Ophthalmology and Therapy最新文献

{"title":"Third-Generation Trabecular Micro-Bypass Implantation with Phacoemulsification for Glaucoma.","authors":"Zachary Vest, Nadia Alinaghizadeh, Connor Prendergast","doi":"10.1007/s40123-024-01087-7","DOIUrl":"10.1007/s40123-024-01087-7","url":null,"abstract":"<p><strong>Introduction: </strong>This retrospective, consecutive, real-world case series assessed the efficacy and safety of third-generation trabecular micro-bypass stent implantation (iStent infinite) with phacoemulsification in patients with mild-to-moderate primary open-angle glaucoma (POAG).</p><p><strong>Methods: </strong>Patients underwent phacoemulsification combined with implantation of iStent infinite (containing three stents) by a single U.S. glaucoma surgeon. Outcomes through 12 months included mean intraocular pressure (IOP) and medications; proportions of eyes with IOP ≤ 18 mmHg, ≤ 15 mmHg, or ≤ 12 mmHg; proportions of eyes on 0, 1, 2, or ≥ 3 topical glaucoma medications; adverse events; and secondary glaucoma procedures. Data are presented for the observed cohort of all available eyes at each time point and the consistent cohort of eyes with data at 12 months postoperative.</p><p><strong>Results: </strong>A total of 121 eyes with mild (66.1%) or moderate (33.9%) POAG underwent iStent infinite implantation between February 2023 and June 2024. In eyes with 12-month follow-up data (n = 32), mean IOP reduced from 18.1 ± 3.3 mmHg preoperatively to 13.8 ± 3.4 mmHg at 12 months (23.8% reduction, p < 0.001), while mean number of medications reduced from 1.38 ± 0.91 to 1.06 ± 1.13 medications (23.2% reduction, p = 0.023). The proportions of eyes achieving IOP ≤ 18/15/12 mmHg increased from 53.1%/21.9%/3.1% preoperatively to 87.5%/75.0%/43.8% at 12 months, respectively (all p < 0.01). Adverse events were largely mild and transient; three eyes (< 3%) had secondary laser or micro-invasive glaucoma interventions due to IOP and/or medications above goal.</p><p><strong>Conclusions: </strong>iStent infinite implantation with cataract surgery resulted in clinically and statistically significant IOP and medication reductions through 12 months postoperative, with favorable safety. This cohort constitutes one of the first and largest published datasets for this device in combination with cataract surgery in real-world usage.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"529-539"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Parameters and Prognostic Factors in Persistent Fetal Vasculature: Insights from a Retrospective Cohort Study.","authors":"Fatima AlGhazal, Valmore A Semidey, Marcos J Rubio-Caso, Sulaiman M AlSulaiman, Gorka Sesma","doi":"10.1007/s40123-024-01088-6","DOIUrl":"10.1007/s40123-024-01088-6","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent fetal vasculature (PFV) is a congenital anomaly associated with significant surgical challenges, including a high risk of postoperative retinal detachment (RD). This study aimed to evaluate the impact of surgical approach and axial length (AL) on RD risk and visual outcomes in pediatric PFV management.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 76 eyes of 74 patients who underwent cataract surgery for PFV between 2014 and 2022. Patients were categorized by RD status postoperatively (14 with RD, 62 without RD). Key predictors, including surgical approach (corneal vs. pars plicata), AL, and age at surgery, were analyzed. The primary outcomes were RD incidence and final best-corrected visual acuity (BCVA).</p><p><strong>Results: </strong>Compared to the pars plicata approach, the corneal approach was associated with a significantly lower risk of RD, as indicated by a multivariate odds ratio of 0.08 (95% CI 0.01-0.6, P = 0.011). A shorter AL increased the risk of RD (median 17 vs. 20 mm, P = 0.002). The RD group showed poorer visual outcomes (P < 0.001), with a 71% loss of light perception. Surgery before 3 months improved outcomes, regardless of RD. Visible ciliary processes were strongly correlated with RD (P < 0.001).</p><p><strong>Conclusions: </strong>Corneal surgical approach and longer AL are associated with a lower RD risk in PFV cataract surgery. Early intervention and thorough preoperative assessment of the AL and ciliary processes are crucial for optimal outcomes.