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Ophthalmology
Published for the American Academy of Ophthalmology by J. B. Lippincott Co
Ophthalmology

Published for the American Academy of Ophthalmology by J. B. Lippincott Co

0161-6420

Ophthalmology/Journal OphthalmologyAHCISCIISTP
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    Trends, Factors, and Outcomes Associated with Immediate Sequential Bilateral Cataract Surgery among Medicare Beneficiaries

    Malwankar, JuiSon, Hyeck-SooChang, David F.Dun, Chen...
    10页
    查看更多>>摘要：Purpose: To report the incidence of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) and to identify factors associated with undergoing ISBCS. Design: Retrospective cohort study. Participants: Medicare beneficiaries aged >= 65 who underwent ISBCS and DSBCS from 2011 through 2019. Methods: Population-based analysis of the 100% Medicare fee-for-service carrier claims data. Logistic regression models were performed to evaluate factors associated with ISBCS. Main Outcome Measures: Incidence of ISBCS and DSBCS; demographic, ocular, and medical characteristics associated with receipt of ISBCS; and rates of endophthalmitis and cystoid macular edema (CME) after ISBCS or DSBCS. Results: A total of 4014 (0.2%) ISBCS and 1 940 965 (99.8%) DSBCS patients were identified. Black (odds ratio [OR], 2.31; 95% confidence interval [CI], 2.06-2.59), Asian (OR, 1.82; 95% CI, 1.51-2.19), and Native American (OR, 2.42; 95% CI, 1.81-3.23) patients were more likely to receive ISBCS than White patients. Patients residing in rural areas showed a higher likelihood of ISBCS (OR, 1.26; 95% CI, 1.17-1.35) than patients in metropolitan areas. Patients undergoing surgery at a hospital, compared with an ambulatory setting (OR, 2.71; 95% CI, 2.53-2.89), were more likely to receive ISBCS. Patients with bilateral complex versus noncomplex cataract (OR, 3.23; 95% CI, 2.95-3.53) were more likely to receive ISBCS. Patients with a Charlson comorbidity index (CCI) of 1 to 2 (OR, 1.45; 95% CI, 1.29-1.62), 3 to 4 (OR, 1.70; 95% CI, 1.47-1.97), 5 to 6 (OR, 1.97; 95% CI, 1.62-2.39), and CCI >= 7 (OR, 1.97; 95% CI, 1.55-2.50) were more likely to receive ISBCS than those with a CCI of 0. In contrast, patients with glaucoma (OR, 0.82; 95% CI, 0.76-0.89), macular degeneration (OR, 0.75; 95% CI, 0.68-0.82), and macular hole or epiretinal membrane (OR, 0.55; 95% CI, 0.48-0.65) were less likely to undergo ISBCS than those without. Cumulatively, no significant difference was found in endophthalmitis rates within 42 days between ISBCS (1.74 per 1000 ISBCS procedures) and DSBCS (1.01 per 1000 DSBCS procedures; P = 0.15). Similarly, there was no significant cumulative difference between CME rates (P = 0.45) in ISBCS (1.79 per 100 ISBCS procedures) and DSBCS (1.96 per 100 DSBCS procedures). Conclusions: Overall use of ISBCS among Medicare beneficiaries remained low over the past decade, although rates of endophthalmitis and CME were comparable to DSBCS. Race, geography, and systemic and ocular comorbidities were associated with receiving ISBCS. ISBCS represents a potential opportunity to improve access to cataract surgery. (C) 2021 by the American Academy of Ophthalmology
      原文链接:
    • NSTL
    • Elsevier

    Focal Serous Retinal Detachment after Intraorbital Arteriovenous Fistulas

    Yu, YueqiShi, BingjieWang, Xinghua
    1页
      原文链接:
    • NSTL

    Factors Threatening Central Visual Function of Patients with Advanced Glaucoma A Prospective Longitudinal Observational Study

