000) did not change significantly. Intraocular pressure did not change during the study period.ConclusionPFH eye drops with a pulsed posology improve signs and symptoms, not affecting the intraocular pressure in SS-related DED. Therefore, this pulsed treatment is safe and efficacious.
 
  • Ute MathisUte Mathis
  • Marita FeldkaemperMarita Feldkaemper
  • Hong LiuHong Liu
  • Frank SchaeffelFrank Schaeffel
Purpose Recently, an increasing number of studies relied on the assumption that visually induced changes in choroidal thickness can serve as a proxy to predict future axial eye growth. The retinal signals controlling choroidal thickness are, however, not well defined. We have studied the potential roles of dopamine, released from the retina, in the choroidal response in the chicken. Methods Changes in retinal dopamine release and choroidal thickness changes were induced by intravitreal injections of either atropine (250 µg or 360 nMol), atropine combined with a dopamine antagonist, spiperone (500 µMol), or spiperone alone and were tracked by optical coherence tomography (OCT). To visually stimulate dopamine release, other chicks were exposed to flicker light of 1, 10, or 400 Hz (duty cycle 0.2) and choroidal thickness was tracked. In all experiments, dopamine and 3,4-Dihydroxyphenylacetic acid (DOPAC) were measured in vitreous, retina, and choroid by high-performance liquid chromatography with electrochemical detection (HLPC-ED). The distribution of the rate-limiting enzyme of dopamine synthesis, tyrosine hydroxylase (TH), neuronal nitric oxide synthase (nNOS), vascular endothelial growth factor (VEGF), and alpha2A adrenoreceptors (alpha2A-ADR) was studied in the choroid by immunofluorescence. Results The choroid thickened strongly in atropine-injected eyes, less so in atropine + spiperone–injected eyes and became thinner over the day in spiperone alone-, vehicle-, or non-injected eyes. Flickering light at 20 lx, both 1 and 10 Hz, prevented diurnal choroidal thinning, compared to 400 Hz, and stimulated retinal dopamine release. Correlation analysis showed that the higher retinal dopamine levels or release, the thicker became the choroid. TH-, nNOS-, VEGF-, and alpha2A adrenoreceptor–positive nerve fibers were localized in the choroid around lacunae and in the walls of blood vessels with colocalization of TH and nNOS, and TH and VEGF. Conclusions Retinal DOPAC and dopamine levels were positively correlated with choroidal thickness. TH-positive nerve fibers in the choroid were closely associated with peptides known to play a role in myopia development. Findings are in line with the hypothesis that dopamine is related to retinal signals controlling choroidal thickness.
 
Calculation of the deposition rate in a sclerotic scatter image of a patient with granular corneal dystrophy type 2. The lesion is outlined in yellow. This figure shows that the lesion occupies 11% of the 7-mm central region of the eye
Correlation between the deposition rate of the lesions and the Corvis Biomechanical Index (CBI) in eyes with granular corneal dystrophy type 2. The CBI was positively correlated with the deposition rate (r = 0.47, P = 0.044)
Purpose To evaluate the corneal biomechanical features of eyes with granular corneal dystrophy type 2 (GCD2) by analyzing corneal biomechanical indices obtained using a Corvis ST (CST) dynamic ultra-high-speed Scheimpflug imaging device. Methods In this retrospective case–control study, 35 CST parameters were compared in normal eyes (control) and eyes of patients with GCD2 treated at Osaka University Hospital, Osaka, Japan. The parameters included the Corvis Biomechanical Index (CBI), which is important in differentiating eyes with keratoconus from normal eyes. We measured the deposition rates of lesions in the central 7-mm region of the eye and assessed the correlation between the deposition rate and the CBI. Results Twenty-one eyes with GCD2 and 23 control eyes were analyzed. Eyes with GCD2 showed significantly less corneal stiffness in 15 CST parameters than did control eyes. In particular, the CBI was remarkably higher in eyes with GCD2 than in control eyes (P = 0.000006). Additionally, the deposition rate and the CBI were positively correlated. Conclusions GCD2 eyes had softer corneas than did control eyes in most biomechanical CST parameters, and one of the parameters (the CBI) was linked to the rate of deposited lesions. Since IOP may be underestimated in GCD2 eyes, management should be especially careful in GCD2 cases complicated by glaucoma.
 
In vivo confocal microscopic images of the subbasal nerve plexus and endothelial cell layer in patients with BD. Subbasal nerve plexus of non-ocular BD (a) and subbasal nerve plexus of ocular BD (b). Subbasal nerve plexus is depicted with arrows, showing thinning, decreasing, and more tortuous nerves of a patient with ocular BD. Normal endothelial cell layer (arrow head) in patients with non-ocular BD (c). Endothelial cell layer reveals decreased endothelial cell density (arrow head) in the endothelium with ocular BD (d)
Purpose We sought to investigate alterations in the corneal subbasal nerve plexus and endothelium in patients with Behçet’s disease (BD). Methods This cross-sectional study included 64 patients with BD and 30 age- and gender-matched healthy control subjects. Those with BD were classified as having ocular or non-ocular disease. All subjects underwent a corneal endothelial and subbasal nerve density evaluation using in vivo confocal microscopy (IVCM). The differences among groups were analyzed using the Kruskal–Wallis test followed by Dunn’s multiple comparison procedure. Results The mean age of study participants was 35.7 ± 10.2 years (16–58) in the ocular BD group, 39.6 ± 14.9 years (11–66) in the non-ocular BD group, and 34.1 ± 11.2 years (21–55) in the control group. No statistical significance was found in terms of age (p = 0.259) or sex (p = 0.560) between groups. The mean endothelial cell density determined with IVCM was 2124.9 ± 417.4 cells/mm2 (1811–3275) in the ocular group and 2546 ± 335 cells/mm2 (1798–3280) in the control group (p = 0.000). In the ocular group, the mean density of the subbasal nerve plexus was significantly lower (p = 0.004), and nerve tortuosity was significantly higher (p = 0.002). Conclusions Ocular BD could be responsible for changes in the corneal layers, especially endothelial and corneal nerve structures. Nerve density and tortuosity differences could be inflammatory indicators for BD.
 
Purpose Retinal neovascularization (RNV) is an intractable pathological hallmark of numerous ocular blinding diseases, including diabetic retinopathy, retinal vein occlusion, and retinopathy of prematurity. However, current therapeutic methods have potential side effects and limited efficacy. Thus, further studies on the pathogenesis of RNV-related disorders and novel therapeutic targets are critically required. Long non-coding RNAs (lncRNAs) have various functions and participate in almost all biological processes in living cells, such as translation, transcription, signal transduction, and cell cycle control. In addition, recent research has demonstrated critical modulatory roles of various lncRNAs in RNV. In this review, we summarize current knowledge about the expression and regulatory functions of lncRNAs related to the progression of pathological RNV. Methods We searched databases such as PubMed and Web of Science to gather and review information from the published literature. Conclusions In general, lncRNA MEG3 attenuates RNV, thus protecting the retina from excessive and dysregulated angiogenesis under high glucose stress. In contrast, lncRNAs MALAT1, MIAT, ANRIL, HOTAIR, HOTTIP, and SNHG16, have been identified as causative molecules in the pathological progression of RNV. Comprehensive and in-depth studies of the roles of lncRNAs in RNV indicate that targeting lncRNAs may be an alternative therapeutic approach in the near future, enabling new options for attenuating RNV progression and treating RNV-related retinal diseases.
 
Purpose It has previously been found that imposing positive defocus changes axial length and choroidal thickness after only 30 min. In the present study, we investigated whether these changes may result from an altered choroidal blood flow. Methods Eighteen young adult subjects watched a movie from a large screen (65 in.) in a dark room at 2 m distance. A 15-min wash-out period was followed by 30 min of watching the movie with a monocular positive defocus (+ 2.5D). Changes in axial length and ocular blood flow were measured before and after the defocus, by using low-coherent interferometer (LS 900, Haag-Streit, Switzerland) and a laser speckle flowgraphy (LSFG) RetFlow unit (Nidek Co., LTD, Japan), respectively. Three regions were analyzed: (1) the macular area, where choroidal blood flow can be measured, (2) the optic nerve head (ONH), and (3) retinal vessel segments. Results Changes in choroidal blood flow were significantly and negatively correlated with changes in axial length that followed positive defocus in exposed eyes (R = − 0.67, p < 0.01). The absolute values of changes in choroidal blood flow in the defocused eyes were significantly larger than in the fellow control eyes (2.35 ± 2.16 AU vs. 1.37 ± 1.44 AU, respectively, p < 0.05). ONH and retinal blood flow were not associated with the induced changes in axial length. Conclusions Positive defocus selectively alters choroidal, but not retinal or ONH blood flow in young human subjects after short-term visual exposure. The results suggest that blood flow modulation is involved in the mechanism of choroidal responses to optical defocus.
 
a Anterior segment optical coherence tomography image: the blue value shows the flap/cap thickness in microns, the orange value shows the underlying stromal layer thickness in microns, and the value over the corneal surface shows the distance away from the corneal vertex in millimeter. b Schema graph of corneal flap/cap measurements (right eye). I inferior, IN inferonasal, IT inferotemporal, N nasal, S superior, SN superonasal, ST superotemporal, T temporal
Refractive outcomes at 3 months after femtosecond Laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE). Attempted versus achieved spherical equivalent refraction after FS-LASIK (a) and SMILE (d); cumulative postoperative uncorrected distance visual acuity (UDVA) and preoperative corrected distance visual acuity (CDVA) for FS-LASIK (b) and SMILE (e); spherical equivalent refraction after FS-LASIK (c) and SMILE (f)
Predictability of corneal flap thickness in the FS-LASIK group (a) and corneal cap thickness in the SMILE group (b) on each measure point at 3 months after surgery. *Significant (P < 0.0109) after correction for multiple comparisons (n = 32) based on false discovery rate (FDR). ‡No significant difference (P > 0.05) was observed when compared to predicted corneal cap/flap thickness
Purpose The aim of this study is to evaluate morphological features of corneal flap/cap and the correlations with corneal higher-order aberrations (HOAs) changes after femtosecond laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE). Methods This was a retrospective study. Pre- and postoperative (1 and 3 months) corneal HOAs were assessed with Pentacam HR. The corneal flap/cap thickness at 32 points (± 1.5 mm, ± 2 mm, ± 2.5 mm, and ± 3 mm from the corneal vertex on meridian 0°/45°/90°/135°) were measured using anterior segment optical coherence tomography at 3 months postoperatively. Morphological features of corneal flap/cap including predictability (P), uniformity (U), and symmetry (S) were calculated and used for correlation analysis with corneal HOAs changes. Results Eighty-six eyes (44 patients) and ninety-six eyes (50 patients) were involved in FS-LASIK and SMILE groups, respectively. Significant thicker corneal flap/cap than the predicted was observed at each measuring point and meridian in both groups (difference > 2.225 μm, the within-subject standard deviation over 6-mm optical zone). There was no statistically significant difference in predictability of corneal flap/cap thickness, while U6 mm (P < .0001), U0 (P < .001), U45 (P = .002), U90 (P < .0001), U135 (P = .004), S6 mm (P < .0001), S0 (P < .001), and S90 (P < .0001) over 6 mm zone were less in SMILE than in FS-LASIK. The changes of corneal tHOAs, Z (3, − 1), Z (3, 1), and SA were significantly correlated with morphological features of corneal flap/cap. Conclusion Both FS-LASIK and SMILE had good predictability in flap or cap thickness, while the uniformity and symmetry of SMILE cap were better than FS-LASIK flap. The quality of flap/cap was closely associated with the changes of corneal HOAs.
 