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"515-528"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Treat or Not to Treat? Resolving the Question of Subretinal and Intraretinal Fluid in Age-Related Macular Degeneration: A Narrative Review.","authors":"Alexander J E Foss, David Almeida, Chui Ming Gemmy Cheung, Yuichiro Ogura, Eduard de Cock, Theo Empeslidis","doi":"10.1007/s40123-025-01093-3","DOIUrl":"10.1007/s40123-025-01093-3","url":null,"abstract":"<p><p>Neovascular age-related macular degeneration (nAMD) is associated with considerable quality of life and economic burden. nAMD is characterized by pathological neovascularization, leading to the accumulation of retinal fluid. Intraretinal fluid (IRF) is a major contributor to vision loss and may predict response to treatment. In contrast, the role of subretinal fluid (SRF) is less clear. Nevertheless, complete resolution of retinal fluid accumulation is often stated to be a key goal of therapy for nAMD, even though some eyes may never achieve a fluid-free macula despite regular anti-vascular endothelial growth factor treatment. In this article, we review the current literature regarding the role of retinal fluid in nAMD disease outcomes and assess whether and when it may be beneficial to leave retinal fluid untreated. In this context, we highlight the importance of correctly identifying retinal fluid types in nAMD and avoiding confusion with other optical coherence tomography signs that may respond differently to therapy, such as subretinal pseudocysts. Current evidence shows that IRF is associated with poor outcomes and an increased risk of developing atrophy and fibrosis; resolution of this retinal fluid type should remain a treatment target. However, the literature around SRF indicates that low levels of this fluid type, potentially up to 150-200 µm in thickness, may be tolerated with minimal impact on vision, and that SRF could be protective against the development and progression of macular atrophy and fibrosis. Although mild SRF may be protective in nAMD, cause and effect between SRF and reduced or slowed atrophy has not yet been proven and requires further research. Treatment should be given for the most aggressive component; when both IRF and SRF are present, treatment should be given for IRF.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"489-514"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Retinal Oxygen Saturation 1 Month After Femtosecond LASIK Treatment in Chinese Adults with Myopia.","authors":"Xiaoqi Ma, Shanshan Ge, Xinwei Yang, Yuehua Zhou","doi":"10.1007/s40123-024-01091-x","DOIUrl":"10.1007/s40123-024-01091-x","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare changes in retinal oxygen saturation 1 month after femtosecond-assisted laser in situ keratomileusis (FS-LASIK) in Chinese adults with myopia using retinal oximetry.</p><p><strong>Methods: </strong>In this prospective, observational, single-center cohort study, Chinese adults aged 18-45 years with myopia were categorized into four groups according to spherical equivalent (SE), with 66 eyes characterized as low myopia (LM -3.00D < SE ≤ -0.50D), 68 eyes as moderate myopia (MM -6.00D < SE ≤ -3.00D), 68 eyes as high myopia (HM -9.00D < SE ≤ -6.00D), and 65 eyes as super-high myopia (SHM: SE ≤ -9.00D). The following were measured before and 1 month after FS-LASIK: SE, intraocular pressure (IOP), average keratometry (Km), and axial length (AL). Other ocular biological parameters included retinal arterial oxygen saturation (SaO₂) and retinal venous oxygen saturation (SvO₂); parameter difference values are expressed as ∆.</p><p><strong>Results: </strong>Of the 267 participants, 63.30% were female and 36.70% were male. The mean SE, AL, SaO₂, and SvO₂ were -5.93 ± 3.24 D, 26.01 ± 1.35 mm, 93.49% ± 1.67%, and 62.97% ± 4.52%, respectively. Before FS-LASIK, SaO₂ was significantly correlated with AL and SE (r_s = -0.305, P < 0.001; r_s = 0.385, P < 0.001). Significant differences were found in SaO₂ across myopia categories (P < 0.001). The changes in the retinal arterial oxygen saturation decreased significantly after FS-LASIK (F = 24.948, P < 0.001). After surgery, SaO₂ demonstrated a statistically significant but weak negative relationship with refractive correction (ΔSE) (r_s = -0.380, P < 0.001) and axial length (r_s = -0.404, P < 0.001), a significant but weak positive correlation with average keratometry cutting value (ΔKm) (r_s = 0.354, P < 0.001), and no correlation with the change in IOP (ΔIOP) (P > 0.05).</p><p><strong>Conclusion: </strong>Ruling out the influence of refractive error, SaO₂ was significantly decreased 1 month after FS-LASIK, while there was no significant change in SvO₂. We conjecture that retinal amplification may affect differences in retinal oxygen saturation.