    Sugisaki, KenjiInoue, ToshihiroYoshikawa, KeijiKanamori, Akiyasu...
    10页
    查看更多>>摘要：Purpose: To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes. Design: Prospective, observational 5-year study. Participants: Advanced glaucoma patients with well-controlled intraocular pressure (IOP), mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24-2 program <=-20 dB and best-corrected visual acuity (BCVA) of 20/40. Methods: The HFA 10-2 test and BCVA examination were performed every 6 months, and the HFA 24-2 test was performed every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA 10-2 and 24-2 results and BCVA. Main Outcome Measures: Deterioration of HFA 10-2 results was defined by the presence of the same >= 3 points with negative total deviation slope <=-1 dB/year at P < 0.01 on >= 3 consecutive tests, deterioration of HFA 24-2 results by an increase >= 2 in the Advanced Glaucoma Intervention Study score on >= 2 consecutive tests, and deterioration of BCVA by an increase of >= 0.2 logarithm of the minimum angle of resolution (logMAR) on >= 2 consecutive tests. Results: A total of 175 eyes of 175 patients (mean age, 64.1 years; mean baseline 10P, 13.2 mmHg; mean BCVA, 0.02 logMAR; mean HFA 24-2 and 10-2 MD, -25.9 and -22.9 dB, respectively) were included. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 +/- 0.043 (standard error), 0.173 +/- 0.031, and 0.194 +/- 0.033, respectively, at 5 years. Lower BCVA at baseline (P = 0.012) was associated significantly with further deterioration of HFA 10-2 results. Better HFA 24-2 MD (P < 0.001) and use of systemic antihypertensive agents (P = 0.009) were associated significantly with further deterioration of HFA 24-2 results, and a greater beta-pen papillary atrophy area-to-disc area ratio (P < 0.001), use of systemic antihypertensive agents (P = 0.025), and lower BCVA (P = 0.042) were associated significantly with further deterioration of BCVA, respectively. Conclusions: In advanced glaucoma eyes with well-controlled IOP, BCVA, beta-peripapillary atrophy area-to-disc area ratio, and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function. (C) 2021 by the American Academy of Ophthalmology
      原文链接:
    • NSTL
    • Elsevier

    The 12-and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept, and Bevacizumab on Intraocular Pressure A Network Meta-Analysis

    Sarohia, Gurkaran S.Kennedy, KevinCeyhan, TiandraMcKechnie, Tyler...
    11页
    查看更多>>摘要：Topic: To investigate the effect of anti-vascular endothelial growth factor (VEGF) therapy on intraocular pressure (IOP) 12 and 24 months after initiation. Clinical Relevance: It is unclear whether serial anti-VEGF injections result in sustained IOP increases. Methods: Randomized controlled trials (RCTs) comparing anti-VEGF agents with each other or with controls for the treatment of neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema were included. Pairwise meta-analysis and Bayesian network meta-analysis examined the proportion of patients whose IOP (1) increased 5 mmHg or more from baseline on consecutive visits, (2) increased 10 mmHg or more from baseline at any visit, (3) was 21 mmHg or more on consecutive visits, (4) was 25 mmHg or more at any visit, (5) was 30 mmHg or more at any visit, (6) prompted initiation of IOP-lowering medications, or (7) increased as per the clinicians' discretion. Grading of Recommendations Assessments, Development, and Evaluations methodology informed the certainty of evidence. Results: Twenty-six RCTs of 12 522 eyes were included. Aflibercept, bevacizumab, ranibizumab (0.3 mg and 0.5 mg), and noninjection controls were analyzed. Eighty-three of 84 network estimates for comparisons between anti-VEGF agents demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates than bevacizumab of IOP measurements of 30 mmHg or more at 12 months (low certainty of evidence). Fifty-three of 56 network estimates for comparisons between anti-VEGF agents and controls demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of 5 mmHg or more at 24 months (low certainty of evidence) and higher rates of IOP increases as per the clinicians' discretion at 12 and 24 months (low and very low certainty of evidence, respectively). The 95% credible intervals in comparisons without statistically significant effects did not rule out important clinical effects. The certainty of evidence in these comparisons is limited by imprecision. Conclusion: This network meta-analysis does not show any clear difference in !OP increases 12 and 24 months after treatment initiation between anti-VEGF agents and controls. Imprecision precludes definitive conclusions. (C) 2021 by the American Academy of Ophthalmology
      原文链接:
    • NSTL
    • Elsevier

    Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children A Multicenter Randomized Controlled Trial

    Zhu, ZhuotingTan, XingpingKong, XiangbinZhong, Hui...
    11页
    查看更多>>摘要：Purpose: To assess the efficacy and safety of repeated low-level red-light (RLRL) therapy in myopia control in children. Design: Multicenter, randomized, parallel-group, single-blind clinical trial. Participants: Two hundred sixty-four eligible children 8 to 13 years of age with myopia of cycloplegic spherical equivalent refraction (SER) of -1.00 to -5.00 diopters (D), astigmatism of 2.50 D or less, anisometropia of 1.50 D or less, and best-corrected visual acuity (BCVA) of 0.0 logarithm of the minimum angle of resolution or more were enrolled in July and August 2019. Follow-up was completed in September 2020. Methods: Children were assigned randomly to the intervention group (RLRL treatment plus single-vision spectacle [SVS]) and the control group (SVS). The RLRL treatment was provided by a desktop light therapy device that emits red light of 650-nm wavelength at an illuminance level of approximately 1600 lux and a power of 0.29 mW for a 4-mm pupil (class I classification) and was administered at home under supervision of parents for 3 minutes per session, twice daily with a minimum interval of 4 hours, 5 days per week. Main Outcome Measures: The primary outcome and a key secondary outcome were changes in axial length and SER measured at baseline and the 1-, 3-, 6-, and 12-month follow-up visits. Participants who had at least 1 postrandomization follow-up visit were analyzed for treatment efficacy based on a longitudinal mixed model. Results: Among 264 randomized participants, 246 children (93.2%) were included in the analysis (117 in the RLRL group and 129 in the SVS group). Adjusted 12-month axial elongation and SER progression were 0.13 mm (95% confidence interval [CI], 0.09-0.17mm) and -0.20 D (95% CI, -0.29 to -0.11D) for RLRL treatment and 0.38 mm (95% CI, 0.34-0.42 mm) and -0.79 D (95% CI, -0.88 to -0.69 D) for SVS treatment. The differences in axial elongation and SER progression were 0.26 mm (95% CI, 0.20-0.31 mm) and -0.59D (95% CI, -0.72 to -0.46 D) between the RLRL and SVS groups. No severe adverse events (sudden vision loss >= 2 lines or scotoma), functional visual loss indicated by BCVA, or structural damage seen on OCT scans were observed. Conclusions: Repeated low-level red-light therapy is a promising alternative treatment for myopia control in children with good user acceptability and no documented functional or structural damage. (C) 2021 by the American Academy of Ophthalmology.
      原文链接:
    • NSTL
    • Elsevier

    Anti-Tumor Necrosis Factor alpha versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema A Multicenter Study from the French Uveitis Network

