Acta Ophthalmologica最新文献

{"title":"Evidence of the benefits of new types of optical corrections for myopia prevention?","authors":"Olavi Pärssinen","doi":"10.1111/aos.16890","DOIUrl":"https://doi.org/10.1111/aos.16890","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p>Over the past few decades, the prevalence of myopia has significantly increased, especially in East and Southeast Asian countries, where the prevalence of myopia in school leavers is now around 80%. The risk of myopia related complications such as myopic macular degeneration, retinal detachment, cataract, glaucoma, visual impairment and blindness, all increase with increased severity of myopia without any safe threshold of myopia for any of its known ocular complications.</p>\u0000 \u0000 <p>Various specially designed contact lenses and spectacle lenses has been developed to prevent myopic progression. The Orto-K treatment contact lenses are worn during the night to decrease the corneal refractive power so that during the day you can see far without optical correction. Peripheral hyperopic refraction is assumed to increase the progression of myopia. To correct the relative peripheral hyperopic refraction various contact lenses and glasses have been developed so that the central myopic refractive error is fully corrected and the peripheral refraction corrected to the direction of hyperopia in relation to the central correction.</p>\u0000 \u0000 <p>The main aims this presentation is to highlight the chalenges, related to conducting and reporting these studies, and with a few examples show differences between statistically significant and in practice significant treatment benefits.</p>\u0000 \u0000 <p>There is a large individual variation in the progression of myopia. Progression of myopia in two same aged myopics with the same myopia can significantly differ from each other. Myopia progresses generally more in the early stages. The most significant factors causing variation in myopia progression are parental myopia, time and intensity spent on near work, time spent outdoors, age of myopia onset, and change in refraction prior to the myopia examination point. Especially the wide range range in baseline refraction and age at the beginning of the research intervention makes reliable randomization challenging. Comparability would be improved if the randomisation to the treatment and control group could be carried out for example half or one year before beginning the treatment intervention. In this way, the potential effects of the natural progression of myopia in study groups could be taken into account.</p>\u0000 \u0000 <p>The the difference between treatment and control groups are often reported as percentage benefit, which actually does mean much. For example 50% benefit of treatment can be received from refraction canges 0.1 D vs 0.2 D, which is practicaly nothing or 1.0 D vs. 2.0. It is also important to report in what period of time the benefit of treatment occurs and when the treatment is no longer beneficial, instead of reporting about sustained benefit, when the changes between the groups do not change.</p>\u0000 \u0000 <p","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.16890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116492","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":"Isolated corneal intraepithelial neoplasia: An unheard variety","authors":"Luis Maria Carles-Cerban,&nbsp;Maria Noelia Moraña-Borrageiros,&nbsp;Andrea Alvarez-Novoa-Rodriguez-Cadarso,&nbsp;Roberto Alvarez-Rodriguez,&nbsp;Victoria De-Rojas-Silva","doi":"10.1111/aos.17336","DOIUrl":"https://doi.org/10.1111/aos.17336","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Aims/Purpose:</b> The purpose of this clinical case is to present the symptoms, as well as biomicroscopical, tomographical and histological findings of the isolated corneal intraepithelial neoplasia, a very rare variety of ocular surface squamous neoplasia.</p>\u0000 \u0000 <p><b>Methods:</b> We present the case of a 78-year-old woman with foreign body sensation in her right eye for four months. The cornea presented, apart from crocodile shagreen, a white patch in the temporal-inferior quadrant, separate from the limbus. This lesion showed punctate staining and contained a thin line of normal aspect. The optical coherence tomography (OCT) showed hyperreflective and thickened epithelium with sudden transition to normal cornea.</p>\u0000 \u0000 <p>On suspicion of corneal intraepithelial neoplasia, excisional biopsy was indicated, with Shields's non-touch technique, 2 mm surgical margins and absolute-alcohol application on the limbus.</p>\u0000 \u0000 <p>Furthermore, a review of the past 25 years literature has been performed, using the following key words: <i>corneal intraepithelial neoplasia</i>; <i>ocular surface squamous neoplasia</i>.</p>\u0000 \u0000 <p><b>Results:</b> The histological result showed a corneal intraepithelial neoplasia with non-assessable margins. One week after surgery, the defect had already been replaced by normal epithelium, and we added two cycles of co-adjuvant topical mitomycin C (0.04%). Two years after surgery, the patient is asymptomatic and with no signs of recurrence.