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"541-553"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replacing Theories with Evidence Around the Axes of the Eye in Intraocular Lens Selection: A Review for the Clinician.","authors":"Joaquín Fernández, Filomena Ribeiro, Noemi Burguera, Neus Burguera-Giménez, Manuel Rodríguez-Vallejo","doi":"10.1007/s40123-025-01092-4","DOIUrl":"10.1007/s40123-025-01092-4","url":null,"abstract":"<p><p>The prevailing narrative in scientific literature has long overemphasized the role of ocular axes in intraocular lens (IOL) implantation, perpetuating misconceptions that have led to unnecessary exclusions of patients. Historical assumptions, coupled with inconsistent terminology and statistical inaccuracies, have muddled clinical decision-making. This review delves into these misconceptions, offering a critical reassessment of their relevance. Drawing from a non-systematic search across PubMed, the IOLEvidence App Database, and additional sources through snowballing, the review includes diverse studies exploring the relationship between ocular axes (angles, chords, kappa, alpha, lens, …) and IOL implantation. The findings reveal widespread confusion in terminology, particularly the interchangeable use of terms like 'angles' and 'chords', and highlight device-specific variability in parameters such as Chord-mu, Chord-alpha, and Chord-lens. Despite these inconsistencies, no robust evidence supports using these measures as grounds for excluding patients from IOL procedures. Interestingly, postoperative IOL centration (Chord-iol) emerged as a more critical factor for visual outcomes than preoperative ocular axes. The evidence suggests that values for Chord-mu, Chord-alpha, and Chord-lens should prompt further evaluation of atypical cases but are not reliable exclusion criteria. Moreover, a shift in focus toward aligning the IOL slightly temporal to the vertex normal appears to optimize visual acuity and minimize photic phenomena, challenging the established paradigm of knowledge about IOL centration.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"471-487"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Retinal and Choriocapillaris Microvascular Changes in Retinal Vein Occlusion and Fellow Eyes by Optical Coherence Tomography Angiography: A Systematic Review and Meta-Analysis.","authors":"Linxin Wei, Qing Zhao, Youxin Chen","doi":"10.1007/s40123-024-01077-9","DOIUrl":"10.1007/s40123-024-01077-9","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to summarize the retinal and choroidal microvascular features detected by optical coherence tomography angiography (OCTA) in the affected and fellow eyes of patients with retinal vein occlusion (RVO).</p><p><strong>Methods: </strong>A comprehensive search of the PubMed, Embase, and Ovid databases was conducted to identify studies comparing OCTA metrics among RVO, RVO-fellow, and control eyes. Outcomes of interest included parameters related to foveal avascular zone (FAZ) and fovea- and optic nerve head (ONH)-centered perfusion measurements of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris layer. Pooled results were presented as mean differences or standardized mean differences with 95% confidence intervals.</p><p><strong>Results: </strong>Fifty-three studies, comprising 2119 RVO, 1393 fellow, and 1178 control eyes, were included in the quantitative meta-analysis. RVO eyes exhibited larger FAZ areas, increased FAZ acircularity, and reduced macular retinal and choriocapillaris perfusion compared to RVO-fellow and control eyes (P < 0.05). RVO eyes also demonstrated significantly lower perfusion density (PD) in the inside-disk and peripapillary regions of the radial peripapillary capillary layer (RPC), as well as lower retinal and choriocapillaris PD in the 4.5 × 4.5 mm² field of view (FOV) of ONH-centered scans (P < 0.05). RVO-fellow eyes showed decreased SCP-PD and DCP-PD in the parafoveal region and the 3 × 3 mm² FOV, reduced inside-disk and 4.5 × 4.5 mm² FOV RPC-PD (P < 0.05), and a diminished choriocapillaris flow area in the 3 × 3 mm² FOV (P < 0.05).</p><p><strong>Conclusions: </strong>Both RVO-affected and RVO-fellow eyes exhibited retinal and choriocapillaris microvascular impairment around the fovea and ONH. OCTA represents a promising tool for comprehensively assessing vascular alterations in RVO and providing evidence of fellow eye involvement.