    Leclercq, MathildeAndrillon, AnaisMaalouf, GeorginaSeve, Pascal...
    10页
    查看更多>>摘要：Purpose: To analyze the factors associated with response (control of ocular inflammation and corticosteroid-sparing effect) to biologics (anti-tumor necrosis factor [TNF]-alpha agents and tocilizumab) in patients with refractory uveitic macular edema (ME). Design: Multicenter, retrospective, observational study. Participants: Adult patients with uveitic ME refractory to systemic corticosteroids, disease-modifying anti-rheumatic drugs, or both. Methods: Patients received anti-TNF-alpha agents (infliximab 5 mg/kg at week 0, 2, 6, and every 4-6 weeks [n = 69] and adalimumab 40 mg/2 weeks [n = 80]) and tocilizumab (8 mg/kg every 4 weeks intravenously [n = 39] and 162 mg/week subcutaneously [n = 16]). Main Outcome Measures: Analysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least 1 eye of >= 1 logarithm of the minimum angle of resolution), corticosteroid-sparing effect, and adverse events at 6 months. Results: Two hundred four patients (median age, 40 years [interquartile range, 28-58 years]; 42.2% men) were included. Main causes of uveitis included Behcet's disease (17.2%), birdshot chorioretinopathy (11.3%), and sarcoidosis (7.4%). The overall response rate at 6 months was 46.2% (21.8% of complete response) with anti-TNF-alpha agents and 58.5% (35.8% of complete response) with tocilizumab. In multivariate analysis, treatment with tocilizumab (odds ratio, 2.10; 95% confidence interval [CI], 1.06-4.06; P = 0.03) was associated independently with complete response of uveitic ME compared with anti-TNF-alpha agents. Anti-TNF-alpha agents and tocilizumab did not differ significantly in terms of relapse rate (hazard ratio, 1.00; 95% CI, 0.31-3.18; P = 0.99) or occurrence of low vision (odds ratio, 1.02; 95% CI, 0.51-2.07; P = 0.95) or corticosteroid-sparing effect (P = 0.29). Adverse events were reported in 20.6% of patients, including serious adverse events reported in 10.8% of patients. Conclusions: Tocilizumab seems to improve complete response of uveitic ME compared with anti-TNF-alpha agents. (C) 2021 by the American Academy of Ophthalmology
      原文链接:
    • NSTL
    • Elsevier

    Posterior Scleral Cyst in a Pediatric Patient

    Hoyek, SandraAronow, Mary ElizabethPatel, Nimesh A.
    1页
      原文链接:
    • NSTL

    Topical Chlorhexidine 0.2% versus Topical Natamycin 5% for the Treatment of Fungal Keratitis in Nepal A Randomized Controlled Noninferiority Trial

    Hoffman, Jeremy J.Yadav, ReenaSanyam, Sandip D.Chaudhary, Pankaj...
    12页
    查看更多>>摘要：Purpose: To investigate if topical chlorhexidine 0.2%, which is low cost and easy to formulate, is noninferior to topical natamycin 5% for the treatment of filamentous fungal keratitis. Design: Randomized controlled, single-masked, noninferiority clinical trial. Participants: Adults attending a tertiary-level ophthalmic hospital in Nepal with filamentous fungal infection confirmed on smear or confocal microscopy. Methods: Participants were randomly allocated to receive topical chlorhexidine 0.2% or topical natamycin 5%. Primary analysis (intention-to-treat) was by linear regression, using baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) and treatment arm as prespecified covariates. Mixed fungal-bacterial infections were excluded from the primary analysis but included in secondary analyses and secondary safety-related outcomes. The noninferiority margin was 0.15 logMAR. This trial was registered with ISRCTN, number ISRCTN14332621. Main Outcome Measures: The primary outcome measure was BSCVA at 3 months. Secondary outcome measures included perforation or therapeutic penetrating keratoplasty by 90 days. Results: Between June 3, 2019, and November 9, 2020, 354 eligible participants were enrolled and randomly assigned: 178 to chlorhexidine and 176 to natamycin. Primary outcome data were available for 153 and 151 of the chlorhexidine and natamycin groups, respectively. Of these, mixed bacterial-fungal infections were found in 20 cases (12/153 chlorhexidine, 8/151 natamycin) and excluded from the primary analysis. Therefore, 284 patients were assessed for the primary outcome (141 chlorhexidine, 143 natamycin). We did not find evidence to suggest chlorhexidine was noninferior to natamycin and in fact found strong evidence to suggest that natamycin-treated participants had significantly better 3-month BSCVA than chlorhexidine-treated participants, after adjusting for baseline BSCVA (regression coefficient, -0.30; 95% confidence interval [CI], -0.42 to -0.18; P < 0.001). There were more perforations and emergency corneal grafts in the chlorhexidine arm (24/175, 13.7%) than in the natamycin arm (10/173, 5.8%; P = 0.018, mixed infections included), whereas natamycin-treated cases were less likely to perforate or require an emergency corneal graft, after adjusting for baseline ulcer depth (odds ratio, 0.34; 95% CI, 0.15-0.79; P = 0.013). Conclusions: Treatment with natamycin is associated with significantly better visual acuity, with fewer adverse events, compared with treatment with chlorhexidine. Natamycin remains the preferred first-line monotherapy treatment for filamentous fungal keratitis. (C) 2021 by the American Academy of Ophthalmology.
      原文链接:
    • NSTL
    • Elsevier