FAZ areas of a child with ROP who was treated with intravitreal Bevacizumab (A) and a term child (B) at macula OCTA
Purpose To compare macula vascular parameters in optical coherence tomography angiography (OCTA) of children with history of retinopathy of prematurity (ROP) who were treated with laser photocoagulation (LPC) or intravitreal Bevacizumab therapy. Methods Forty eyes of 28 ROP children treated with LPC and 36 eyes of 22 ROP children treated with intravitreal Bevacizumab and 40 eyes of 40 age-gender matched term children were included the study. Capillary plexus densities in macula, FAZ parameters, outer retina and choriocapillaris flow rates, and central foveal thickness were measured. Results Foveal superficial and deep capillary plexus densities were found significantly higher in LPC and intravitreal Bevacizumab injection (IBI) groups compared to control group. FAZ area was found significantly lower in LPC and IBI groups compared to control group (p ‹ 0.001). Higher foveal superficial capillary plexus density, higher central foveal thickness, and lower FAZ area were found to be associated with poorer visual acuity in correlation analysis (p ‹ 0.05). In IBI group, earlier anti-VEGF therapy was found to be associated with lower foveal superficial capillary plexus density. Conclusion Microvascular characteristics such as FAZ area and capillary plexus densities of macula are deteriorated in ROP. There is no significant difference between the treatment alternatives of ROP in terms of macular microvascular parameters.
 
Trends in the age-adjusted prevalence of subtypes of diabetic retinopathy in overall participants with diabetes (A) and individuals with duration of diabetes of 5 years or more (B) from 1998 to 2017. Abbreviations: DR, diabetic retinopathy; PDR, proliferative diabetic retinopathy; NPDR, non-proliferative diabetic retinopathy. The top numbers of the columns indicate the total percentages of any DR in each survey. Black bars indicate the prevalence of PDR, diagonal bars indicate the prevalence of both moderate and severe NPDR, and white bars indicate the prevalence of mild NPDR. The prevalence of any DR in each year was compared with the first survey (1998) and trend analysis throughout the surveys was performed. The frequency of each stage of DR was estimated only by trend analysis. n, number of participants of each survey. *p < 0.01 vs. 1998, #p < 0.20 vs. 1998, and.†p for trend < 0.01
Trends in the prevalence of any diabetic retinopathy and proportions of participants according to HbA1c levels (A) and systolic blood pressure levels (B) in overall individuals with diabetes from 1998 to 2017. Abbreviations: DR, diabetic retinopathy; HbA1c, haemoglobin A1c; SBP, systolic blood pressure. A The left upper figure shows the prevalence of DR in individuals with diabetes with HbA1c levels ≥ 8.0% (solid line), 7.0–7.9% (dashed line), and < 7.0% (dotted line) in each survey. The left lower figure shows the proportions of individuals with diabetes with HbA1c levels of ≥ 8.0% (black bars), 7.0–7.9% (diagonal bars), and < 7.0% (white bars) in each survey. B The right upper figure shows the prevalence of DR in individuals with diabetes with an SBP level of ≥ 160 mmHg (solid line), 140–159 mmHg (dashed line), and < 140 mmHg (dotted line) in each survey. The right lower figure shows the proportions of individuals with diabetes with an SBP level of ≥ 160 mmHg (black bars), 140–159 mmHg (diagonal bars), and < 140 mmHg (white bars) in each survey. *p for trend < 0.05, †p for trend < 0.01
Purpose To examine the secular trends in the prevalence, incidence, and progression rates of diabetic retinopathy (DR) in a Japanese community. Methods Community-dwelling Japanese residents aged ≥ 40 years with diabetes participated in comprehensive systemic and ophthalmological surveys, including an examination for DR, in 1998 (n = 220), 2007 (n = 511), 2012 (n = 515), and 2017 (n = 560). DR was assessed using colour fundus photographs after pupil dilation according to the modified Airlie House classification system. To compare the frequencies of newly developed or progressed DR between the studied decades, two eye cohorts were established (the 2000s cohort included 145 participants examined in 1998 and 2007; the 2010s cohort included 255 participants examined in 2007, 2012, and 2017). Trends in the prevalence, incidence, and progression rate of DR were tested by logistic regression analysis with a generalised estimating equation. Results The age-adjusted prevalence of DR among individuals with diabetes decreased significantly with time from 1998 to 2017 (27.4% in 1998, 22.8% in 2007, 12.8% in 2012, and 6.4% in 2017; p for trend < 0.001). During this period, the prevalence of DR was decreasing in every haemoglobin A1c category, but it remained constant in the high systolic blood pressure category. In addition, the rates of new-onset of DR were significantly lower in the 2010s compared to the 2000s (p < 0.001). Conclusion Our findings suggest that the prevalence and incidence of DR among diabetic people significantly decreased with time over the past two decades in a general Japanese population.
 
The eye position and MRI in Subject 02. A Eye position demonstrated ptosis, esotropia, and hypoplasia. B Coronal MRI showed atrophy of the left SR muscle (white asterisk). C Axial MRI showed the LR muscle of the left eye had a string-like configuration, which suggested muscle fibrosis the hypoplasia (yellow asterisk). MRI, magnetic resonance imaging; SR, superior rectus. LR, lateral rectus. MR, medial rectus. IR, inferior rectus. SO, superior oblique. ON, optic nerve
Pedigrees of CFEOM1 families identified with KIF21A mutations. A-L Genogram and haplotype of CFEOM1 family 01 to 12. Squares represent males, circles represent females, arrows indicate probands, and black symbols identify clinically affected individuals. Eight families (02, 03, 04, 05, 06, 07, 08, and 09) with c.2860C > T (p.R954W), two families (01 and 12) with c.2861G > T (p.R954L), and two families (10 and 11) with c.2861G > A (p.R954Q) were identified. The palpebral fissure length
Effects and diagram of surgical management, and MRI in Subject 15. A Before ptosis and strabismus surgery, the individual was presented with severe ptosis, fixed infraduction, and esotropia. B After surgery, she got an excellent prognosis with bilateral PFH improvement and microtropia. C MRI showed slight atrophy of bilateral LR, compared to MR. D Diagram of modified levator muscle complex suspension. MRI, magnetic resonance imaging; SR, superior rectus. LR, lateral rectus. MR, medial rectus. IR, inferior rectus. SO, superior oblique. ON, optic nerve. CFS, combined fascia sheath
Purpose Congenital fibrosis of extraocular muscles type 1 (CFEOM1), a classical subtype of CFEOM, is characterized by restrictive ophthalmoplegia and ptosis. It is mainly caused by aberrant neural innervation of the extraocular muscles. This study aimed to investigate the genetic characteristics and clinical manifestations of CFEOM1 in Chinese families. Methods The clinical data, including ocular examinations, magnetic resonance imaging (MRI), and surgical procedures of affected individuals from 16 Chinese CFEOM1 families, were collected. The genomic DNA of 16 probands and their family members were sequenced for causative KIF21A gene mutations. Linkage analysis using microsatellite markers across KIF21A was also conducted. Results Affected individuals were presented with bilateral non-progressive ptosis, restricted horizontal eye movement, fixed infraduction of both eyes, compensatory chin-up head position, and neuromuscular abnormalities. Three heterozygous KIF21A mutations, c.2860C > T (p.R954W) (in eight families), c.2861G > T (p.R954L) (in two families), and c.2861G > A (p.R954Q) (in two families) were identified, which implied that hotspot mutations were common in Chinese CFEOM1 families. Germline Mosaicism was likely to be the cause of affected individuals with asymptomatic parents without KIF21A mutations presented in the eight families. Two affected individuals underwent modified levator muscle complex suspension surgery and achieved a good result without any complications. Conclusion Instead of evaluating the whole CFEOM1 gene variant, hotspot mutations could be given priority for screening. The occurrence of germline mosaicism has to be taken into account in genetic counseling. Patients with CFEOM1 who have ptosis may benefit from an innovative surgical procedure called modified levator muscle complex suspension.
 
A Standardized regression coefficients (b) for associations of total retinal thickness with visual acuity and contrast sensitivity metrics (AULCSF curve, CA, and contrast sensitivity CS thresholds) per ETDRS subfield in the total cohort of ERM patients and B in a subgroup analysis of patients with BCVA 20/30–3.. The left side of each grid represents the temporal retina, and the right side represents the nasal retina. * signifies statistically significant association at the level of p < .05
of individual retinal layer thickness effect on visual acuity and contrast sensitivity metrics
Purpose To investigate structure–function associations between retinal thickness, visual acuity (VA), and contrast sensitivity (CS), using the quantitative contrast sensitivity function (qCSF) method in patients with idiopathic epiretinal membrane (ERM). Methods Retrospective, cross-sectional observational study. Patients with a diagnosis of idiopathic ERM were included. Patients underwent complete ophthalmic examination, spectral-domain optical coherence tomography imaging (SD-OCT) (SPECTRALIS® Heidelberg), and CS testing using the qCSF method. Outcomes included area under the log CSF (AULCSF), contrast acuity (CA), and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). Results A total of 102 eyes of 79 patients were included. Comparing standardized regression coefficients, retinal thickness in most ETDRS sectors was associated with larger reductions in AULCSF, CA, and CS thresholds at 3 and 6 cpd than those in logMAR VA. These differences in effect on VA and CS metrics were more pronounced in the central subfield and inner ETDRS sectors. Among the retinal layers, increased INL thickness had the most detrimental effect on visual function, being significantly associated with reductions in logMAR VA, AULCSF, CA, and CS thresholds at 3 and 6 cpd (all p < .01), as well as at 1.5 and 12 cpd (p < .05). Conclusion Retinal thickness seems to be associated with larger reductions in contrast sensitivity than VA in patients with ERM. Measured with the qCSF method, contrast sensitivity may serve as a valuable adjunct visual function metric for patients with ERM.
 
