Acta Ophthalmologica最新文献

{"title":"Intraocular and extraocular manifestations of thyroid dysfunction in Danish patients – A Nationwide Study","authors":"Lena Boulakh","doi":"10.1111/aos.16734","DOIUrl":"10.1111/aos.16734","url":null,"abstract":"<p>The population in all our studies are Danish residents who received treatment at a Danish hospital. Therefore, the following sections contain a brief description of the Danish healthcare system and Danish nationwide registries. In studies <b>I</b> and <b>II</b>, the data was obtained from Danish nationwide registries, while for study <b>III</b>, we collected data retrospectively from patient records from the two Danish hospitals, namely Rigshospitalet and Zealand University Hospital. Thus, the population frame is the same in all three studies, but the data sources and the inclusion criteria differ between the studies.</p><p>All exudative AMD cases and patients with TED are treated at a hospital; therefore, we choose to use the Danish nationwide registries as our material source for studies <b>I</b> and <b>II</b>. For study <b>III</b>, we evaluated the outcomes of single muscle recessions performed using pure TA. Danish nationwide registries do not include details such as the type of anaesthesia used for the strabismus surgery and the surgical outcomes; thus, we used patient records to collect data.</p><p>Study <b>I</b> was a longitudinal nationwide cohort study using Danish nationwide registries. We included all residents of Denmark aged 50–100 years between 2008 and 2018 and studied the interaction between the exposures thyroid dysfunction (either hypo- or hyperthyroidism) and cataract surgery on the outcome of exudative AMD. We defined thyroid dysfunction as two prescriptions for thyroid hormone supplementary medication or antithyroid medication within 5 years. We defined cataract surgery as a diagnosis code for cataract and a procedure code for cataract surgery. We defined exudative AMD as a diagnosis code for AMD followed by an anti-VEGF injection treatment code. We excluded all patients who had been or were prescribed lithium or amiodarone during the time period of the study. Furthermore, we excluded all thyroidectomies and thyroid cancer diagnoses. We included the following confounders: sex, age, education level, hypertension and chronic obstructive pulmonary disease (COPD). Because smoking is not registered in the Danish registries, we used COPD as a confounder and a proxy for smoking. See Table A1 in Appendix for the diagnosis codes, procedure codes and prescription definitions used in this study.</p><p>To determine the thyroid status of the included patients, we studied the prescriptions 5 years prior to the TED diagnosis. If a patient received L-thyroxine and antithyroid medication, then we considered the patient to be hyperthyroid. See Table A2 in Appendix for the diagnosis codes, procedure codes and prescription definitions used in this study.</p><p>Study <b>III</b> was a retrospective case series of all consecutive single muscle recessions conducted at two Danish centres between 2007 and 2018 by one surgeon. We divided the two groups undergoing surgery into a TED and a non-TED group. None of the muscles operated on had previously ","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"102 S283","pages":"3-25"},"PeriodicalIF":3.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.16734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138960","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":"Intraocular and extraocular manifestations of thyroid dysfunction in Danish patients—A nationwide study","authors":"Lena Boulakh","doi":"10.1111/aos.16743","DOIUrl":"10.1111/aos.16743","url":null,"abstract":"<p>Thyroid eye disease (TED) is an autoimmune orbital disorder manifested through the immune system attacking the thyrotropin receptors on orbital fibroblasts. TED is mostly seen in hyperthyroid patients with Graves's disease but can also manifest in hypo- and euthyroid patients. The disease leads to orbital remodelling and disfigurement and has a wide array of manifestations such as strabismus, proptosis and eyelid retraction. These manifestations can lead to severe outcomes such as recurrent keratitis and, in the worst cases, dysthyroid optic neuropathy and vision loss. In Denmark, the structural end-stage changes caused by the disease can currently only be treated with surgery. This thesis follows the path of a thyroid patient through every stage of their eye disease. First, the patient has abnormal laboratory thyroid function testing and exhibits other ophthalmological manifestations than TED (Study I). Second, the patient is diagnosed with TED (Study II). Finally, the symptoms become so severe that the patient needs surgery (Studies II and III).