Clinical and Experimental Ophthalmology最新文献

{"title":"Stromal Curvature, Power and Corneal-Stromal Curvature Ratios From a Hybrid AS-OCT in Eyes With Keratoconus.","authors":"Jascha A Wendelstein, Annabella Ostermaier, Katrin Freller, Arianna Grendele, Giacomo Savini, Catarina Praefke Coutinho, Robert Herber, Nikolaus Luft, Stefan Kassumeh, Achim Langenbucher, Siegfried Priglinger","doi":"10.1111/ceo.70001","DOIUrl":"https://doi.org/10.1111/ceo.70001","url":null,"abstract":"<p><strong>Background: </strong>To characterise stromal curvature and curvature ratios in keratoconus (KCN) using anterior segment OCT, and to evaluate the implications of using single-, two-, and three-surface refractive models for corneal power estimation in ectatic eyes.</p><p><strong>Methods: </strong>Retrospective observational study. Anterior segment OCT measurements (MS-39, CSO) were analysed. Anterior, stromal, and posterior curvature radii were computed across five concentric zones (2.0-6.0 mm) using a floating best-fit sphere, and curvature ratios were subsequently derived: anterior-to-stromal (ASR), stromal-to-posterior (SPR), and anterior-to-posterior (APR). Corneal power was calculated using one-, two-, and three-surface models. KCN severity was classified according to the Belin ABC grading stage and ASR, SPR, and APR were stratified accordingly.</p><p><strong>Results: </strong>Data from 944 keratoconic eyes were analysed. Peripheral zones (6.0 mm) exhibited reduced variability in curvature measurement compared to central zones (3.0 mm). Differences between simplified (one- and two-surface) and three-surface power models correlated moderately with increased APR and SPR values. ASR, SPR, and APR all increased progressively with advancing ABC grade.</p><p><strong>Conclusion: </strong>In advanced keratoconus, three-surface modelling yields different corneal power estimates versus simplified models in KC; prospective outcome studies are needed to assess clinical impact. Stromal curvature and its derived ratios provide novel structural metrics that change with KCN severity. Curvature ratio increase -especially APR and SPR- reflects posterior steepening and anterior-posterior decoupling, with possible implications for staging and surgical planning.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long Journey of Treatment for Wet Macular Degeneration, Is It Worth It?","authors":"Mark Gillies","doi":"10.1111/ceo.70004","DOIUrl":"https://doi.org/10.1111/ceo.70004","url":null,"abstract":"","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Surveillance Guidelines for Uveal Melanoma: A Systematic Review.","authors":"Farzana Y Zaman, Aisha Ghaus, Mark Shackleton, Damien Kee, Anthony M Joshua, Roderick O'Day, Malaka Ameratunga","doi":"10.1111/ceo.70002","DOIUrl":"https://doi.org/10.1111/ceo.70002","url":null,"abstract":"<p><strong>Background: </strong>Uveal melanoma (UM) is the most common primary intraocular tumour. Despite effective local therapies, UM has a high risk of metastatic recurrence, most frequently to the liver. A significant proportion of patients treated definitively for primary UM eventually experience metastatic disease. Systemic surveillance to detect recurrence is critical to maximise therapeutic options. Whilst international guidelines exist, there are currently no standardised Australian guidelines for surveillance imaging. This systematic review examines the literature regarding systemic surveillance methods following local treatment for UM.</p><p><strong>Methods: </strong>Medline, Embase and PubMed databases were searched, from 2010 to 01-07-2024, using keywords related to uveal melanoma and surveillance. Eligible studies were identified by two independent reviewers, and a systematic review was undertaken.</p><p><strong>Results: </strong>Of 840 records, six guidelines and institutional consensus statements were identified, and an additional 13 studies were included. Most studies were cohort studies (n = 7), with the rest being case-control studies and reliability analyses. Risk stratification methods and surveillance strategies varied, with most studies recommending increased frequency (at least every 6 months) and higher-resolution imaging modalities (MRI over ultrasound) for higher-risk patients.</p><p><strong>Conclusion: </strong>Despite several published guidelines, existing evidence regarding optimal surveillance strategies in localised primary UM is of variable quality, relying on cohort studies and limited by heterogeneity, as assessed by the modified Newcastle-Ottawa Scale. There is a clear need to further define local practices and outcomes to direct future guidelines.