Changes in posterior corneal elevation at the central and thinnest point (A). Four points in rings with a diameter of 2 mm (B) and 6 mm (C) before and after surgery
No significant correlations were found between PTA and the changes in posterior K2 value (A), ACD (B), PCE (C), and PTE (D) at 2 years after TPRK. ACD anterior chamber depth, PCE posterior central elevation, PTE posterior corneal surface at thinnest point, PTA ablation depth/central corneal thickness
No significant correlations were found between age and the changes in posterior K2 value (A), ACD (B), PCE (C), and PTE (D) at 2 years after TPRK
Purpose This study aimed to investigate the stability of posterior corneal surface 2 years after transepithelial photorefractive keratectomy (TPRK) in patients with a residual stromal thickness less than 350 μm. Methods In total, 408 eyes of 212 patients (160 women, 52 men) who underwent TPRK were enrolled in this retrospective study. All surgeries were performed in the Amaris 750S excimer laser platform with smart pulse technology. The posterior corneal elevation, anterior chamber depth, Q value, and curvature were measured using Pentacam preoperatively and postoperatively. All patients were followed up for 2 years. The relationship between percent tissue altered (PTA), age, and changes in posterior corneal surface was analyzed. Results The mean preoperative spherical equivalent was − 6.80 ± 1.18 D (range: − 9.00 to − 2.63 D). The mean residual stromal thickness was 336.46 ± 7.25 μm (range: 310–348 μm). The mean PTA was 30.93 ± 2.03% (range: 24.29–35.28%). At 2 years after surgery, the elevation of six points in the central area decreased by 1.91 ± 2.97 μm, 2.98 ± 3.23 μm, 1.17 ± 3.85 μm, 1.70 ± 2.88 μm, 1.36 ± 3.19 μm, and 1.65 ± 3.18 μm, compared with the preoperative value (P < 0.05). The elevation of three points in the peripheral area increased by 1.87 ± 6.34 μm, 0.68 ± 6.00 μm, and 0.95 ± 5.50 μm (P < 0.05). There was no significant linear relationship between PTA, age, and changes in posterior corneal surface, anterior chamber depth, and K2 (all P > 0.05). Conclusion Within 2 years after TPRK, the posterior corneal surface remained stable in patients with a residual stromal thickness between 310 and 350 μm. There was no sign of iatrogenic ectasia during the follow-up period.
 
Line graph of IOP after DMEK. A The IOP data of 19 patients with IOP elevation is displayed. B The IOP data of 71 patients without IOP elevation. The 22-mmHg line is shown on the vertical axis to better delineate IOPs ≥ 22 mmHg. IOP, intraocular pressure; DMEK, Descemet membrane endothelial keratoplasty
BOX plot of IOP after DMEK. A For patients with multiple IOP measurements available in each time interval, e.g., 1–6 months after DMEK, mean values of IOP within the time interval are calculated and used for analysis. B The preoperative IOP is not significantly different from the mean IOP every 6 months after DMEK. “P-val” = P-values from one-sample t-test for H0: mean = 0. IOP, intraocular pressure; DMEK, Descemet membrane endothelial keratoplasty
Scatter plot of IOP before DMEK and maximum IOP at 36 months after DMEK. The overall trendline is estimated using the locally weighted scatterplot smoothing (LOWESS) method for all cases. All cases are divided into [1] PEX − , pre glaucoma − ; [2] PEX − , pre glaucoma + ; [3] PEX + , PEX glaucoma − ; and [4] PEX + , PEX glaucoma + , and then plotted. Trendlines for the subgroups are not estimated due to the limited data points for valid estimation in each subgroup. When IOP before DMEK is below the median (12 mmHg), postoperative maximum IOP exceeded 22 mmHg only in patients with either PEX or glaucoma. On the other hand, cases with preoperative IOP ≥ 12 mmHg tend to have relatively high postoperative IOP, but most cases with postoperative IOP ≥ 22 mmHg are those with PEX, preexisting glaucoma without PEX, or PEX glaucoma. IOP, intraocular pressure; DMEK, Descemet membrane endothelial keratoplasty; PEX, pseudoexfoliation syndrome
PurposeTo investigate risk factors for increased intraocular pressure (IOP) after Descemet membrane endothelial keratoplasty (DMEK) in Asian patients.Methods Data from January 2015 to February 2021 were obtained from our prospective database. IOP elevation after DMEK was defined as IOP ≥ 22 mmHg or an increase in IOP of ≥ 10 mmHg from baseline. In addition, we examined maximum IOP. Using iCare, we measured IOP 1, 2, 3, and 6 months after DMEK, and every 6 months thereafter. Logistic regression and linear regression were performed to find factors predictive of IOP elevation and maximum IOP, respectively, based on the results of univariate analysis.ResultsWe enrolled 90 eyes (mean patient age, 74.9 ± 7.5 years; mean follow-up duration, 25.6 ± 9.9 months) that underwent DMEK. IOP elevation was present in 19 eyes (21%). IOP increased from 12.6 ± 3.9 mmHg preoperatively to a postoperative maximum of 17.0 ± 5.5 mmHg up to 36 months after DMEK (p < 0.0001). In univariate logistic regression analysis for IOP elevation, only one variable, pseudoexfoliation syndrome (PEX) and preexisting glaucoma, was significant (p < 0.05). Preexisting glaucoma without PEX (OR, 19.33; 95% CI, 4.75–93.46), PEX without glaucoma (OR, 7.25; 95% CI, 1.20–41.63), and PEX glaucoma (OR, 58.00; 95% CI, 6.78–1298.29) were associated with higher risk of IOP elevation.Conclusions In this cohort, the eyes of patients with PEX and preexisting glaucoma were found to be prone to IOP elevation after DMEK.
 
Representative images of type 3 macular neovascularization with subretinal fluid. An arrow in panel C indicates a type 3 macular neovascularization lesion. Arrowheads in panel D indicate subretinal fluid. A Fundus photography; B fluorescein angiography; C indocyanine green angiography; D optical coherence tomography
Focal retinal hemorrhages in eyes with type 3 macular neovascularization with subretinal fluid. Arrows in panels A, C, and E indicate focal retinal hemorrhages. Arrowheads in panels B, D, and F indicate subretinal fluid. A, C, and E Fundus photography; B, D, and F optical coherence tomography
A Kaplan–Meier graph showing the cumulative incidence of patients with lesion reactivation after initial three loading injections in type 3 macular neovascularization with subretinal fluid (SRF) (n = 39, solid line) and without SRF (n = 51, dotted line). There was a significant difference in the lesion reactivation between the two groups (P = 0.019)
Purpose To compare the characteristics and incidence rates of lesion reactivation after anti-vascular endothelial growth factor (VEGF) treatment in type 3 macular neovascularization (MNV) with and without subretinal fluid (SRF) at baseline. Methods This retrospective study included 95 patients diagnosed with type 3 MNV. After the initial loading injections, re-treatment was performed when lesion reactivation occurred defined as the re-accumulation of subretinal or intraretinal fluid or the new development of a retinal/subretinal hemorrhage. The differences in the baseline characteristics and the incidence rates of lesion reactivation were compared between patients with SRF (SRF group, n = 42) and those without SRF (non-SRF group, n = 53). Results At diagnosis, the mean visual acuity was worse (0.68 ± 0.41 vs 0.50 ± 0.36; P = 0.032), mean central retinal thickness was greater (515.4 ± 145.9 μm vs 383.8 ± 105.5 μm; P < 0.001), and the incidence of focal retinal hemorrhages was higher (90.5% vs 66.0%; P = 0.005) in the SRF group than in the non-SRF group. In the SRF group, the first lesion reactivation was noted in 89.7% at a mean of 5.8 ± 4.4 months after the third injection. In the non-SRF group, the first lesion reactivation was noted in 70.6% at a mean of 6.1 ± 3.8 months. There was a significant difference in lesion reactivation between the two groups (P = 0.019). Conclusions The difference in the baseline characteristics and incidence of lesion reactivation between type 3 MNV with and without SRF suggests that the presence of SRF may be indicative of more advanced disease with a high risk of visual deterioration. This result also suggests the need for more active treatment to preserve vision in patients with SRF.
 
Example of eyelid weight positioning and measurement (weighted and unweighted margin reflex distance 1 (MRD1) and pupil to brow distance (PTB)) on a patient with unilateral ptosis
Mean absolute MRD1/PTB with 95% confidence intervals by weight condition in normal and ptosis groups. MRD1 margin reflex distance 1; PTB pupil to brow distance
Mean difference (weighted-unweighted) MRD1/PTB with 95% confidence intervals by weight condition in normal and ptosis groups. MRD1 margin reflex distance 1; PTB pupil to brow distance
Purpose This study aims to characterize the physiologic response of both eyelid and eyebrow position to increasing downward forces simulated by external weights. Methods In this prospective observational study, both normal individuals and patients affected by ptosis were tested. External eyelid weights were placed on one upper eyelid with incrementally increasing weight from 0.2 to 2.4 g. The eyelid carrying the weight was randomly selected for normal subjects and patients with bilateral ptosis, whereas for unilateral ptosis, the ptotic eyelid was utilized. Photographs were obtained at baseline and with increasing weight until MRD1 reached 0 on the weighted side or, until 2.4 g was reached. Eyelid and brow position on the weighted and unweighted sides were digitally measured in millimeter. Primary outcome measures were change in the margin to reflex distance (MRD1) and pupil to brow distance (PTB) with weight on the weighted and unweighted sides for normal and ptosis subjects. Results The weighted eyelid MRD1 decreased linearly with increasing weight. This was true for normal and ptosis subjects. The unweighted eyelid MRD1 increased linearly with increasing weight. This was also the case for both normal and ptosis subjects. With increasing weight, PTB increased linearly on the weighted side. No significant intergroup differences were noted. Conclusions In normal and ptosis subjects, when external weight on the eyelid is incrementally increased, the weighted eyelid MRD1 decreases, the unweighted eyelid MRD1 increases, and both brows elevate in a linear fashion.
 
Purpose The purpose of this study was to measure the anti-angiogenic effect of N-desulfated Re–N-acetylated, a chemically modified heparin (mHep).Methods In vitro assays (cell tube formation, viability, proliferation, and migration) with endothelial cells were performed after 24 h of treatment with mHep at 10, 100, and 1000 ng/mL or saline. In vivo tests were performed after laser-induced choroidal neovascularization (CNV) in rats, followed by an intravitreal injection (5 µL) of mHep (10, 100, 1000 ng/mL) or balanced salt solution. Immunofluorescence analysis of the CNV was performed after 14 days.ResultsmHep produced a statistically significant reduction in cell proliferation, tube formation, and migration, without cell viability changes when compared to saline. Mean measures of CNV area were 54.84 × 106 pixels/mm (± 12.41 × 106), 58.77 × 106 pixels/mm (± 17.52 × 106), and 59.42 × 106 pixels/mm (± 17.33 × 106) in groups 100, 1000, and 10,000 ng/mL, respectively, while in the control group, mean area was 72.23 × 106 (± 16.51 × 106). The P value was 0.0065. Perimeter analysis also demonstrated statistical significance (P = 0.0235) with the mean measure of 93.55 × 104, 94.23 × 104, and 102 × 104 in the 100 ng/mL, 1000 ng/mL, and control groups, respectively.Conclusions These results suggest that mHep N-DRN is a potent anti‐angiogenic, anti‐proliferative, and anti-migratory compound with negligible anticoagulant or hemorrhagic action and no cytotoxicity for retina cells. This compound may serve as a candidate for treating choroidal neovascularization.
 