</p>\u0000 \u0000 <p>Regarding the review, only 10 cases of isolated corneal intraepithelial neoplasia have been described in the past 25 years. No references of crocodile shagreen concurrence have been found, whereas there is some consensus of surgery as main treatment and OCT as useful diagnostic tool.</p>\u0000 \u0000 <p><b>Conclusions:</b> Isolated corneal intraepithelial neoplasia should always be included in differential diagnosis when it comes to a thickened and atypical lesion in the cornea. In this context, OCT can be useful, whereas final diagnosis and treatment should include excisional biopsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.17336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116512","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":"The polarity effect of direct current stimulation on the vascular regulation of the inner retina","authors":"Stefanie Freitag,&nbsp;Dietmar Link,&nbsp;Sascha Klee","doi":"10.1111/aos.17399","DOIUrl":"https://doi.org/10.1111/aos.17399","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Aims/Purpose:</b> Electrical stimulation is not only a suitable method for researching the human nervous system but also for treating neuronal disorders. In ophthalmology, it is applied to patients suffering from various retinal diseases like retinitis pigmentosa. It is known that in the application of direct current stimulation (DCS), the polarity of the current determines the increase or decrease in neuronal activity and enables different therapeutic approaches. However, the polarisation-dependent effect of the current on the vascular processes in the retina has not yet been investigated. This study examined the effect of anodal and cathodal DCS on the temporal vessels of the inner retina.</p>\u0000 \u0000 <p><b>Methods:</b> The study was conducted on 24 healthy subjects (14w, 10m, mean age 25.5 ± 3.2yr) who were randomly assigned to either an anodal or a cathodal DCS group (symmetrical design). To test the effect of the DCS (800μA; ring-shaped electrode placed surrounding the eye, square electrode placed at the occiput) on vascular regulation, the DCS was combined with visual flicker stimulation using the Dynamic Vessel Analyzer (DVA, Imedos Systems GmbH; standard protocol). Exclusion criteria were ocular and systemic diseases. We investigated two primary vessel segments (superior temporal artery (STa) and vein (STv)) located between 0.5 and 2.0 disc diameters from the optic disc. For each subject the DVA was performed two times (first baseline DVA1, followed by a 20-minute DCS (different polarity depending on the group), and directly afterwards a second DVA2). For statistical analysis, the t-test for paired samples was used and Bonferroni corrected.</p>\u0000 \u0000 <p><b>Results:</b> The mean vascular responses (STa/STv) for the anodal DCS group were DVA1: 3.7 ± 1.7%/3.4 ± 1.6%; DVA2: 3.5 ± 1.3%/5.4 ± 3.2% and for the cathodal DCS group DVA1: 3.2 ± 2.0%/4.0 ± 2.6%; DVA2: 3.2 ± 1.4%/2.5 ± 1.3%. For the venous vascular response, we found a significant increase after anodal DCS (<i>p</i> = 0.019) and a significant decrease after cathodal DCS (<i>p</i> = 0.018).</p>\u0000 \u0000 <p><b>Conclusions:</b> We were able to successfully determine the effect of different DCS polarities on the retinal vascular system. We found significant effects on the veins. The absence of effects on the arteries indicates different regulatory pathways in the retina. This should be investigated by further selective stimulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.17399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116519","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":"Investigating the temporal variability of the tear fluid proteome for biomarker discovery","authors":"Erika Ponzini,&nbsp;Carlo Santambrogio,&nbsp;Rita Grandori,&nbsp;Silvia Tavazzi","doi":"10.1111/aos.17020","DOIUrl":"https://doi.org/10.1111/aos.17020","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Aims/Purpose:</b> This study aims to investigate the intraday and day-to-day variability in the tear fluid proteome to better exploit its potential as a source of non-invasive biomarkers by assessing the consistency of tear protein abundance over time.</p>\u0000 \u0000 <p><b>Methods:</b> Tear protein composition was monitored in two individuals over three weeks. Tears were collected weekly, both in the morning and in the afternoon, by microcapillary tube sampling. Ultrahigh-resolution shotgun proteomics was used to analyze the tear fluid samples, providing a detailed profile of the tear proteome.</p>\u0000 \u0000 <p><b>Results:</b> The differential analysis of proteomics data provided a comprehensive overview of the tear fluid proteome. The majority of the identified proteins maintained consistent levels throughout the monitoring period. Specifically, only 25 proteins exhibited significant intraday variation, but no day-to-day fluctuation. These variations were observed in the morning and afternoon samples, indicating that while some proteins may be up- or downregulated within a day, the overall proteome remains largely stable.