</p><p>TED is an ophthalmological disease that is known to be associated with thyroid disorder. Because there are thyroid hormone receptors located in the retina, it has been suggested that thyroid hormones also may play a role in the pathogenesis of age-related macular degeneration (AMD). Several studies have investigated the association between AMD and thyroid dysfunction, although the results have been contradictory. Cataract surgery has also been suggested to lead to AMD progression. Therefore, we investigated the association between thyroid dysfunction and cataract surgery on exudative AMD. We included all patients who received anti-vascular endothelial growth factor (VEGF) treatment for their AMD in Denmark between 2008 and 2018 by using the Danish nationwide registries. We evaluated 26 998 individuals who developed exudative AMD and found an association between both hyper- and hypothyroidism, but only in patients who had not undergone previous cataract surgery (Study I).</p><p>The treatment landscape for patients with TED in Denmark has changed over the past 20 years with the implementation of new medications, national guidelines and centralisation of treatment. Knowledge of the incidence of a disease is important for healthcare planning and patient information. Studying changes in incidence over time provides information on disease patterns and can provide insight into how it has been affected by new treatment approaches. The current data on the incidence of TED originates from studies of selected populations with a relatively small number of patients (<i>n</i> = 120–447; Abraham-Nordling et al., <span>2011</span>; Bartley, <span>1994</span>; Laurberg et al., <span>2012</span>). Therefore, we investigated the incidence of TED in Denmark by using the Danish nationwide registries. Additionally, we studied the cumulative incidence of the ophthalmological sequelae of TED: strabismus, strabismus su","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"102 7","pages":"849-850"},"PeriodicalIF":3.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.16743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138959","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":"Review of Hydroxypropyl Methylcellulose in Artificial Tears for the Treatment of Dry Eye Disease","authors":"O. Martin B. Mysen,&nbsp;Leif Hynnekleiv,&nbsp;Morten S. Magnø,&nbsp;Jelle Vehof,&nbsp;Tor P. Utheim","doi":"10.1111/aos.16753","DOIUrl":"10.1111/aos.16753","url":null,"abstract":"<p>Dry eye disease (DED) is a highly prevalent condition, resulting in reduced quality of life, lower participation in social life and impaired work efficiency. Hydroxypropyl methylcellulose (HPMC) is a cellulose-based viscosity-enhancing agent and is one of the most popular therapeutic ingredients in artificial tears. This review aims to evaluate the literature on the efficacy and safety of HPMC used in the treatment of DED. Literature searches were conducted in PubMed and Cochrane CENTRAL. A total of 28 clinical trials from 26 publications are included in this review, including 21 clinical intervention studies evaluating the effect of HPMC treatment over time and seven single instillation studies evaluating the short-term physical and symptomatic effects of HPMC after drop-instillation. The duration of clinical intervention studies ranged from 2 weeks to 5.5 months. DED severity ranged from mild to severe. Drop frequency ranged from two to up to 16 drops per day. HPMC concentration in artificial tears ranged from 0.2% to 0.5%. No major complications or adverse events were reported. Artificial tears containing HPMC were effective at improving symptoms and some signs of DED. However, combination drops with HPMC plus other therapeutic ingredients seem more effective than HPMC alone. HPMC appears to be equally effective or inferior to hyaluronic acid (HA). There is no evidence of superiority or inferiority to either carboxymethylcellulose (CMC) or polyethylene glycol 400/propylene glycol (PEG/PG). No single study explained the choice of drop frequency or HPMC concentration. More well-designed studies are needed to determine an evidence-based standard for HPMC treatment, including drop frequency, concentration and molecular weight for different DED severity and subgroups.