Severity of uveitis attacks over time during pregnancy
Severity of uveitis attacks over time during pregnancy in women with one pregnancy and in 2 or more pregnancies
Purpose To explore the effect of pregnancy on the clinical course, outcome, and treatment in multiparous women with non-infectious uveitis. Methods Retrospective study of women with a history of non-infectious uveitis and pregnancies prior to and during disease course. Disease activity and severity 1-year prior pregnancy, during pregnancy, and 1-year postpartum were recorded as well as patients’ and diseases’ characteristics. The main outcome measures included the rate and severity of uveitis attacks and the effect on ocular complications and therapies. Results Included were 32 women (70 pregnancies, mean of 2.6 pregnancies/patient), with a mean follow-up time of 6.5 years. The most common uveitis types were anterior (31%) and pan-uveitis (31%). Flare-ups were more frequent in the year prior to pregnancy, in the first trimester, and in the postpartum period and decreased markedly during pregnancy. Women who experienced a flare-up during pregnancy had a higher rate of flare-ups in the year prior pregnancy than those who did not experience a flare-up during pregnancy (p-0.047). The rate of flare-ups 12 months’ postpartum was also higher compared to women without any flare-up during pregnancy (p = 0.01). Severity of flare-ups in the postpartum period was worse in women who experienced a flare-up during pregnancy compared to women without flare-ups (p = 0.001). The severity of flare-ups was higher in the first pregnancy compared to subsequent pregnancies. Conclusions Women who had active or non-controlled uveitis prior to pregnancy have higher disease activity and severity during pregnancy as well. The first pregnancy seems to behave differently from subsequent pregnancies, in terms of disease severity.
 
Signs of “Atypical” Pigment Dispersion Syndrome (a) Krukenberg spindle (white arrow), (b) trabecular meshwork pigmentation, (c) zonular pigmentation, (d) lenticular pigmentation (green arrow). (Reprinted from Qing et al. [7] with permission of Eye.)
Pathogenic Mechanism of Pigment Dispersion Syndrome. The green line indicates that the mechanism is common in Caucasian patients. The red line indicates that the mechanism is common in Asian patients. The blue line indicates that the mechanism is common in black patients. The black lines represent unreported race specificity.
Pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) are two stages within the same ophthalmic disease spectrum, which are known to be affected by race. The prevalence of PDS is underestimated, largely due to its minor clinical symptoms. Although the prevalence of PG is low, the visual impairment associated with PG is extremely severe. The prevalence of PDS-PG is four or more times higher in Caucasians than in Blacks or Asians, and the “classic” PDS in Caucasians has long been used as a benchmark diagnostic criterion. Following extensive research focused on African Americans and Asians, the standard for diagnosing PDS-PG was refined. At the same time, the pathogenesis of PDS is not the same in different races. Hence, the effectiveness of preventive treatment and the need for treatment may not be equivalent in different races. The rate of conversion of PDS to PG is nearly 1/3 in Caucasians and higher in blacks and Asians, requiring more aggressive treatment and monitoring. We systematically searched a PubMed database from inception to March 2022 to provide an overview of research progress in various aspects of PDS-PG. Specifically, this paper considers the effects of race on disease prevalence, clinical manifestation, diagnostic criteria, disease mechanism, hereditary traits, treatment, and prevention to provide an accurate and comprehensive guide for the diagnosis and treatment of PDS-PG in various races.
 
Computed tomographic images in the medial group. a Orbital floor fracture with a hinge at the junction between the medial orbital wall and orbital floor (asterisk) occurs medially to the infraorbital groove (yellow arrow). b Unhinged orbital floor fracture is located medial to the infraorbital groove (yellow arrow). c Orbital floor fracture medial to the infraorbital groove (yellow arrow) with orbital fat incarceration (yellow arrowhead). d Orbital floor fracture with a hinge (asterisk) at the infraorbital groove (yellow arrow)
Computed tomographic images in the in-groove group. A part of the bottom of the infraorbital groove drops into the maxillary sinus (green arrowheads). The yellow arrows indicate the intact part of the infraorbital groove
Computed tomographic images in the lateral group. The infraorbital groove (yellow arrows) drops into the maxillary sinus
Measurement of the length of prolapsed orbital fat. The line between the edges of the orbital floor fracture was drawn (line #1), and the vertical distance from the line to the tip of prolapsed orbital fat was measured (line #2)
Purpose To examine the relationship between patterns of orbital floor fracture around the infraorbital groove and development of infraorbital nerve hypoesthesia.Methods This retrospective, observational study included 200 patients (200 sides) of pure orbital floor fracture with or without medial orbital wall fracture. Data on the presence or absence of infraorbital nerve hypoesthesia were collected from medical records. Based on coronal computed tomographic images, patients were classified into 3 groups: a fracture extending medially to (medial group), into (in-groove group), and laterally to the infraorbital groove (lateral group).ResultsInfraorbital nerve hypoesthesia was found in 72 patients (36.0%). A fracture extended into or laterally to the infraorbital groove in 86.2% of patients with infraorbital nerve hypoesthesia, while a fracture was limited to the portion medial to the infraorbital groove in 77.3% of patients without infraorbital nerve hypoesthesia (P < 0.001). A logistic regression analysis demonstrated that patients in the lateral and in-groove groups were highly associated with development of infraorbital nerve hypoesthesia, with an odds ratio of 134.788 in the lateral group (95% confidence interval, 30.496–595.735; P < 0.001) and that of 20.323 in the in-groove group (95% confidence interval, 6.942–59.499; P < 0.001) with the medial group as the reference.Conclusions This study indicates that patients with orbital floor fracture extending into or laterally to the infraorbital groove have a high risk of infraorbital nerve hypoesthesia, compared to those with orbital floor fracture limited to the portion medial to the infraorbital groove.
 
Punctate fluorescein staining of the superior conjunctiva and the upper cornea
PurposeTo analyse risk factors for the development of superior limbic keratoconjunctivitis (SLK) in thyroid eye disease (TED).Methods This prospective, observational study included 638 eyes/sides from 319 patients with TED. The eyes were classified into two groups, based on the presence and absence of SLK. Multivariate logistic regression analysis was performed to evaluate potential risk factors, including sex, patient age, past treatment history (steroid, orbital radiotherapy and radioiodine therapy), smoking, clinical activity score, margin reflex distance (MRD)-1 and -2, Graefe sign/lid lag, Hertel exophthalmometric results, Schirmer’s test results, tear break-up time (TBUT) and tear meniscus height (TMH).ResultsSLK was found in 198 eyes (31.0%) from 121 patients. Young age (OR, 0.977; P = 0.006), smoker (OR, 1.785; P = 0.009), presence of Graefe sign (OR, 2.912; P < 0.001), absence of lid lag (OR, 0.485; P = 0.031), high Hertel exophthalmometric values (OR, 1.125; P = 0.002), shorter Schirmer’s test results (OR, 0.962; P < 0.001), shorter TBUT (OR, 0.815; P = 0.002) and high upper TMH (OR, 1.003; P = 0.013) were associated with the development of SLK. A high MRD-1 measurement value also tended to be associated with a risk of SLK, with an OR of 1.187 (P = 0.056).Conclusion The present study proposed several risk factors in relation to the development of SLK in TED.
 
Purpose Oxidative stress and inflammation had been proved to play important role in the progression of diabetic keratopathy (DK). The excessive accumulation of AGEs and their bond to AGE receptor (RAGE) in corneas that cause the formation of oxygen radicals and the release of inflammatory cytokines, induce cell apoptosis. Our current study was aimed to evaluate the effect of ALA on AGEs accumulation as well as to study the molecular mechanism of ALA against AGE-RAGE axis mediated oxidative stress, apoptosis, and inflammation in HG-induced HCECs, so as to provide cytological basis for the treatment of DK. Methods HCECs were cultured in a variety concentration of glucose medium (5.5, 10, 25, 30, 40, and 50 mM) for 48 h. The cell proliferation was evaluated by CCK-8 assay. Apoptosis was investigated with the Annexin V- fluorescein isothiocyanate (V-FITC)/PI kit, while, the apoptotic cells were determined by flow cytometer and TUNEL cells apoptosis Kit. According to the results of cell proliferation and cell apoptosis, 25 mM glucose medium was used in the following HG experiment. The effect of ALA on HG-induced HCECs was evaluated. The HCECs were treated with 5.5 mM glucose (normal glucose group, NG group), 5.5 mM glucose + 22.5 mM mannitol (osmotic pressure control group, OP group), 25 mM glucose (high glucose group, HG group) and 25 mM glucose + ALA (HG + ALA group) for 24 and 48 h. The accumulation of intracellular AGEs was detected by ELISA kit. The RAGE, catalase (CAT), superoxide dismutase 2 (SOD2), cleaved cysteine-aspartic acid protease-3 (Cleaved caspase-3), Toll-like receptors 4 (TLR4), Nod-like receptor protein 3 (NLRP3) inflammasome, interleukin 1 beta (IL-1 ß), and interleukin 18 (IL-18) were quantified by RT-PCR, Western blotting, and Immunofluorescence, respectively. Reactive oxygen species (ROS) production was evaluated by fluorescence microscope and fluorescence microplate reader. Results When the glucose medium was higher than 25 mM, cell proliferation was significantly inhibited and apoptosis ratio was increased (P < 0.001). In HG environment, ALA treatment alleviated the inhibition of HCECs in a dose-dependent manner, 25 μM ALA was the minimum effective dose. ALA could significantly reduce the intracellular accumulation of AGEs (P < 0.001), activate protein and genes expression of CAT and SOD2 (P < 0.001), and therefore inhibited ROS-induced oxidative stress and cells apoptosis. Besides, ALA could effectively down-regulate the protein and gene level of RAGE, TLR4, NLRP3, IL-1B, IL-18 (P < 0.05), and therefore alleviated AGEs-RAGE-TLR4-NLRP3 pathway–induced inflammation in HG-induced HCECs. Conclusion Our study indicated that ALA could be a desired treatment for DK due to its potential capacity of reducing accumulation of advanced glycation end products (AGEs) and down-regulating AGE-RAGE axis–mediated oxidative stress, cell apoptosis, and inflammation in high glucose (HG)–induced human corneal epithelial cells (HCECs), which may provide cytological basis for therapeutic targets that are ultimately of clinical benefit.
 