    X-Linked Retinoschisis Deep Phenotyping and Genetic Characterization

    Georgiou, MichalisFinocchio, LuciaFujinami, KaoruFujinami-Yokokawa, Yu...
    10页
    查看更多>>摘要：Purpose: To examine the genetic and clinical features in children and adults with X-linked retinoschisis (XLRS). Design: Single-center consecutive, retrospective, observational study. Participants: Adults and children with molecularly confirmed XLRS followed up between 1999 and 2020. Methods: Analysis of genetic, clinical, and retinal imaging findings, including OCT and fundus autofluorescence (FAF), cross-sectionally and longitudinally, was performed. Main Outcomes Measures: RS1, variants, type of variants and phenotype correlations, age of onset, complications rates and types, fundoscopy findings, OCT metrics, FAF patterns, correlations including between best corrected visual acuity (BCVA) and age, and OCT characteristics. Results: One hundred thirty-two male patients were identified harboring 66 retinoschisin 1 variants, with 7 being novel. The mean age at onset was 16.5 years (range, 0-58 years). Seventy-one patients (71/75 [94.7%]) were symptomatic at presentation; all had decreased best-corrected visual acuity (BCVA). Funduscopy findings were symmetric in 104 patients (104/108 [96.3%]), with the most common finding being macular schisis (82.4%), whereas peripheral retinoschisis was present in 38.9% and macular atrophy was present in 11.1 %. Twenty patients (18.5%) demonstrated complications (vitreous hemorrhage, retinal detachment, or both). Mean BCVA was 0.65 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/89) in the right eye and 0.64 logMAR (Snellen equivalent, 20/87) in the left eye. Mean BCVA change over a mean interval of 6.7 years was 0.04 and 0.01 log MAR for right and left eyes, respectively. A normal FAF pattern was identified in 16 of 106 eyes (15.1 %); 45 eyes (42.5%) showed a spoke-wheel pattern, 13 eyes (12.3%) showed foveal hyperautofluorescence, and 18 eyes (17.0%) showed a central reduction in signal. In total, 14 patients demonstrated evidence of progression on FAF overtime. On OCT, foveoschisis was observed in 172 eyes (172/215 [80%]), parafoveal schisis was observed in 171 eyes (171/215 [79.5%]), and foveal atrophy was observed in 44 eyes (44/215 [20.5%]). Cystoid changes were localized to the inner nuclear layer (172/181 eyes [95%]), the outer nuclear layer (97/181 [53.6%]), and the ganglion cell layer (92/181 [50.8%]). Null variants were associated with worse final BCVA and aforementioned complications. Conclusions: X-linked retinoschisis is highly phenotypically variable, but with relative foveal and BCVA preservation until late adulthood, allowing more accurate prognostication. The slowly (often minimally) progressive disease course may pose a challenge in identification of early end points for therapeutic trials aimed at altering the kinetics of degeneration. (C) 2021 by the American Academy of Ophthalmology.
      原文链接:
    • NSTL
    • Elsevier

    Opacification in a Preloaded Intraocular Lens

    Leshno, AriSchwalb, Emmanuel
    1页
      原文链接:
    • NSTL