</p>\u0000 \u0000 <p>The proteins that showed significant variation included those involved in immune response, protein synthesis, and cellular stress response. These findings suggest that while the tear proteome is generally stable, certain proteins may be sensitive to external factors or physiological changes occurring throughout the day.</p>\u0000 \u0000 <p><b>Conclusions:</b> The stability of the tear proteome indicates its viability for non-invasive diagnostic applications, making it a promising source of biomarkers for personalized medical approaches. The study underscores the need for further research into the temporal variability of tear proteins to fully harness their potential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.17020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116523","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":"Molecular responses of the aging retina are sexually divergent in Ephx2−/− mice","authors":"Caroline Manicam,&nbsp;Elahe Zare,&nbsp;Norbert Pfeiffer,&nbsp;Natarajan Perumal","doi":"10.1111/aos.17097","DOIUrl":"https://doi.org/10.1111/aos.17097","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Aims/Purpose:</b> Aberrant molecular changes are a major driver of age-related retinopathies. Furthermore, sexual dimorphism is a key variable in disease predilection, although it is not well defined in preclinical studies. Among the potential targets for mitigating age-related proteome modifications attributed to vision impairment, we recently unraveled the protective effects of soluble epoxide hydrolase (sEH/ <i>Ephx2</i>) inhibition in glaucoma. Here, we hypothesized that molecular responses of the aging retina are also sexually divergent in the <i>Ephx2</i>^<i>-/-</i> (KO) mice.</p>\u0000 \u0000 <p><b>Methods:</b> Retinae were isolated from 160 young (3-5 months) and old (12-24 months) wild type (WT) and KO mice of both sexes. Samples were pooled (<i>n</i> = 5 mice/group/replicate) with 4 biological replicates per group and subjected to robust proteomic and bioinformatic analyses to elucidate the underlying mechanistic changes.</p>\u0000 \u0000 <p><b>Results:</b> We observed age- and sex-related body weight changes in mice of both sexes, with no significant differences between the WT and KO mice. Proteome profiling showed significant (<i>p</i> &lt; 0.05) differential expression of proteins between the genders, with a significant involvement in the eIF2 and ferroptosis signaling pathways in both sexes. Remarkably, the female sex exhibited striking resilience against ferroptosis, while the male counterpart demonstrated profound activation of this pathway in both WT (<i>p</i> = 4.2×10^-4; z-score: 1.3) and KO mice (<i>p</i> = 4.2×10^-4; z-score: 2). Intriguingly, aged WT females were highly susceptible to retinal diseases (<i>p</i> = 9.6×10^-4) and neurodegeneration (<i>p</i> = 9.9×10^-4), but KO significantly regulated proteins related to synaptogenesis (<i>p</i> = 3.8×10^-2) and neurotransmission (<i>p</i> = 1.7×10^-2). In addition, KO significantly activated neuritogenesis (<i>p</i> = 5.4×10^-5) and cell-cell contact (<i>p</i> = 1.2×10^-3) in both sexes. It is noteworthy that a major upstream transcription regulator, X-box binding protein 1 (XBP1), which is responsible for maintaining protein homeostasis by ameliorating ER stress, was found only in aged male retinae (WT: <i>p</i> = 3.9×10^-4; KO: <i>p</i> = 8.1×10^-3).</p>\u0000 \u0000 <p><b>Conclusions:</b> Taken together, we showed for the first time a sex-related trend in the proteome of aging KO retina, which is crucial for understanding the pathomechanistic underpinnings of age-related retinal diseases and potential targeted intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.17097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116529","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":"Effectiveness of intravitreal antitNF-ALFA for neuroinflammation control and neuroprotection in experimental rabbit glaucoma model","authors":"Okyanus Bulut Tarlabolen,&nbsp;Mine Esen Baris,&nbsp;Emrah Soylu,&nbsp;Banu Yaman,&nbsp;Timur Kose,&nbsp;Suzan Guvenyilmaz","doi":"10.1111/aos.17102","DOIUrl":"https://doi.org/10.1111/aos.17102","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Aims/Purpose:</b> The aim of the study is to create a microbead induced ocular hypertension (OHT) model in rabbits, and to evaluate the effects of intravitreal and intraperitoneal injections of Adalimumab (ADA) on the number of retinal ganglion cells (RGC), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness.</p>\u0000 \u0000 <p><b>Methods:</b> 15 rabbits of mixed strain (9–12 months old, 3.5-4kg) were randomized into 4 groups. OHT was induced with microbead injection into the anterior chamber of right eyes. On 7th, 14th days of OHT, ADA was injected at one of two concentrations (2.5mg group 1: G1/5mg group 2:G2) into right eyes of two groups, intraperitoneally 5mg/kg into the third group (G3), and balanced salt solution into fourth group (sham). The left eyes were used as controls. At 40^th day, the rabbits were euthanized. Retinal and optic nerve head (ONH) histology was studied with hematoxylin-eosin and toluidine blue staining.