Phenotypic heterogeneity in RPGR-mutation heterozygotes. Five examples of UW-CFP, UW-FAF, and macular OCT phenotypes are shown. A–C Left eye of a patient with regional pigmentary changes including bone spicule–like pigmentation involving the nasal and inferior quadrants (UW-CFP, grade 2) and focal pigmentary retinopathy patchy pigmentation with a radial reflex pattern (F-pattern). On macular SD-OCT, no atrophy of the outer retinal layers is seen on the horizontal scan (grade 1). D–F Left eye of a young patient with apparently normal UW-CFP (grade 0) but clear radial spoke–shaped reflexes extending from the central macular area in a radial pattern on UW-FAF (R-pattern) and a normal macular OCT (grade 1). G–I Right eye of a heterozygote with typical male-like changes, including pigmentary changes in the periphery and a parafoveal hyperautofluorescent ring on UW-FAF (M-pattern). The horizontal scan on macular SD-OCT shows a concentric loss of outer retinal layers outside the central 1 mm (grade 2). J–L Right eye of a heterozygote with normal UW-CFP (grade 0), UW-FAF (N-pattern), and macular SD-OCT (grade 1; no outer retinal atrophy). M–O Right eye of a heterozygote with advanced disease (male-type presentation), including macular atrophy depicted by macular hypoautofluorescence. On SD-OCT, preservation of the outer retinal layers is only observed subfoveally (grade 3)
Sector-wise comparison of the peripapillary retinal nerve fiber layer (pRNFL) thickness between RPGR heterozygotes from our cohort and controls from the Spectralis® pRNFL age-adjusted reference database for European descent
Multimodal imaging and visual field of P7 (the right eye of this patient is shown in Fig. 1G–I). A Left eye (LE) UW-FAF depicting a parafoveal hyperautofluorescent ring (M-pattern). B LE macular horizontal SD-OCT showing a concentric loss of outer retinal layers outside the central 1 mm. C On 24-2 Humphrey visual field testing of the LE, peripheral concentric visual field loss is observed, establishing a perfect structure–function correlation with UW-FAF and SD-OCT. The right eye (not shown) is very similar. D pRNFL thickening is observed in both eyes, especially in the temporal sector (red arrows)
Purpose Phenotypic heterogeneity with variable severity has been reported in female carriers of retinitis pigmentosa GTPase regulator (RPGR) mutations, including a male-type phenotype. A phenomenon not fully understood is peripapillary retinal nerve fiber layer (pRNFL) thickening in male patients with RPGR-associated X-linked retinitis pigmentosa, especially in the temporal sector. We aim to describe the genetic spectrum, retinal phenotypes, and pRNFL thickness in a cohort of Caucasian RPGR-mutation heterozygotes. Methods A cross-sectional study was conducted at an inherited retinal degeneration (IRD) reference center in Portugal. Female patients heterozygous for clinically significant RPGR variants were identified using the IRD-PT registry. A complete ophthalmologic examination was performed, complemented by macular and peripapillary spectral domain optical coherence tomography (SD-OCT), ultra-widefield color fundus photography (UW-CFP), and ultra-widefield fundus autofluorescence (UW-FAF). The retinal phenotypes were graded according to previously described classifications. The pRNFL thickness across the superior, inferior, nasal, and temporal quadrants was compared to the Spectralis® RNFL age-adjusted reference database. Results Forty-eight eyes from 24 females (10 families) were included in the study. Genetic analysis yielded 8 distinct clinically significant frameshift variants in RPGR gene, 3 of which herein reported for the first time. No association was found between mutation location and best-corrected visual acuity (BCVA) or retinal phenotype. Age was associated with worse BCVA and more advanced phenotypes on SD-OCT, UW-CFP, and UW-FAF. Seven women (29.17%) presented a male-type phenotype on UW-FAF in at least one eye. An association was found between UW-FAF and pRNFL thickness in the temporal sector (p = 0.003), with the most advanced fundus autofluorescence phenotypes showing increased pRNFL thickness in this sector. Conclusion This study expands the genetic landscape of RPGR-associated disease by reporting 3 novel clinically significant variants. We have shown that clinically severe phenotypes are not uncommon among female carriers. Furthermore, we provide novel insights into pRNFL changes observed in RPGR heterozygotes that mimic what has been reported in male patients.
 
Vascular density maps of two patients in NPDR and PDR groups; top row represents a NPDR patient. (a) The vascular density map in superficial capillary plexus (SCP), (b) the vascular density map in deep capillary plexus (DCP), and (c) the vascular density map in total retinal layer (Retina). Additionally, the bottom row contains (d) vascular density map in SCP, (e) vascular density map in DCP, and (f) vascular density map in total retinal layer for a PDR class
The mean accuracy of model 3 in vascular density maps of DCP for differentiating PDR from NPDR reached 0.895%, the mean of precision was 0.91, the mean of recall was 0.905, and finally, the mean of F-measure value was 0.9
The receiver operating characteristic curve (ROC curve) of the proposed models of the algorithm for detecting PDR and NPDR in OCT-A vascular density maps. The performance of the proposed model 3 (feature extraction with Gabor filter, feature selection, and classification with SVM improved by genetic algorithm) is compared with other methods. According to the area under the curve (AUC), the proposed model 3 is capable of making better discrimination between PDR and NPDR based on vascular density maps of all layers, especially DCP layer. SCP superficial capillary plexus, DCP deep capillary plexus
PurposeThe study aims to classify the eyes with proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) based on the optical coherence tomography angiography (OCTA) vascular density maps using a supervised machine learning algorithm.MethodsOCTA vascular density maps (at superficial capillary plexus (SCP), deep capillary plexus (DCP), and total retina (R) levels) of 148 eyes from 78 patients with diabetic retinopathy (45 PDR and 103 NPDR) was used to classify the images to NPDR and PDR groups based on a supervised machine learning algorithm known as the support vector machine (SVM) classifier optimized by a genetic evolutionary algorithm.ResultsThe implemented algorithm in three different models reached up to 85% accuracy in classifying PDR and NPDR in all three levels of vascular density maps. The deep retinal layer vascular density map demonstrated the best performance with a 90% accuracy in discriminating between PDR and NPDR.Conclusions The current study on a limited number of patients with diabetic retinopathy demonstrated that a supervised machine learning–based method known as SVM can be used to differentiate PDR and NPDR patients using OCTA vascular density maps.
 
Schema showing the location of the bridging suture relative to the iris and intraocular lens (IOL). a The iris capture by the optic of the IOL is at the area without the haptics (arrows). b Parallel bridging sutures are placed between the anterior surface of the optic of the IOL and the posterior surface of the iris. The sutures are placed orthogonal to the IOL haptics
Anterior segment optical coherence tomographic (AS-OCT) images and intraoperative images of the surgery during the placements of the bridging sutures in a 53-year-old man. a AS-OCT image 1 month before the iris capture showing widely opened angle with retracted iris. b AS-OCT image of a reverse pupillary block with the nasal iris captured behind the IOL. The tilt of the IOL is 12.2°. c After the dislocated IOL is repositioned by a microhook, a straight needle with a 10–0 polypropylene suture is inserted 1.5 mm posterior to the limbus into the space between the iris and the IOL. The IOL was repositioned by a microhook. d The straight needle is docked into a 27-G needle inserted from the opposite side. e The straight needle is inserted 1.5 mm posterior to the limbus into the space between the iris and the IOL. f The rectangularly shaped suture pattern is located at the vertical position of the haptics of the IOL and between the iris and the IOL
Slit-lamp photograph and anterior segment optical coherence tomography (AS-OCT) image of a 64-year-old man with an iris capture. a Slit-lamp photograph showing that the iris is captured by the optic of the intraocular lens (IOL). b AS-OCT image of a horizontal section showing that the nasal iris is dislocated behind the optic of the IOL. c Slit-lamp photograph showing that the iris capture is repaired and the bridging sutures are located behind the iris and above the anterior surface of the IOL. d Horizontal AS-OCT image showing that the iris plane is located above the anterior surface of the IOL
Anterior segment optical coherence tomography (AS-OCT) images of a 64-year-old man before and after the placement of bridging sutures. a Before the bridging sutures, the AS-OCT image shows the nasal iris dislocated behind the IOL. b Immediately after the eye returns from a lateral gaze to the primary position at 0 s, the temporal iris is elevated and the nasal iris captured by the IOL is descended according to the movement of the aqueous. AS-OCT image at 0.2 s (c) and 0.4 s (d) shows that the irises on both sides are flattened. e After the bridging sutures, the AS-OCT image at the baseline shows that the iris capture was repaired on the nasal side. f Immediately after the eye turns from a lateral gaze to the primary position at 0 s, the temporal iris is elevated more and the nasal iris is descended more but not behind the IOL. Thus, the bridging suture has prevented the iris from slipping behind the IOL. The dotted line indicates the location of the bridging sutures. AS-OCT images at 0.2 s (g) and 0.4 s (h) show that the irises on both sides are flattened
Changes in the height of the iris of the anterior segment optical coherence tomography (AS-OCT) images in eyes with nasal or temporal iris captured. The nasal height of the iris decreases more after the bridging suture and returns from a lateral gaze to the primary position at 0 s on both sides of the captured eye
PurposeThe study aims to determine the effectiveness of bridging sutures in preventing iris capture and a subsequent reverse pupillary block after an intrascleral fixation of an implanted intraocular lens (IOL).Methods We studied 6 eyes that had an iris capture with reverse pupillary block due to a dislocated IOL after an intrascleral fixation. After the dislocated IOL was repositioned, 10–0 polypropylene sutures were inserted 1.5 mm posterior to the limbus and directed to run between the iris and the IOL. The sutures were placed orthogonal to the haptics of the IOL. Anterior segment optical coherence tomography (AS-OCT) was used in 4 eyes to evaluate the degree of iridodonesis before and after the bridging sutures. The heights of the temporal and nasal sectors of the middle iris from the iris plane (the line between anterior chamber angles) were compared for each 0.2-s AS-OCT image taken immediately after the eye moved from a lateral to a primary position.ResultsNone of the eyes had a recurrence of the iris capture after the bridging sutures. The refractive error, anterior chamber depth, and vision were not significantly altered after the bridging sutures were placed. The AS-OCT images showed that the height of the nasal iris was decreased more at 0 s postoperatively blocking the excessive downward movement of the nasal iris but not the iridodonesis.Conclusion Bridging sutures were effective in preventing iris capture and subsequent reverse pupillary block after an intrascleral fixation of an IOL.
 
Kaplan–Meier curve of graft rejection (1—graft rejection-free survival) for all eyes
Kaplan–Meier curve of graft failure (1—graft survival) for all eyes
Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. Results The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” ( n = 16) compared to Fuchs’ dystrophy ( n = 74) ( p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) ( n = 10) compared to no surgery/iridectomy ( n = 109) ( p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). Conclusion The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.
 
Plot of median intraocular pressure (IOP) at baseline and follow-up. AADI, Aurolab aqueous drainage implant group; Trab, trabeculectomy group
Kaplan–Meier curves showing cumulative probability of failure in the trabeculectomy and Aurolab aqueous drainage implant (AADI) groups
Kaplan–Meier curves showing cumulative probability of failure in the trabeculectomy, Aurolab aqueous drainage implant (AADI) with prior trabeculectomy and primary AADI groups
Purpose To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. Materials and methods This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision. Results The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31–83%) and 24% in the AADI group (95%CI = 11–48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16–1.40). Conclusion AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.
 