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"391-411"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating Between Perfluorohexyloctane Ophthalmic Solution and Water-Free Cyclosporine Ophthalmic Solution 0.1% for Dry Eye Disease: A Review of Preclinical and Clinical Characteristics.","authors":"Laura M Periman, Darrell E White, Douglas Katsev","doi":"10.1007/s40123-024-01076-w","DOIUrl":"10.1007/s40123-024-01076-w","url":null,"abstract":"<p><p>Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences-in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle-are important considerations in treatment selection for patients with DED.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"283-293"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allogenic Cultured Limbal Epithelial Transplantation and Cultivated Oral Mucosal Epithelial Transplantation in Limbal Stem Cells Deficiency: A Comparative Study.","authors":"Mohamed Elalfy, Kareem Elsawah, Sundas Maqsood, Nigel Jordan, Mansour Hassan, Ahmed Zaki, Zisis Gatzioufas, Samer Hamada, Damian Lake","doi":"10.1007/s40123-024-01083-x","DOIUrl":"10.1007/s40123-024-01083-x","url":null,"abstract":"<p><strong>Introduction: </strong>This study compared the clinical outcomes of allogenic cultured limbal epithelial transplantation (ACLET) and cultivated oral mucosal epithelial transplantation (COMET) in the management of limbal stem cell deficiency (LSCD).</p><p><strong>Methods: </strong>Forty-one COMET procedures in 40 eyes and 69 ACLET procedures in 54 eyes were performed in the Corneoplastic Unit of Queen Victoria Hospital, East Grinstead. Data were examined for demographics, indications, ocular surface stability, absence of epithelial defect, ocular surface inflammation, visual outcomes, and intra- and postoperative complications.</p><p><strong>Results: </strong>Kaplan-Meier analysis showed that patients in the ACLET group with longer follow-up had a significantly higher graft survival rate (81.7%, n = 56) than the COMET group (60.7%, n = 25) and the difference was statistically significant (p = 0.01). In the COMET group, there was no statistically significant improvement in the visual acuity (VA) while in the ACLET group there was statistically significant improvement in the final VA. Elevated intraocular pressure (IOP) developed in 9 eyes (22.0%) in the COMET group and in 18 eyes (26.1%) in the ACLET group; infection developed in 4 eyes (9.8%) in the COMET group and in 10 eyes (14.5%) in the ACLET group; and perforation or melting happened in 4 eyes (9.8%) in the COMET group and in 1 eye (1.4%) in the ACLET group. Postoperative immunosuppression complications were noted in 9 eyes (13.0%) in the ACLET group. No graft rejection was observed in either group.</p><p><strong>Conclusion: </strong>Both ACLET and COMET are effective therapeutic procedures for managing advanced and bilateral cases of LSCD. Although COMET has lower graft survival rate than ACLET, it does not mandate systemic immunosuppression therapy to protect against potential graft rejection.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"413-432"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Treatment Outcomes of Micropulse Transscleral Cyclophotocoagulation in Primary and Secondary Glaucoma: A 5-Year Analysis.","authors":"Ronald M P C de Crom, Stefani Kujovic-Aleksov, Carroll A B Webers, Tos T J M Berendschot, Henny J M Beckers","doi":"10.1007/s40123-024-01080-0","DOIUrl":"10.1007/s40123-024-01080-0","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate 5-year outcomes on intraocular pressure (IOP) and safety of micropulse transscleral cyclophotocoagulation (TSCPC) in patients with glaucoma.</p><p><strong>Methods: </strong>Patients with mild to advanced glaucoma who underwent a standardized micropulse TSCPC procedure at the University Eye Clinic Maastricht from November 2016 to February 2019 were included.</p><p><strong>Results: </strong>A total of 165 eyes were included, with outcomes for 112 eyes available after 5-year follow-up. Mean age was 67.3 ± 13.9 years; 58.2% were male. Glaucoma subtypes were primary glaucoma (n = 108) and secondary glaucoma (n = 57). Prior glaucoma surgery was performed in 65 of 165 eyes (39.4%). In the primary glaucoma group, mean preoperative IOP was 20.7 ± 7.1 mmHg. Mean postoperative IOP at 1, 2, 3, 4, and 5 years significantly reduced to 15.2 ± 6.5, 14.3 ± 5.0, 14.0 ± 4.9, 13.5 ± 4.1, and 12.9 ± 4.3 mmHg, respectively. Preoperatively, the mean number of IOP-lowering medications was 3.3 ± 1.3, which changed to 2.8 ± 1.3, 2.8 ± 1.2, 2.8 ± 1.2, 2.9 ± 1.2, and 2.7 ± 1.3 at 1, 2, 3, 4, and 5 years, respectively. In the secondary glaucoma group, mean preoperative IOP was 28.7 ± 10.3 mmHg, dropping significantly to 19.3 ± 10.4, 18.6 ± 11.3, 17.8 ± 9.8, 18.1 ± 12.0, and 15.5 ± 7.6 mmHg at the same intervals. The number of IOP-lowering medication was significantly reduced from 3.5 ± 1.1 to 2.5 ± 1.5, 2.2 ± 1.5, 2.6 ± 1.4, 2.6 ± 1.5, and 2.5 ± 1.7. In the total group, mean IOP reduction was 32.5% after 5 years. Postoperative complications included cystic macular edema (n = 3), fibrinous/uveitic reaction (n = 1), and rejection of corneal graft (n = 2), all reversible after treatment. One patient developed late and persisting hypotony. Other adverse events were retinal venous occlusion (n = 1) and retinal vasculitis (n = 1), unrelated to the laser treatment. In patients with a preoperative Central Distance Visual Acuity (CDVA) > 0.05 on the Snellen chart, more than two lines of visual acuity (VA) loss were attributed to cataract (n = 10), retinal disease (n = 5), glaucoma progression (n = 3), corneal decompensation (n = 2), or other factors (n = 11).</p><p><strong>Conclusion: </strong>Micropulse TSCPC is a safe and effective treatment for reducing IOP and the number of IOP-lowering medications after a 5-year follow-up period. It is a viable alternative for patients after failed incisional glaucoma surgery or high-risk patients.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"323-335"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Non-Digital, Clinical Workflows to Detect and Track Vision-Threatening Diabetic Retinopathy via a Digital Platform Integrating Artificial Intelligence: Implementation Research.","authors":"Peranut Chotcomwongse, Paisan Ruamviboonsuk, Chaiwat Karavapitayakul, Koblarp Thongthong, Anyarak Amornpetchsathaporn, Methaphon Chainakul, Malee Triprachanath, Eckachai Lerdpanyawattananukul, Niracha Arjkongharn, Varis Ruamviboonsuk, Nattaporn Vongsa, Pawin Pakaymaskul, Turean Waiwaree, Hathaiphan Ruampunpong, Richa Tiwari, Viroj Tangcharoensathien","doi":"10.1007/s40123-024-01086-8","DOIUrl":"10.1007/s40123-024-01086-8","url":null,"abstract":"<p><strong>Introduction: </strong>Screening diabetic retinopathy (DR) for timely management can reduce global blindness. Many existing DR screening programs worldwide are non-digital, standalone, and deployed with grading retinal photographs by trained personnel. To integrate the screening programs, with or without artificial intelligence (AI), into hospital information systems to improve their effectiveness, the non-digital workflow must be transformed into digital. We developed a cloud-based digital platform and implemented it in an existing DR screening program.</p><p><strong>Methods: </strong>We conducted the following processes in the platform for prospective DR screening at a community hospital: capturing patients' retinal photographs, uploading them for grading by AI or trained personnel on alternate weeks for 32 weeks, and referring vision-threatening DR to a referral center. At this center, the platform was applied for the assessment of potential missed referrals via remote over-reading by a retinal specialist and tracking referrals. Implementational outcomes, such as detecting positive cases, agreement between AI and over-reading, and referral adherence were assessed.</p><p><strong>Results: </strong>Of 645 patients screened by AI, 201 (31.2%) were referrals, 129 (64.2%) of which were true positives agreeable by over-reading; 115 of these true positives (89.1%) had referral adherence. False negatives judged by over-reading were 1.1% (5/444). Of 730 patients in manual screening, 175 (24.0%) were potential referrals, 11 (6.3%) of which were referred at the point-of-screening; eight of these (72.7%) adhered to referral. The remaining 164 cases were appointed for later examination by a visiting general ophthalmologist; 11 of these 116 examined (9.5%) were referred for non-DR-related eye conditions with 81.8% (9/11) referral adherence. No system failure or interruption was found.</p><p><strong>Conclusions: </strong>The digital platform can be practically integrated into the existing non-digital DR screening programs to implement AI and monitor previously unknown but important indicators, such as referral adherence, to improve the effectiveness of the programs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov. (registration number: NCT05166122).</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"447-460"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}