</p>\u0000 \u0000 <p><b>Results:</b> OHT was induced with microbeads in 13 eyes. 2 rabbits were excluded (endophthalmitis, total hyphema). The average pre-OHT IOP from all eyes 9.7±09mmHg (8-11). Statistically significant IOP increase was observed in all subject eyes on day 7 (14±1.4 (12-18)) (<i>p</i> = 0.01) and maintained until ADA injection (day 21). RGCs in the eyes with elevated IOP were 7.2±1.2 and 7.6±1.5, 6.3+1.1 cells in ADA treated groups, G1, G2, G3, respectively. There was no statistically significant difference between treatment groups. The average RNFL was 125.9±10.9 μm in control, 60.2±9.4 μm in G1, 45.7±2.9 μm in G2, 22.8±2.9 μm in G3, 21.7±10 μm in sham. Significant elevation was observed in G1 compared to all treatment groups. (<i>p</i> = 0.01). The average GCC of control was 45.5±1.9 μm, G1 41.2±2.2 μm, G2 39.3±3.3 μm, G3 34.1±1.6 μm, sham was 38.3±1.1 μm. Significant increase was observed in G1 compared to G3. (<i>p</i> = 0.01).</p>\u0000 \u0000 <p><b>Conclusions:</b> OHT triggers inflammatory response in which TNF-α expression is increased around the ONH. Blocking TNF-α might prevent axonal degeneration and RGC loss by inhibiting this response. These findings may further contribute to the literature for a new treatment strategy for glaucoma using TNF-α antagonists or inflammation suppressors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.17102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116536","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":"Intravitreal anti-vegf agents and combination treatment in proliferative diabetic retinopathy","authors":"Maciej Gawęcki","doi":"10.1111/aos.16882","DOIUrl":"https://doi.org/10.1111/aos.16882","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p>Proliferative diabetic retinopathy (PDR) poses as a significant threat to patient's vision if untreated or treated insufficiently. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. The advent of anti-VEGF therapy provided an additional option for the management of this condition. The aim of the presentation is to present the effects of anti VEGF treatment in PDR with special emphasis on the combination: PRP with anti-VEGF therapy. Results of treatment with these modalities, especially regression of neovascularization, together with the incidence of potential complications will be discussed. Additional aspects of such therapy, such as BCVA improvement and central retinal thickness reduction will also be presented. Potential indications for such treatment will be outlined as well as possible treatment schedules for such management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.16882","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116551","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":"Development of resources for training machine learning systems for the eye","authors":"Salil A. Lachke","doi":"10.1111/aos.16867","DOIUrl":"https://doi.org/10.1111/aos.16867","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p>Regulation of distinct molecular pathways in coordinately developing tissues drives eye development. This process involves factors in signaling, transcription, translation and post-transcriptional control that together determine the proteome of individual cells. Characterizing these regulatory events and their relationships with each other in distinct ocular tissues will lead to the derivation of gene regulatory networks (GRNs) for eye development, which in turn will allow building of the “developmental oculome” (Lachke, Maas (2010) Wiley Interdiscip Rev Syst Biol Med 2(3):305-323 doi: 10.1002/wsbm.59). Toward this goal, we generated and analyzed various omics datasets on developing eye tissues, performed functional characterization of key molecules, and developed a web resource called iSyTE (Anand, Lachke (2017) Exp Eye Res 156:22-33 PMC5026553; Kakrana et al (2018) Nucleic Acids Res 46(D1): D875-D885 doi: 10.1093/nar/gkx837; Lachke (2022) Exp Eye Res 214:108889 PMC8792301). To extract further insights from these omics data, it is necessary to analyze them in the context of experimentally verified data on the eye. These data can be used for training machine learning systems to develop models for eye development. The data used for training represents a an important factor in machine learning systems, i.e. the quality of these data is a key contributor that determines the robustness of the resulting models. There is a wealth of molecular functional (i.e. experimental evidence-based) data on the eye that has been generated by researchers worldwide over the past several decades. These individual regulatory data “nodes” (regulators and targets) – currently “static” in the literature with limited connectivity – hold rich potential to define detailed, and importantly, experimentally validated GRNs that can be used for training machine learning systems. As proof of principle, we have focused on ocular lens development and curated mechanistic data from individual gene perturbation evidences in the mouse from &gt;100 original research articles. This has led to definition of thousands of experimentally validated relationships (edges) between key factors and their targets (nodes) in lens development. These resources serve as strong foundational data for training machine learning systems and