A Nelson’s grade 1 impression cytology specimen (epithelial cells with eosinophilic cytoplasm, nuclear/cytoplasmic ratio 1:3, solitary goblet cells, local impaired cell integrity (H&E, × 100); B Nelson’s grade 3 impression cytology specimen (dense layer of round epithelial cells, nuclear-cytoplasmic ratio 1:2–1:1, local thickening of epithelium) (H&E, × 400)
PurposeTo evaluate anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease in comparison to non-diabetic controls based on conjunctival impression cytology, objective scales (Efron, Oxford) and OSDI, to correlate vision-related quality of life with grades of squamous metaplasia in T2DM patients suffering from DED.Methods All participants underwent complete ophthalmologic examination including Shirmer test, TBUT, conjunctival/corneal staining (Oxford scheme), evaluation of conjunctival redness (Efron grading scale), and conjunctival impression cytology (Nelson’s scale). The OSDI questionnaire was completed by both groups of patients to assess severity of DED and QoL.ResultsSquamous metaplasia was observed in 94% of the study group and 19.3% of controls (p = 0.0000). Based on the OSDI scores, 73.5% of patients reported mild DED and 26.5% suffered from moderate DED in the study group. The mean OSDI score for the study group with Nelson’s grade 2 was 18 ± 3.52 and 20.8 ± 4.68 for Nelson’s grade 3, respectively (p = 0.0745). Hence, no significant difference in QoL between grade 2 and grade 3 of squamous metaplasia was observed in patients of the study group.Conclusion Impression cytology is a reliable minimally invasive tool for an accurate evaluation of the ocular surface damage in patients with DED and type 2 diabetes mellitus. Severe squamous metaplasia (Nelson’s grade 3) was observed in 29.4% (10/34) of T2DM patients. In contrast, it was not detected in the control group (p = 0.0032). The absence of goblet cells in T2DM patients nether significantly reduces QoL nor contributes to the subjective DED severity (OSDI) due to complex pathways leading to DED. Thus, diagnosis of DED severity should not be solely based on subjective symptoms in this population.
 
Images of the right eye of one representative patient. Preoperative AS-OCT image and slit-lamp image show closed angle and shallow anterior chamber. A, B Postoperative slit-lamp image shows deepened anterior chamber. C Postoperative gonioscopic image shows complete removal of TM (red arrow) and topical synechia (blue arrow) in the nasal treated angle. D Postoperative AS-OCT image shows a cleft and tubular synechia (yellow arrow) in the nasal angle after cataract surgery with goniotomy E, F
Progression of IOP and medications at each time-point over follow-up
The Kaplan–Meier survival curves for qualified success
Identified risk factors for surgical failure. Being a male, and short AL was risk factors for surgical failure. While combined circumferential GSL was identified as protective factor for failure. GSL: combined goniosynechialysis; AL: axial length; Baseline medications: number of antiglaucoma medications used preoperatively; VF: visual field; Post day1 IOP: intraocular pressure in day 1 postoperatively
PurposeTo evaluate the therapeutic success, and risk factors for combined phacoemulsification and Kahook Dual Blade excisional goniotomy (Phaco/KDB) in primary angle-closure glaucoma (PACG).MethodsA retrospective review was conducted on glaucoma patients who underwent Phaco/KDB between September 2019 and August 2021 at 2 ophthalmology centers. Complete success was defined as unmedicated intraocular pressure (IOP) ≤ 18 mmHg with no further glaucoma surgery, while the medicated IOP ≤ 18 mmHg was defined as qualified success with lesser medications than at baseline.ResultsSeventy-two eyes (64 patients) with a mean age of 67.1 ± 8.1 years were included in this study, and 70.2% were female. The mean medicated baseline IOP decreased from 23.4 ± 8.1 to 16.6 ± 3.9 mmHg at an average of 11.6 ± 3.7 months of follow-up (− 29.1%; P < 0.00). Medications decreased from 2.6 ± 1.3 to 0.4 ± 0.9 (− 82.6%; P < 0.001). Complete success and qualified success were achieved in 65.3% and 79.2% of eyes, respectively. Male gender [hazard ratio (HR): 6.00 (1.57–22.9); P = 0.009] was observed a risk factor for surgical failure, whereas higher axial length (HR:0.37 (0.16–0.86); P = 0.021), and a combined circumferential goniosynechialysis procedure (HR: 0.13 (0.02–0.74); P = 0.022) lowered the risk of surgical failure. Hyphema, postoperative shallowing anterior chamber, and IOP spike were the most common complications. The cumulative survival proportion for qualified success at 12 months was 82.5% ± 0.05 (95% CI, 0.70–0.90).Conclusion Phaco/KDB provided acceptable therapeutic success rate and may, therefore, be recommended in patients with coexisting cataract and PACG. Identifying patients with risk factors preoperatively may help clinicians predict surgical success.
 
The changes in systolic blood pressure compared with the preoperative values. There was a significant difference between the control and standardized groups upon entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < .0001, respectively)
The changes in diastolic blood pressure compared with the preoperative values. There was no significant difference in the changes in diastolic blood pressure between the control and standardized groups during cataract surgery
The changes in pulse pressure compared with the preoperative values. There was a significant difference between the control and standardized groups at the beginning of the operation and at the end of the operation (P = 0.001 and 0.001, respectively)
PurposeAlthough perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia.Methods Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation.ResultsAlthough there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use.Conclusion Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.
 
A, B Preoperative CT images revealed a well‑defined homogeneous mass (arrow) that was located in the left extraconal and above the orbital temporal. C Axial CT image 6 months after surgery showed that the tumour was totally removed
Orbital MRIs were shown with T1 image (A), fat-suppressed, axial T2 image (B), post-contrast T1 image (C), sagittal image (D), and coronal image (E). A well-circumscribed lesion in the orbito-cranial communicating region shows homogeneous contrast enhancement with marked homogeneous enhancement. The mass destroyed the outer orbital wall and invaded the intracranial with obvious enhancement. A dumbbell-shaped neoplasm can be seen in sagittal T1
The results of histological and immunohistochemical examination. A The immunohistochemical examination showed that the SFT were composed of irregularly arranged spindle cells (× 200). B A “staghorn” vessel was seen (× 400). C, D, E, and F The positive stain of CD34, CD99, BCL-2, and STAT-6, respectively, (× 400)
Kaplan–Meier plot for the recurrence risk by age (P = 0.898), sex (P = 0.082), size (P = 0.394), site-1 (P = 0.098), site-2 (P = 0.036), and ki67(P = 0.033). OCCR: orbito-cranial communicating region
BackgroundSFTs are thought to have an unpredictable clinical course and currently have no recognized prognostic criterion. Our study aimed to determine the relationship between clinicopathological characteristics and the prognosis of patients with orbital SFTs.Methods The clinicopathological features of these patients were extracted from clinical records. The relationships between these features and prognosis were analysed.ResultsThe positive rates of CD34, CD99, Blc2, and STAT6 expression were 90.3%, 90.3%, 83.9%, and 100%, respectively. The tumour recurrence rate was 38.7%. A higher recurrence rate was observed in patients with Ki67 index ≥ 5 (56.25% vs. 20%, P = 0.038).ConclusionA Ki67 index ≥ 5 was an effective parameter for predicting tumour recurrence of orbital SFTs. Close follow-up is needed for these patients.
 
Flowchart showing enrollment and analysis. Abbreviations: alloHCT, allogeneic hematopoietic stem cell transplantation; GVHD, graft-versus-host disease
Radar graph representing the mean scores for the various dimensions of QOL. Vision-specific QOL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and cancer-specific QOL was measured by European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire (EORTC QLQ-C30). Solid line represents oGVHD group, and dotted line represents non-oGVHD group. *P < 0.05 statistically significant. Note that all the dimensions were decreased in oGVHD group. Abbreviations: QOL, quality of life; oGVHD, ocular graft-versus-host disease
Purpose To compare the vision-specific and cancer-specific quality of life (QOL) between patients with and without ocular graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT).Methods This cross-sectional observational study analyzed 142 patients after alloHCT including 94 patients with oGVHD and 48 without. oGVHD was diagnosed according to International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. QOL was assessed by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30).ResultsCompared with non-oGVHD patients, patients with oGVHD had worse vision-specific (NEI VFQ-25: 64.3 ± 20.3 vs. 77.6 ± 19.3, P < 0.001) and cancer-specific (EORTC QLQ-C30: 59.9 ± 20.3 vs. 67.4 ± 17.5, P = 0.03) QOL, as well as impaired cognitive function (72.7 ± 22.1 vs. 82.3 ± 19.0, P = 0.01). The vision-specific QOL was significantly correlated with ICOGCG score (β = − 1.88, 95%CI: − 3.35 to − 0.41, P = 0.01) and post-alloHCT medical expense (β = − 5.70, 95%CI: − 10.35 to − 1.05, P = 0.02), while cancer-specific QOL was strikingly correlated with post-alloHCT medical expense (β = − 9.91, 95%CI: − 14.43 to − 5.39, P < 0.001), frequency of ophthalmic medication (β = − 0.93, 95%CI: − 1.64 to − 0.21, P = 0.01), education (β = − 6.97, 95%CI: − 13.31 to − 0.62, P = 0.03), and peripheral blood stem cell use (β = − 6.42, 95%CI: − 12.59 to − 0.25, P = 0.04).Conclusions Patients with oGVHD experienced significant impairment in both vision-specific and cancer-specific QOL including cognitive function when compared with those without after alloHCT. Multidimensional QOL assessment should be included in the long-term alloHCT survivorship care.
 
Vision changes at the time of each follow-up visit after standalone or combined Ahmed valve surgery
PurposeTo determine factors associated with vision loss 1 year after Ahmed glaucoma valve (AGV) surgery in Black or Hispanic patients, who bear disproportionate glaucoma burdens yet have been underrepresented in pivotal trials.Methods This retrospective study included Black or Hispanic patients who received AGVs standalone or combined with phacoemulsification and/or cyclodestructive lasers. Univariate and multivariate generalized estimating equations evaluated the effects of baseline, surgical, and postoperative factors on vision loss of two Snellen lines or more at the 1-year follow-up visit. The primary term was the hypertensive phase (HP), which signified an intraocular pressure (IOP) reading > 21 mmHg within the first 3 postoperative months after reduction below 22 in the first week, without other tube malfunction.ResultsOf 241 eyes from 186 patients, vision loss of ≥ 2 lines at the 1-year follow-up visit occurred in 21.6% (N = 52). Vision loss of ≥ 2 lines occurred in 52.5% of eyes at week 1, 36.9% of eyes at month 1, and 27.0% of eyes at month 3. Between 6 months and 1 year, vision loss frequencies stabilized. In the multivariate model, HP (OR = 4.71 (2.14, 10.38)), total quadrants with split fixation (1.47 (1.20, 1.81)), follow-up non-glaucomatous eye pathology (2.89 (1.44, 5.80)), and concurrent cataract surgery (0.42 (0.22, 0.82)) each met significance (p < 0.05).Conclusion Post-AGV vision loss in the early follow-up period among Black or Hispanic patients was often transient. Hypertensive phase and split fixation each increased the odds of vision loss at 1 year, while concurrent cataract surgery decreased the odds.
 
PurposeTo develop a selective micropulse individual retinal therapy (SMIRT) based on the age and appearance type of the patient, to derive a formula for calculating power, and evaluate clinical efficacy for the treatment of central serous chorioretinopathy (CSCR).Methods73 patients (aged 30–65 years) with acute CSCR and types 1–4 on the Fitzpatrick scale were divided into 2 groups. In the first group (33 patients), the testing of the micropulse mode (50 µs, 2.4%, 10 ms, 100 µm, 0.4–1.9 W) on the Navilas 577 s laser system defined as selective by computer modeling was performed. A logistic regression function based on probability damage detection (PDD) of the 1584 laser spots from power, age, and type on the Fitzpatrick scale was constructed. PDD is the probability of detecting the laser spots using the autofluorescence method. The second group was divided into 4 subgroups of 10 eyes each. Groups 2.1, 2.2, and 2.3 were treated without preliminary testing. The power for Groups 2.1, 2.2, and 2.3 was obtained with the inverse PDD function, so that PDD was 50%, 70%, and 90%, respectively. Control group 2.4 went without treatment.ResultsThe transmission and absorption coefficients of laser radiation of the eye depend on the age and the Fitzpatrick scale type. In Groups 2.1–2.3, complete resorption of subretinal fluid was observed 3 months after CSCR treatment in 5 (P < 0.35), 8 (P < 0.023), and 10 eyes (P < 0.0008) out of 10, respectively.Conclusion The developed SMIRT is effective for CSCR treatment with PDD 90%.
 