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"102 8","pages":"881-896"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.16753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103275","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":"Hyperautofluorescent material inside areas of macular atrophy may reveal non-lipofuscin fluorophores in late stage AMD.","authors":"Melih Tarhan, Daniel Meller, Martin Hammer","doi":"10.1111/aos.16752","DOIUrl":"https://doi.org/10.1111/aos.16752","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize fundus autofluorescence (FAF) in complete (cRORA) and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) by fluorescence lifetime imaging ophthalmology (FLIO).</p><p><strong>Methods: </strong>Overall, 98 macular atrophy (MA) lesions in 42 eyes of 37 age-related macular degeneration (AMD) patients (mean age: 80.9 ± 5.8 years), 25 of them classified as iRORA and 73 as cRORA by OCT, were investigated by FLIO in a short (SSC: 498-560 nm) and a long wavelength channel (LSC: 560-720 nm). Differences of FAF lifetimes and peak emission wavelength (PEW) between atrophic lesions and intact retinal pigment epithelium (RPE) in the outer ring of the ETDRS grid were considered.</p><p><strong>Results: </strong>FAF lifetimes in MA were longer and PEW were significantly (p < 0.001) shorter than in intact RPE by 112 ± 78 ps (SSC), 91 ± 64 ps (LSC), 27 ± 18 nm (PEW) in iRORA and by 227 ± 112 ps (SSC), 167 ± 81 ps (LSC), and 54 ± 17 nm (PEW) in cRORA. 37% of iRORA and 24% of cRORA were hyperautofluorescent in SSC. Persistent sub-RPE-BL material in MA was newly found as a hyperautofluorescent entity with lifetimes considerably longer than that of drusen and RPE.</p><p><strong>Conclusions: </strong>Despite RPE and, thus, lipofuscin are greatly absent in MA, considerable FAF, preferably at short wavelengths, was found in those lesions. Drusen, persistent sub-RPE-BL material, basal laminar deposits, persistent activated RPE, and sclera were identified as putative sources of this fluorescence. FLIO can help to characterize respective fluorophores.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for primary open-angle glaucoma: A randomized controlled trial.","authors":"Wenqing Ye, Jinxing Li, Shaodan Zhang, Shuqing Zhu, Yanqian Xie, Rongrong Le, Weihe Zhou, Mingguang He, Ningli Wang, Yuanbo Liang","doi":"10.1111/aos.16750","DOIUrl":"https://doi.org/10.1111/aos.16750","url":null,"abstract":"<p><strong>Purpose: </strong>To report the 2-year efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for the treatment of primary open-angle glaucoma (POAG).</p><p><strong>Setting: </strong>A single surgical site in China.</p><p><strong>Design: </strong>This was a prospective, randomized controlled trial. POAG patients were randomly assigned to the penetrating canaloplasty or ab externo canaloplasty group.</p><p><strong>Methods: </strong>This study enrolled POAG patients who underwent penetrating canaloplasty or ab externo canaloplasty randomly. Surgical success, intraocular pressure (IOP), number of glaucoma medications, and surgical complications were evaluated until 24 months post-operatively. Surgical success was defined as 6 mmHg ≤ IOP ≤21 mmHg with an IOP reduction ≥20%, which included qualified success (with or without medications) and complete success (without medications).</p><p><strong>Results: </strong>A total of 52 eyes (45 patients) were randomly assigned to one of two groups: the penetrating canaloplasty group (PCP, n = 26) or the ab externo canaloplasty group (CP, n = 26). The probabilities of qualified success and complete success were 92.3% and 76.9%, respectively, in the PCP group and 64.1% and 52.1%, respectively, in the CP group at 24 months (p = 0.013, p = 0.042, log-rank test). The mean IOP decreased from 30.8 ± 10.7 and 28.6 ± 11.8 mmHg to 14.1 ± 3.3 mmHg in the PCP group and 22.1 ± 13.6 mmHg in the CP group at year two (p = 0.007). The PCP group also received fewer medications (0.2 ± 0.5) than did the CP group (0.7 ± 1.2) at year two (p = 0.038). Post-operative complications were similar, and the most common complications were transient IOP elevation and hyphema in the PCP group (42.3%, 46.2%) and the CP group (38.5%, 23.1%) (p > 0.05).</p><p><strong>Conclusions: </strong>Compared to ab externo canaloplasty, penetrating canaloplasty had a greater surgical success rate and better IOP reduction with a comparable rate of complications.