represent the essential first step toward advancing our understanding of the natural computing governing eye development, and how its perturbation results in ocular developmental disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.16867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116579","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":"Dalk – when and how","authors":"Mohamed Goweida","doi":"10.1111/aos.16861","DOIUrl":"https://doi.org/10.1111/aos.16861","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p>Deep anterior lamellar keratoplasty (DALK) is a surgical procedure that involves replacing the anterior portion of the cornea with donor tissue while preserving the patient's endothelium. This technique has gained popularity in recent years as an alternative to traditional penetrating keratoplasty (PK) due to its potential advantages in terms of visual outcomes, graft survival and reduced risk of endothelial rejection.</p>\u0000 \u0000 <p>The decision to perform DALK in keratoconus is based on various factors, including the keratometric readings, corneal thickness, corneal clarity and RGP tolerability.</p>\u0000 \u0000 <p>Surgical technique plays a critical role in the success of DALK. Several approaches have been described to perform the DALKs; the big bubble technique is considered the most convenient for all surgeons. Other techniques were used according to the associated pathology.</p>\u0000 \u0000 <p>This presentation is a quick journey into DALK indications and various techniques used in eyes with keratoconus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.16861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116581","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":"Early vitrectomy in the management of diabetic macular oedema","authors":"Odysseas Georgiadis","doi":"10.1111/aos.16873","DOIUrl":"https://doi.org/10.1111/aos.16873","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;p&gt;Diabetic macular oedema (DMO) poses a significant challenge in the management of diabetic retinopathy (DR), contributing to substantial visual impairment in diabetic patients. Over the years, vitrectomy has emerged as a valuable surgical approach in the armamentarium against DMO, and has evolved to play a pivotal role in addressing cases refractory to conventional therapies, either as a standalone or as adjunctive therapy. The rationale behind this approach lies in the ability of vitrectomy to directly remove the vitreous scaffold, which is implicated in the pathogenesis of DMO via two basic mechanisms, the tractional and the biochemical.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Vitrectomy can eliminate both the anterior-posterior traction caused by the vitreous, and the tangential forces on the macula, caused by epiretinal membranes, both common contributors to DMO. Clearance of the vitreomacular interface alleviates the mechanical stress on the macula, leading to improvements in central retinal thickness and visual acuity. Furthermore, improved visualisation of the macula facilitates the monitoring and management of the DMO and the DR in the long term.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;In terms of the biochemical component, vitrectomy can play a significant role in modulating oxygen consumption of the vitreous and alleviating retinal hypoxia. The vitreous humour serves as a conduit for oxygen diffusion to the avascular inner retina. In diabetic eyes, vitreous liquefaction and retinal vascular deficiency disrupt oxygen transport, exacerbating retinal hypoxia and promoting VEGF production and neovascularisation. Studies have shown that vitrectomy can increase the oxygen delivery to the retina and improve the perifoveal capillary blood flow. Oxygen is known to suppress VEGF, and thus reduce vascular permeability leading to DMO improvement. Moreover, recent studies have shown that removal of the vitreous reduces the levels of histamine, VEGF, and free radicals in the preretinal space. Additionally, the foveal avascular zone has been shown to decrease after vitrectomy, which might indicate a protective effect on DMO, similar to anti-VEGF injections.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;However, the exact mechanisms by which vitrectomy may improve DMO are not yet fully understood, neither is the prognosis for post-operative visual improvement. The functional outcomes in different studies are very heterogenous and vary from significant vision gain to no improvement despite good anatomical results. The preoperative integrity of the external limiting membrane and the pre-existing damage to the outer retina often limit the outcome. Additionally, a subretinal fluid component of DMO seems to affect the visual prognosis, while the advantage of inner limiting membrane peeling, in the cases of non-tractional DMO, remains controversial, as there is no substantial data available to clarify its efficacy.&lt;/p&gt;\u0000 ","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":"103 S284","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/10.1111/aos.16873","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143116585","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}