Causes of anterior, intermediate, posterior, and panuveitis
Distribution causes of uveitis by age
Different causes of various types of uveitis reported from different parts of the world
Purpose To describe the distribution patterns and clinical characteristics of patients diagnosed with uveitis at a specialized uveitis center in Bogotá, Colombia, from 2013 to 2021 and compare these patterns with the previously reported between 1996 and 2006. Methods We performed an observational descriptive cross-sectional study systematically reviewing clinical records of patients attending between 2013 and 2021. Data were analyzed and compared with previous reports. Results Of the 489 patients with uveitis, 310 were females (63.4%). The mean age of onset was 38.7, with a range between 1 and 83 years. Bilateral (52.8%), anterior (45.8%), non-granulomatous (90.8%), and recurrent (47.6%) were the most common types of uveitis found in our population sample. The most common cause of uveitis in this study was idiopathic, followed by toxoplasmosis and HLA-B27 + associated uveitis, which differs from the previous Colombian study where ocular toxoplasmosis was the most frequent cause. This highlights a significant shift from infectious etiologies to more immune-mediated processes as the cause of uveitis in Colombia nowadays. Conclusion The results of this study provide a comparison between the clinical patterns of presentation of uveitis from 1996 to 2006 and the patterns observed from 2013 to 2021, enhancing awareness about the changing dynamics of uveitis in Colombia to guide a better understanding of the diagnosis, classification, and correlation with other systemic conditions of the disease.
 
Mean intraocular pressure at the 12-month timepoint in patients treated with one (N = 25), two (N = 38), three (N = 15) and four (N = 7) hypotensive topical treatments. The upper and the lower whiskers indicate the 95% confidence interval. The points indicate the mean postoperative intraocular pressure (IOP) value
Kaplan–Meier curve showing the estimated probability of maintaining overall success at 1 year following XEN45 gel stent implantation defined as the sum of complete success and qualified success. Complete success was defined as intraocular pressure (IOP) < 18 mmHg plus IOP reduction > 20% from medicated baseline without topical IOP-lowering therapy 1-year after surgery
Kaplan–Meier curve showing the estimated probability of maintaining complete success at 1 year following XEN45 gel stent implantation defined as intraocular pressure (IOP) < 18 mmHg plus IOP reduction > 20% from medicated baseline without topical IOP-lowering therapy 1-year after surgery
Preoperative medicated intraocular pressure (IOP) levels compared with postoperative IOP at 1 year of follow-up
Postoperative intraocular pressure at 1 year of follow-up compared with time since glaucoma diagnosis
Purpose The aim of this study was to determine the preoperative characteristics influencing hypotensive efficacy of the XEN45 gel stent in patients with open-angle glaucoma at one-year follow-up. Materials and methods This was a retrospective multicentre study. All patients who underwent XEN45 gel stent implantation between January 2017 and January 2021 were included. The main study outcome was the assessment of one-year postoperative intraocular pressure (IOP) and glaucoma medication differences according to the number and type of preoperative topical treatments or glaucoma surgery, glaucoma stage and time since diagnosis. Follow-up period was 1-year post-surgery in all cases. IOP reduction and surgery success (not requiring reoperation or pressure failures [IOP > 18 mmHg and < 20% reduction in IOP]), safety and cost savings in topical glaucoma therapy after surgery were secondarily assessed. Linear regression analysis to determine the preoperative parameters influence on 1-year postoperative results was performed. Results XEN45 gel stent was implanted in 85 patients. One-year postoperative mean IOP dropped from 20.6 ± 4.1 to 13.7 ± 2.8 mmHg (p < 0.0001). Likewise, mean number of topical treatments decreased from 2.05 ± 0.9 to 0.36 ± 0.65 (p < 0.001). Both were mainly influenced by the number of preoperative glaucoma treatments, such that for each one-glaucoma medication increase, postoperative intraocular pressure increased by 1.18 mmHg (95% CI 0.56–1.79, p < 0.0001) and number of glaucoma medications increased by 0.3 (95% CI 0.16–0.43, p < 0.001). Overall success rates (with and without supplemental glaucoma medication use) were 97.6% (95% CI 94.5–100%), 87.1% (95% CI 80.2–87.1%) and 61.2% (95% CI 51.6–72.5%) at 3, 6 months and 1 year after surgery. No sight-threatening adverse events were reported. Mean annual cost savings on medical treatment since surgery reached EUR 251.19 ± 169. 93 euros. Conclusions One year after surgery, XEN45 gel implant significantly reduced IOP and number of topical medications with an adequate safety profile being both mainly influenced by the number of preoperative glaucoma treatments.
 
Outer wall holes demonstrated by SD-OCT. a Peripheral fundus photograph demonstrating two large outer retinal breaks (arrowheads) in a temporal retinoschisis cavity of a 55-year-old asymptomatic woman, with b and c SD-OCT clearly delineating the edges of the break (arrows) attached firmly to the retinal pigment epithelium (RPE). These are in contrast to d and e SD-OCT images of the eye of a 70-year-old asymptomatic woman demonstrating the edges of an outer wall break (arrows) in which the retina is elevated off the RPE in a different eye with an inferotemporal schisis detachment
Inner wall breaks were detected with SD-OCT in 4 (2.1%) of 195 eyes with peripheral retinoschisis as in this eye of a 9-year-old boy with bilateral involvement of juvenile X-linked retinoschisis and no associated retinal detachment
Splitting of multiple layers occurred in 26.8% (15 of 56 eyes) as seen in this SD-OCT of a 52-year-old asymptomatic woman with bilateral temporal retinoschisis. It occurred most commonly at the posterior border of the peripheral retinoschisis
PurposeTo characterize retinoschisis in a large series using spectral domain optical coherence tomography (SD-OCT), including rates of schisis detachment and macular involvement in cases of peripheral retinoschisis.Methods In this retrospective, cross-sectional, descriptive study, consecutive patients with diagnosis of retinoschisis in at least one eye were identified using billing codes between January 2012 and May 2021. Charts were reviewed to verify diagnosis of retinoschisis or schisis detachment. SD-OCT and clinical examination was used to identify frequency of macular schisis, peripheral schisis, and schisis detachment, and characteristics of retinoschisis including frequency of inner and outer wall breaks, distribution of layers split, and location of involvement of peripheral pathology. SD-OCT images of insufficient quality were excluded from the pertinent analysis.Results281 eyes of 191 patients were included. 195 (69.4%) eyes had peripheral retinoschisis, 15 (5.3%) had schisis detachment, 66 (23.5%) had macular retinoschisis alone, and 5 (1.8%) had combined macular and peripheral retinoschisis. Of the eyes without macular retinoschisis, 7.0% had schisis detachment. Of the remainder, 4 (2.1%) had inner wall breaks, and 24 (12.3%) had outer wall breaks. In eyes with peripheral retinoschisis, splitting occurred in the outer plexiform layer in 58.9%, the retinal nerve fiber layer in 8.9%, a combination of layers in 26.8%, and indeterminate in 5.4%. Location of peripheral involvement was inferotemporal in 58.5%, superotemporal in 14.1%, temporal in 13.7%, and inferior in 12.2%.ConclusionSD-OCT helped to identify the presence of schisis detachment and breaks, confirmed diagnosis in challenging cases, and demonstrated the layer of splitting within the neurosensory retina. This series represents the largest such study to date.
 
A Superficial capillary plexus vascular density (%) centered 1 mm diameter ring considered as central area and the 3 mm diameter ring surrounding this ring as the parafoveal area. B Deep capillary plexus vascular density (%) centered 1 mm diameter ring considered as central area and the 3 mm diameter ring surrounding this ring as the parafoveal area
PurposeWe aimed to examine the possible effects of the postmenopausal period on retinal and choroidal microvascular circulation using swept-source optical coherence tomography angiography (SS-OCTA).Methods This cross-sectional study included 45 eyes of 45 subjects in menstrual group and 40 eyes of 40 subjects in postmenopausal group. SS-OCTA was used for the assessment of vessel density (VD), foveal avascular zone (FAZ), choroidal thickness (CT), choriocapillaris VD, central macular thickness (CMT), nerve fiber layer thickness (RNFL), and ganglion cell layer (GCL) measurements.ResultThe VDs of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) measurements were similar in both group. FAZ area was wider in postmenopausal group (0.305 mm2 (range, 0.212–0.498 mm2)) compared to menstrual group (0.271 mm2 (range, 0.131–0.464 mm2)) (p = 0.013). Choriocapillaris VD was significantly lower in postmenopausal group (p = 0.049). CT was thicker in the postmenopausal group, but with no statistically significant difference (p = 0.066). Central macular thickness, RNFL, and GCL were similar in both groups.Conclusion This is the first study in the literature to evaluate the retinochoroidal microcirculation in the menstrual and postmenopausal periods with SS-OCTA. We observed an increase in both superficial and deep FAZ area and a decrease in choroidal blood flow in the postmenopausal period. We think that this enlargement in the FAZ area may be related to the decreased amount of estrogen.
 
Introduction The objective of this prospective study was to evaluate the effects of intraocular macular lens implantation and visual rehabilitation on the quality of life of patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Methods Patients with bilaterally decreased near vision (not better than 0.3 logMAR with the best correction), pseudophakia, were included in the project. The Scharioth macula lens (SML) was implanted into the patients’ better-seeing eye. Intensive visual rehabilitation of the ability to perform nearby activities was performed for 20 consecutive postoperative days. All subjects were examined before and after SML implantation ophthalmologically. The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was administered before and 6 months after surgery. Results Twenty eligible patients with mean age 81 years (63 to 92 years) were included in the project: 7 males and 13 females. Nineteen of them completed the 6-month follow-up. Near uncorrected visual acuity was 1.321 ± 0.208 logMAR before SML implantation and improved to 0.547 ± 0.210 logMAR after 6 months ( dz = − 2.846, p < 0.001, BF 10 = 3.29E + 07). In the composite score of the NEI VFQ-25, there was an improvement in the general score and the specific domains related to the implantation. Participants reported fewer difficulties in performing near activities ( dz = 0.91, p = 0.001, BF 10 = 39.718) and upturns in mental health symptoms related to vision ( dz = 0.62, p = .014, BF 10 = 3.937). Conclusion SML implantation, followed by appropriate rehabilitation, improved near vision and increased the quality of life of visually handicapped patients with AMD in our project.
 