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142015979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phacoemulsification practices: A comprehensive analysis of the surgical landscape in Sweden 2021-2022.","authors":"Johan Ursberg, Madeleine Zetterberg, Andreas Viberg","doi":"10.1111/aos.16754","DOIUrl":"https://doi.org/10.1111/aos.16754","url":null,"abstract":"<p><strong>Purpose: </strong>This cross-sectional survey study aimed to explore the phacoemulsification techniques among Swedish cataract surgeons, and investigate the association between technique preferences and surgical outcomes, particularly posterior capsular rupture (PCR).</p><p><strong>Methods: </strong>A survey questionnaire was responded by 170 cataract surgeons and data from 192 494 cases, linked to the surgeons, were analysed from the Swedish National Cataract Registry (SNCR) for 2021-2022. Surgeons' demographic characteristics, surgical techniques and complications were assessed. Associations between surgical technique preferences and outcomes were analysed with binary logistic regression.</p><p><strong>Results: </strong>The chopping technique (stop and chop or direct chop) was favoured by 64.6% of surgeons, followed by divide and conquer (32.4%), and tilt and tumble (7.6%). Surgeons' annual caseloads varied widely (range 11-2687). No significant correlation was found between technique preference and PCR rates, which was consistently 0.5%-0.6% in all groups, except for a trend suggesting reduced risk with tilt and tumble. Mentoring activity (35.0%) and public surgical setting (40.3%) was highest in the direct chop group. Notably, 75% of the surgeries were performed by surgeons with more than 10 years' experience. Confounding factors, such as high-volume surgeons having a low frequency of complications, have been accounted for in a logistic regression.</p><p><strong>Conclusion: </strong>This study provides insights into cataract surgery practices in Sweden and suggests that surgeons can choose their preferred approach without significantly affecting complication rates. This research also underscores the need for continued exploration of surgical practices and their impact on patient outcomes, particularly in the case of the tilt and tumble technique, which is less commonly employed.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myopia dominance in preterm infants without and with retinopathy of prematurity: Indian Twin Cities ROP study (ITCROPS) report number 15.","authors":"Swapnil Thakur, Seema Kumari, Vishwa Sanghavi, Akash Belenje, Manjushree Bhate, Tapas Ranjan Padhi, Subhadra Jalali, Pavan K Verkicharla","doi":"10.1111/aos.16748","DOIUrl":"https://doi.org/10.1111/aos.16748","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the refractive error profile and progression in infants with different stages of ROP, without ROP, and those who received laser treatment for ROP.</p><p><strong>Methods: </strong>This retrospective study included the data from 838 infants (baseline mean age 3.7 ± 5.4 months) who had premature birth. Among these, 433 infants had one of the stages of ROP and 405 had no ROP. Infants with ROP were sub-divided into stage 1 (n = 76), stage 2 (n = 142), and stage 3 (n = 136) and aggressive posterior ROP, (APROP, n = 79). They were further categorized into those who received treatment (n = 213) and with no treatment for ROP (n = 220). Data from a subset of 117 infants was used to assess the 1-year change in the refractive error. Myopia was defined as spherical equivalent refraction (SER) <-0.50 diopters (D). Eyes with retinal detachment were excluded.</p><p><strong>Results: </strong>Higher percentage of myopia was found in infants with ROP (39.7%) than no-ROP (19.8%), and it increased with severity of ROP: stage 1: 19.7%, stage 2: 33.8%, stage 3: 45.6%, and 59.5% in APROP. Percentage of myopia doubled in those who underwent treatment for ROP (54.5%) compared to no-treatment group (25.5%). Mean (± SEM) change in SER after 1 year was significantly greater in infants with APROP -4.55 ± 1.38 D and stage 3 ROP -2.28 ± 0.57 D compared to other stages and no-ROP.</p><p><strong>Conclusion: </strong>Myopia was found to be more prevalent in preterm infants in general, and more in the presence of ROP. Preterm infants without or with any form of ROP, particularly those with severe form of ROP and those who received treatment require meticulous periodic refractive error assessment.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating optic neuropathies using laser speckle flowgraphy: Evaluating blood flow patterns in the optic nerve head and peripapillary choroid.","authors":"Chiaki Yamaguchi, Naoki Kiyota, Noriko Himori, Kazuko Omodaka, Satoru Tsuda, Toru Nakazawa","doi":"10.1111/aos.16747","DOIUrl":"https://doi.org/10.1111/aos.16747","url":null,"abstract":"<p><strong>Purpose: </strong>To compare blood flow (BF) impairment patterns in different optic neuropathies using laser speckle flowgraphy (LSFG).