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRAF Mutation Status in Inflamed Juvenile Conjunctival Nevus, Primary Acquired Melanosis and Conjunctival Common Nevus.","authors":"Lei-Chi Wang, Wei-Kuang Yu, Chih-Chien Hsu, Yu-Yun Huang, Chieh-Chih Tsai, Tai-Chi Lin","doi":"10.1111/ceo.14599","DOIUrl":"https://doi.org/10.1111/ceo.14599","url":null,"abstract":"<p><strong>Background: </strong>To investigate BRAF mutation status and its associated clinicopathological features in conjunctival melanocytic lesions.</p><p><strong>Methods: </strong>We analysed surgical specimens from 79 conjunctival melanocytic lesions, including inflamed juvenile conjunctival nevi, primary acquired melanosis (PAM) and conjunctival common nevi collected from 2013 to 2022. PAM lesions were further categorised into those without atypia and with mild, moderate or severe atypia. Conjunctival common nevi were subcategorized into junctional, subepithelial and compound nevi. BRAF V600E immunohistochemistry was performed on all specimens, with PCR-mass spectrometry used for ambiguous cases. The main outcome measures were the BRAF V600E mutation rate and related clinicopathological features.</p><p><strong>Results: </strong>Inflamed juvenile conjunctival nevi showed a BRAF V600E mutation rate of 36.8% (7/19), while the mutation was rare in PAM (4.3%, 1/23). The mutation rate in conjunctival common nevi (67.6%, 25/37) was similar to that in cutaneous common nevi, and most BRAF V600E-mutated cases were found in the subepithelial nevus group (93.8%, 15/16). BRAF mutations were significantly associated with intralesional inflammatory stroma and subepithelial growth pattern, but not with age, lesion location, intralesional cyst and solar elastosis.</p><p><strong>Conclusions: </strong>BRAF mutations are key driver mutations in inflamed juvenile conjunctival nevi and conjunctival common nevi. Histologically, an 'inflamed juvenile conjunctival nevus'-like inflammatory stroma correlated with BRAF mutations. In our study, solar elastosis was infrequently observed in conjunctival nevi, suggesting that the mutational signature of conjunctival melanocytic lesions resembles that of cutaneous non- or low-level cumulative solar damage type. For cases with equivocal BRAF staining, high-sensitivity sequencing is recommended to confirm mutation status.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-Year Incidence, Risk Factors and Progression Rate of Macular Atrophy in Neovascular Age-Related Macular Degeneration.","authors":"Francesco Romano, Marco Casaluci, Antonio Valastro, Matteo Airaldi, Paolo Milella, Francesco Pozzo Giuffrida, Elisa Cozzi, Andrea Aretti, Kelvin Yc Teo, Chui Ming Gemmy Cheung, Marco Nassisi, Francesco Viola, Giovanni Staurenghi, Alessandro Invernizzi","doi":"10.1111/ceo.14608","DOIUrl":"https://doi.org/10.1111/ceo.14608","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the 10-year cumulative incidence, progression rates, and risk factors for macular atrophy (MA) in neovascular age-related macular degeneration (nAMD) patients receiving long-term anti-vascular endothelial growth factor (VEGF) therapy.</p><p><strong>Methods: </strong>Retrospective, multicenter, cohort study including 148 eyes from 140 nAMD patients treated with a pro-re-nata (PRN) anti-VEGF regimen and followed for ≥ 10 years. Annual multimodal imaging-including blue autofluorescence [BAF], spectral-domain optical coherence tomography [SD-OCT] and near-infrared reflectance-was reviewed to detect and quantify MA using RegionFinder. Kaplan-Meier analysis estimated cumulative MA incidence, while mixed-effects Cox and linear regressions identified risk factors and progression rates.</p><p><strong>Results: </strong>Baseline MA prevalence was 23.0%, increasing to 64.9% at 5 years and 79.8% at 10 years. Foveal involvement occurred in 47.4% of cases. Significant predictors for MA included baseline BCVA < 20/40 (HR = 1.50, p = 0.02), greater central subfield thickness (CST) fluctuations (HR = 1.04, p = 0.01), and more frequent submacular haemorrhages (HR = 1.34, p = 0.04). Type 3 macular neovascularization was associated with fovea-involving MA (HR = 2.03, p = 0.02). Mean MA size increased from 0.34 to 2.27 mm at 10 years, progressing at 0.20 mm/year (β = 0.15, p < 0.001). Eyes with incident MA exhibited faster progression (β = 0.03, p = 0.01) and worse BCVA decline compared to those with baseline MA (-1.96 vs. -1.42 letters/year, p < 0.001).