Development of intraocular pressure (IOP). An asterisk marks a statistically significant change
Development of endothelial cell density (ECD). An asterisk marks a statistically significant change
Yellow CyPass stent material with fibrous obliteration
Fibrous obliteration of the yellow CyPass material through fenestration into the lumen (black arrow)
Fibrous obliteration of the yellow CyPass material accompanied by giant cell macrophages (indicated by black ellipses)
PurposeTo retrospectively assess the histopathological particularities of explanted CyPass® Micro-Stent of patients with significant loss of endothelial cell density.Methods This is a case series of fourteen eyes from eleven patients who underwent CyPass® Micro-Stent implantation due to mild to moderate glaucoma and who subsequently suffered from loss of endothelial cell density. Therefore, the explantation of the device was necessary. In addition to the retrospective evaluation of the intraocular pressure and the endothelial cell density at the time of implantation and explantation, every surgically removed implant was histologically examined and evaluated.ResultsFourteen eyes of eleven patients were in total analysed. The patients—seven males and four females—had a mean age of 62.9 years. The average time between CyPass implantation and explantation was 3.7 years. Eight patients suffered from primary-open-angle glaucoma (POAG), while two patients had a pseudoexfoliation glaucoma (PXG) and one patient had low-pressure glaucoma. Ten of the patients were already pseudophakic before the CyPass implantation and four patients underwent previously glaucoma interventions. There was a significant reduction in the intraocular pressure from 18.57 ± 5.27 mmHg at the time of implantation to 14.78 ± 3.32 mmHg at the time of explantation (p = 0.037). The average endothelial cell density decreased from 1843.67 ± 421.81 to 932.92 ± 412.86/mm2 at the time of explantation (p < 0.01). The histological findings showed a fibrous obliteration of the CyPass accompanied by a chronic granulomatous inflammation with giant cell macrophages. Histologically, these findings were consistent with a foreign body granuloma.Conclusions Implants made of polyimides such as the CyPass® Micro-Stent are considered to be biocompatible, but there is no guarantee not to be obliterated or encapsulated. This is the first case series that has detected a foreign body granuloma in multiple eyes after CyPass implantation. However, there is no connection with the type of glaucoma, the extent of previous operations or with the presence of a prolonged postoperative inflammatory reaction.
 
Flowchart of participant assignment. LRL low-intensity red-light, SFS single-focus spectacles
The distribution of SER (a), AL (b), and SFCT (c) between in the LRL group and in the SFS group for 15 months. SER spherical equivalent refraction, AL axial length, SFCT subfoveal choroidal thickness, LRL low-intensity red-light, SFS single-focus spectacles, D dioptre. The red arrow mean the time-point as LRL cessation. * and ** represent “p value < 0.05” and “p value < 0.001” comparing the data of each follow-up with that of baseline in the LRL group
Change trend of AR (a) and PRA (b) between in the LRL group and in the SFS group for 1 year. AR accommodative response, PRA positive relative accommodation, LRL low-intensity red-light, SFS single-focus spectacles, D dioptre. ** and * represent “p value < 0.001” and “p value < 0.05” comparing the data of each follow-up with that of baseline in the LRL group
Purpose: To investigate the effect of low-intensity red-light (LRL) therapy on myopic control and the response after its cessation. Methods: A prospective clinical trial. One hundred two children aged 6 to 13 with myopia were included in the LRL group (n = 51) and the single-focus spectacles (SFS) group (n = 51). In LRL group, subjects wore SFS and received LRL therapy provided by a laser device that emitted red-light of 635 nm and power of 0.35 ± 0.02 mW. One year after the control trial, LRL therapy was stopped for 3 months. The outcomes mainly included axial length (AL), spherical equivalent refraction (SER), subfoveal choroidal thickness (SFCT), and accommodative function. Results: After 12 months of therapy, 46 children in the LRL group and 40 children in the SFS group completed the trial. AL elongation and myopic progression were 0.01 mm (95%CI: - 0.05 to 0.07 mm) and 0.05 D (95%CI: - 0 .08 to 0.19 D) in the LRL group, which were less than 0.39 mm (95%CI: 0.33 to 0.45 mm) and - 0.64 D (95%CI: - 0.78 to - 0.51 D) in the SFS group (p < 0.05). The change of SFCT in the LRL group was greater than that in the SFS group (p < 0.05). Accommodative response and positive relative accommodation in the LRL group were more negative than those in the SFS group (p < 0.05). Forty-two subjects completed the observation of LRL cessation, AL and SER increased by 0.16 mm (95%CI: 0.11 to 0.22 mm) and - 0.20 D (95%CI: - 0.26 to - 0.14 D) during the cessation (p < 0.05), and SFCT returned to baseline (p > 0.05). Conclusions: LRL is an effective measure for preventing and controlling myopia, and it may also have the ability to improve the accommodative function. There may be a slight myopic rebound after its cessation. The effect of long-term LRL therapy needs to be further explored. Trial registration: Chinese Clinical Trial Registry: Chinese Clinical Trails registry: ChiCTR2100045250. Registered 9 April 2021; retrospectively registered. http://www.chictr.org.cn/showproj.aspx?proj=124250.
 
Distribution of age at surgery in bilateral and unilateral cataract patients
Purpose Evaluation for systemic diagnosis is an important part of pediatric cataract management. While there are reports on associated systemic and ocular associations in children with infantile cataracts, reports specifying associations in large cohorts of children undergoing cataract surgery are lacking. Methods Retrospective chart review of consecutive patients undergoing cataract surgery at a pediatric tertiary referral center during 30-year period was performed. Associated systemic and ocular associations were recorded. The etiologies were analyzed depending on laterality, age, and gender. Results Seven-hundred twenty-seven patients (1135 eyes) were included for analysis: 408 (56%) with bilateral and 319 (44%) with unilateral cataract. An identifiable cause for cataract was identified in 66% (270/408) bilateral and 55% (176/319) unilateral cataract patients. Hereditary cataract accounted for 22% of bilateral cataracts. An underlying syndrome or genetic diagnosis was found in 24% bilateral (97/408, 86 genetic/syndromic, 11 metabolic) but only in 2% of unilateral cases (5/319). Cataracts were the result of treatment for cancer, or other systemic conditions requiring steroids, in 60/408 bilateral (15%) and 15/319 (5%) unilateral cataract patients. In contrast, unilateral cataracts had higher ocular associations (49%, 156/319) than bilateral cataracts (6%, 23/408) primarily ocular trauma (20%, 64/319) and persistent fetal vasculature (20%, 62/319). Conclusion Clinicians should be aware of potential systemic and ocular associations among children with visually significant cataracts. Those with no family history of juvenile cataract should be evaluated for systemic associations, and referral to genetics may be warranted in select cases.
 
Landmarks and methods of the nine linear measurements
Landmarks and methods of the six angular measurements
Periocular morphology changes in young and old people of different genders. Young female (above, left), old female (above, right), young male (below, left), old male (below, left)
Purpose To determine age-and sex-related changes in periocular morphology in Caucasians using a standardized protocol. Methods Healthy Caucasian volunteers aged 18–35 and 60–90 years old were recruited from the Department of Ophthalmology, Faculty of Medicine and University Hospital, Cologne, between October 2018 and May 2020. Volunteers with facial asymmetry, facial deformities, history of facial trauma, facial surgery, botox injection, eyelid ptosis, strabismus, or nystagmus, were excluded. Standardized three-dimensional facial photos of 68 young volunteers and 73 old volunteers were taken in this clinical practice. Position changes of endocanthion, pupil center, and exocanthion were analyzed in different age and gender groups, including palpebral fissure width (PFW): distance between endocanthions (En-En), pupil centers (Pu–Pu), exocanthions (Ex-Ex), endocanthion and nasion (En-Na), pupil center and nasion (Pu-Na), exocanthion and nasion (Ex-Na), endocanthion and pupil center (Pu-En), exocanthion and pupil center (Pu-Ex), and palpebral fissure inclination (PFI); angle of endocanthions to nasion (En-Na-En), pupils to nasion (Pu-Na-Pu), exocanthions to nasion (Ex-Na-Ex); endocanthion inclination (EnI), and exocanthion inclination (ExI). Results PFW, En-En, Ex-Na, Pu-Ex, PFI, ExI, and Ex-Na-Ex were significantly different between the young and old groups ( p ≤ 0.004). There were sex-related differences in PFW, Ex-Ex, En-Na, Pu-Na, Ex-Na, Pu-En, PFI, and EnI between both groups ( p ≤ 0.041). Conclusion The position change of the pupil is minimal relative to age; it is preferred to establish the reference plane to describe periocular changes. The endocanthion tends to move temporally and inferiorly, while the exocanthion tends to shift nasally and inferiorly with age.
 
IOP distribution of 205 eyes after ab interno trabeculotomy using a Kahook Dual Blade. Box plots (25%, median, 75%) show the IOP distribution at each time point. **p < 0.01, ***p < 0.001, Steel’s multiple comparison
IOP distribution in different glaucoma types after ab interno trabeculotomy using a Kahook Dual Blade. Box plots (25%, median, 75%) show the IOP distribution at each time point in POAG, EXG, UG, and SG. *p < 0.05, **p < 0.01, ***p < 0.001, Steel’s multiple comparison
Kaplan–Meier survival curves of POAG (red), EXG (black), UG (blue), and SG (green)
Purpose To verify the surgical results and risk factors for ab interno trabeculotomy using a Kahook Dual Blade (KDB-LOT) in patients with various glaucoma types. Methods This study was a retrospective case series of 205 eyes that underwent KDB-LOT. For Kaplan–Meier survival analysis, criterion A was defined as a ≤ 20% reduction in intraocular pressure (IOP) from baseline. Criteria B, C, and D were IOPs of ≤ 21, 18, and 15 mmHg, respectively. The Cox proportional hazard (CPH) model investigated prognostic factors. Results The mean (SD) IOP decreased from 24.7 (7.98) to 17.6 (4.80) mmHg in all cases, from 21.3 (6.88) to 17.8 (3.52) mmHg in primary open-angle glaucoma (POAG), from 25.4 (7.32) to 17.1 (4.65) mmHg in exfoliation glaucoma, from 30.6 (8.88) to 17.8 (8.29) mmHg in uveitic glaucoma, and from 30.8 (7.29) to 17.3 (0.83) mmHg in steroid-induced glaucoma at 1 year after KDB-LOT. The Kaplan–Meier survival analysis showed that patients with POAG had the best prognosis under criteria B and C, and the 1-year survival rate in patients under criterion D was less than 35% for any disease type. CPH analysis revealed that age and KDB-LOT with phacoemulsification were good prognostic factors. Risk factors for surgical failure were previous cataract surgery, selective laser trabeculoplasty, and postoperative peripheral anterior synechiae. Conclusion KDB-LOT was effective in treating patients with several glaucoma types but showed difficulty in pushing IOP below 15 mmHg. Prognostic factors should be considered when making decisions regarding surgical indications.
 
Top-cited authors
J. Fernando Arevalo
  • Johns Hopkins University
Nicolas Feltgen
  • Universitätsmedizin Göttingen
Antonia M. Joussen
  • Charité Universitätsmedizin Berlin
Lihteh Wu
  • Asociados de Macula Vitreo y Retina de Costa Rica
Francisco J Rodríguez
  • Universidad del Rosario