</p><p><strong>Methods: </strong>This retrospective study enrolled 24 eyes of 24 patients with non-arteritic anterior ischemic optic neuropathy (NAAION), 59 eyes of 59 patients with optic neuritis (ON), 677 eyes of 677 patients with open-angle glaucoma (OAG), and 110 eyes of 110 controls. The patient backgrounds of all groups were compared. Ophthalmologic findings were evaluated, adjusting for age, sex, blood pressure, pulse rate, and underlying systemic diseases with 1:1 optimal propensity score matching. We used LSFG to obtain optic nerve head (ONH) vessel-area mean blur rate (MBR; ONH-MV), ONH tissue-area MBR (ONH-MT), and choroidal MBR. The NAAION and ON groups were compared with the control and OAG groups.</p><p><strong>Results: </strong>Best-corrected visual acuity was worse in the NAAION, ON, and OAG groups than in controls (p < 0.001). Circumpapillary retinal nerve fibre layer thickness was higher in the NAAION and ON groups and lower in the OAG group than in controls (p < 0.001). Compared to controls, the NAAION and OAG groups had significantly lower ONH-MV, ONH-MT, and choroidal MBR (p < 0.05). Additionally, the NAAION group had lower ONH-MV and choroidal MBR than the OAG group (p = 0.003 and p < 0.001, respectively) but no difference in ONH-MT (p = 0.857). The ON group had significantly lower ONH-MV and choroidal MBR compared to the controls (p < 0.001 and p = 0.022, respectively) but no difference in ONH-MT (p = 0.773).</p><p><strong>Conclusion: </strong>Optic neuropathies showed different patterns of ocular BF impairment. Therefore, LSFG can be a useful tool for differentiating optic neuropathies.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing glaucoma risk in children receiving low-dose and high-dose glucocorticoid treatment after cataract surgery.","authors":"Diana Chabané Schmidt, Torben Martinussen, Ameenat Lola Solebo, Dorte Ancher Larsen, Daniella Bach-Holm, Line Kessel","doi":"10.1111/aos.16746","DOIUrl":"https://doi.org/10.1111/aos.16746","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery.</p><p><strong>Methods: </strong>This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.</p><p><strong>Results: </strong>Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.</p><p><strong>Conclusion: </strong>Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizations in Swedish cataract surgery - when resources are limited-Exemplified by the COVID-19 pandemic.","authors":"Ruben Kreku, Anders Behndig, Andreas Viberg","doi":"10.1111/aos.16749","DOIUrl":"https://doi.org/10.1111/aos.16749","url":null,"abstract":"<p><strong>Purpose: </strong>To study the prioritization effects of the of COVID-19 pandemic on Swedish cataract surgery using a national healthcare registry with high coverage.</p><p><strong>Setting: </strong>A study from the Swedish National Cataract Register (NCR), involving all patients undergoing cataract surgery in Sweden during 2019-2022 - before, during and after the COVID-19 pandemic.</p><p><strong>Results: </strong>With the pandemic outbreak, the number of cataract surgeries fell by 22% in 2020 (15 369 procedures), albeit with large regional differences (-43% to +58%). The numbers recovered in 2021, and in 2022, a new top notation was seen (n = 149 952). On a national level, the patients were younger (-0.46 years, p < 0.001), with a larger proportion of less difficult cases (p < 0.001) and the proportion of males was higher (p < 0.001) during the pandemic, but all these variables also differed substantially between different regions and clinics.</p><p><strong>Conclusion: </strong>A national registry with high coverage can map the consequences of an event disrupting elective surgery in detail. During the COVID-19 pandemic, the impact on Swedish cataract surgery varied largely between different regions, clinics, and healthcare providers, leading to inequality in the availability of surgery. These differences likely owed to variations in healthcare policy approaches in different parts of the country. The present study shows that outcomes at one clinic or region cannot be extrapolated to larger regions under these circumstances. It actualizes the need to aim for a healthcare on equal terms, but it also shows a system that delivers care to many despite difficult times.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}