</p><p><strong>Conclusions: </strong>nAMD patients treated with PRN anti-VEGF therapy demonstrated a high 10-year cumulative incidence of MA (79.8%), with poor baseline BCVA and CST fluctuations as key risk factors. Eyes with incident MA progressed faster and were associated with greater visual decline, suggesting a more visually impactful atrophy.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth Factor Responses of Human Iris Pigment Epithelial Cells to High Glucose Conditions.","authors":"Yuefang Ma, Getasew Mersha, Justine R Smith, Liam M Ashander","doi":"10.1111/ceo.70000","DOIUrl":"https://doi.org/10.1111/ceo.70000","url":null,"abstract":"","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-Of-The-Bag Intraocular Lens Dislocation in Dead Bag Syndrome and Its Association With Eye Rubbing.","authors":"Soon-Phaik Chee, Nicole Shu-Wen Chan, Jia Xu Lim","doi":"10.1111/ceo.14606","DOIUrl":"https://doi.org/10.1111/ceo.14606","url":null,"abstract":"<p><strong>Background: </strong>To describe clinical features, risk factors and outcomes of out-of-the-bag (OTB) intraocular lens (IOL) dislocation in dead bag syndrome (DBS).</p><p><strong>Methods: </strong>Retrospective review of a single-surgeon series of eyes with IOLs that developed OTB IOL dislocation, managed at Singapore National Eye Centre (January 2014-December 2021), with a minimum of 6 months of follow-up. Eyes with OTB IOL dislocation following secondary IOL implantation and intraoperative capsule complications were excluded. Patient demographics, ocular history, clinical findings, ocular trauma/eye rubbing, surgical procedures and postoperative outcomes were obtained.</p><p><strong>Results: </strong>Fifty eyes (40 unilateral, 5 bilateral) of 45 patients were included. Patients were predominantly male (82.2%), presenting at 61.9 ± 14.1 years old, 11.2 ± 6.0 years after cataract surgery. Eye rubbing was the only form of ocular trauma (n = 34; 68.0%). Compared to non-eye rubbers, eye rubbers were significantly more likely to have elevated intraocular pressure (IOP) (32.4% vs. 6.2%; OR 10.9, 95% confidence interval [CI] 1.12-107; p = 0.040), larger posterior capsule defects (median 60% vs. 50%; p = 0.029), vitreous in the anterior chamber (38.2% vs. 6.2%; OR 10.3, 95% CI 1.05-101; p = 0.045) and lower endothelial cell counts than the non-affected eye (-145 ± 507 vs. 315 ± 639 cells/mm²; p = 0.026). The most common complications after IOL exchange were elevated IOP (n = 11; 22.0%) including glaucoma (n = 8; 16.0%) and recurrent IOL subluxation (n = 7; 14.0%).</p><p><strong>Conclusions: </strong>Eye rubbing appears to play an important role in the development of OTB IOL dislocations in DBS and is associated with more severe clinical manifestations. Treating the underlying cause and counselling patients to avoid or minimise eye rubbing may reduce this complication.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Based Detection of Reticular Pseudodrusen in Age-Related Macular Degeneration.","authors":"Himeesh Kumar, Yelena Bagdasarova, Scott Song, Doron G Hickey, Amy C Cohn, Mali Okada, Robert P Finger, Jan H Terheyden, Ruth E Hogg, Pierre-Henry Gabrielle, Louis Arnould, Maxime Jannaud, Xavier Hadoux, Peter van Wijngaarden, Carla J Abbott, Lauren A B Hodgson, Roy Schwartz, Adnan Tufail, Emily Y Chew, Cecilia S Lee, Erica L Fletcher, Melanie Bahlo, Brendan R E Ansell, Alice Pébay, Robyn H Guymer, Aaron Y Lee, Zhichao Wu","doi":"10.1111/ceo.14607","DOIUrl":"10.1111/ceo.14607","url":null,"abstract":"<p><strong>Background: </strong>Reticular pseudodrusen (RPD) signify a critical phenotype driving vision loss in age-related macular degeneration (AMD). This study sought to develop and externally test a deep learning (DL) model to detect RPD on optical coherence tomography (OCT) scans with expert-level performance.</p><p><strong>Methods: </strong>RPD were manually segmented in 9800 OCT B-scans from individuals enrolled in a multicentre randomised trial. A DL model for instance segmentation of RPD was developed and evaluated against four retinal specialists in an internal test dataset. The primary outcome was the performance of the DL model for detecting RPD in OCT volumes in five external test datasets compared to two retinal specialists.</p><p><strong>Results: </strong>In an internal test dataset consisting of 250 OCT B-scans, the DL model produced RPD segmentations that had higher agreement with four retinal specialists (Dice similarity coefficient [DSC] = 0.76) than the agreement amongst the specialists (DSC = 0.68; p < 0.001). In the five external test datasets consisting of 1017 eyes from 812 individuals, the DL model detected RPD in OCT volumes with a similar level of performance as two retinal specialists (area under the receiver operator characteristic curve [AUC] = 0.94, 0.95 and 0.96 respectively; p ≥ 0.32).</p><p><strong>Conclusions: </strong>We present a DL model for automatic detection of RPD with expert-level performance, which could be used to support the clinical management of AMD. This model has been made publicly available to facilitate future research to understand this critical, yet enigmatic, AMD phenotype.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening Plus Corneal Cross-Linking for Keratoconus Is Cost-Effective for New Zealand: A Proof-of-Concept Markov Analysis.","authors":"Chuen Yen Hong, Sheng Chiong Hong, Graham Wilson","doi":"10.1111/ceo.14604","DOIUrl":"https://doi.org/10.1111/ceo.14604","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of keratoconus in New Zealand is higher compared to the global prevalence of 1.38 per 1000, with Māori and Pacific Islander being over-represented. The form of keratoconus in New Zealand has been shown to have a more rapid progression of disease. In this study, we aimed to evaluate the cost-effectiveness of introducing screening for keratoconus in the New Zealand context, with corneal cross-linking as treatment for those screening positive.</p><p><strong>Methods: </strong>A Markov simulation was used to model the impact of screening plus corneal cross-linking compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost-effectiveness was determined by the incremental cost-effectiveness ratio, with utility measured in quality-adjusted life-years. Univariate and probabilistic sensitivity analyses were carried out to investigate factors influencing cost-effectiveness.</p><p><strong>Results: </strong>The incremental cost-effectiveness for screening with corneal cross-linking treatment was -NZ$1278 (95% CI -1418, -1139) per QALY gained. Factors that had the most influence on incremental cost-effectiveness were the specificity of the screening test, the prevalence of keratoconus at the time of screening, the discount rate, the probability of patients who are progressors, adherence, and efficacy of cross-linking treatment.</p><p><strong>Conclusion: </strong>Screening for keratoconus at age 15 with corneal cross-linking treatment for children who screened positive is likely to be cost saving. Our results support the need for a real-world trial and cost-effectiveness analysis in New Zealand to ensure that we identify and treat those at risk early in the disease course before significant vision loss has occurred.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Segment Optical Coherence Tomography and Anterior Segment Optical Coherence Tomography Angiography After Bleb Forming Glaucoma Surgeries: A Systematic Review.","authors":"Martin Kallab, Alex S Huang, Matthias Bolz, Clemens A Strohmaier","doi":"10.1111/ceo.14602","DOIUrl":"https://doi.org/10.1111/ceo.14602","url":null,"abstract":"<p><strong>Background: </strong>The bleb-forming surgical spectrum in open-angle glaucoma has recently been expanded by novel surgical approaches. Through a medical device implantation (Xen Gel Stent (XGI) or Preserflo Microshunt (PMI)), these procedures aim at more standardised aqueous humour shunting and an intra- and postoperative risk reduction. Postoperatively, however, XEN, PMI and trabeculectomy share their dependence on the proper function of the filtration bleb. This review summarises available literature on anterior segment optical coherence tomography (AS-OCT)- and AS-OCT angiography (AS-OCTA)-based bleb parameters with an emphasis on their association with bleb function.</p><p><strong>Methods: </strong>A systematic PubMed search was performed to identify the available evidence.</p><p><strong>Results: </strong>A total of 52 suitable reports were identified and are presented in a structured manner.</p><p><strong>Conclusion: </strong>The retrieved literature demonstrates that there exists a broad body of evidence for the use of AS-OCT and AS-OCTA after TE, XGI and PMI with the potential for AS-OCT and AS-OCTA enhanced follow-up plans. Their implementation in clinical routine is, however, currently impaired by highly variable and impractical study endpoints, lacking transferability of available evidence between different surgical procedures and missing evidence from prospective interventional trials.</p>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}