American Journal of Ophthalmology最新文献

{"title":"Analysis of Spaceflight-Associated Biometric and Refractive Changes in Astronauts.","authors":"Alexander A Svoronos, Cambria S O'Grady, Evan Walker, Natalie A Afshari, Brandon R Macias, Steven S Laurie, Robert N Weinreb, Alex S Huang","doi":"10.1016/j.ajo.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.001","url":null,"abstract":"<p><strong>Purpose: </strong>To study changes in ocular biometry and refraction in the largest cohort to date of astronauts who have experienced long-duration spaceflight on the International Space Station (ISS).</p><p><strong>Design: </strong>A prospective cohort study.</p><p><strong>Participants: </strong>29 astronauts METHODS: Preflight and postflight cycloplegic refraction and ocular biometry measurements were obtained from 56 eyes among 29 subjects. For each eye, the preflight-to-postflight changes in spherical equivalent (SE), axial length (AL), average corneal curvature (K), and anterior chamber depth (ACD) were calculated. The Fyodorov and Olsen-C formulas were used to estimate the relative contribution of each biometric parameter individually to the total change in SE. A linear mixed-model approach was used to assess the relationships between refraction measurements, biometric parameters, optic disc edema, and duration on the ISS.</p><p><strong>Main outcome measures: </strong>Preflight-to-postflight changes in spherical equivalent, axial length, average corneal curvature, and anterior chamber depth.</p><p><strong>Results: </strong>27/56 (48.2%) eyes underwent a hyperopic shift, 8/56 (14.3%) underwent a myopic shift, and 21/56 (37.5%) eyes had no measurable change in SE. On average, this equated to a mild hyperopic shift of +0.12 D (95% CI, +0.02 to +0.22 D) that arose from a decrease in AL of -0.09 mm (95% CI, -0.14 to -0.04 mm), mitigated by a shortening in ACD of -0.09 mm (95% CI, -0.12 to -0.06 mm). Changes in K were variable and had little contribution to SE changes at the group level but often showed substantial change at the individual level. Statistical modeling revealed the greatest predictor for refractive change was baseline preflight refraction (P = 0.034), with myopic individuals experiencing the largest hyperopic shifts (and never a myopic shift) and baseline hyperopic individuals experiencing variable myopic to mildly hyperopic shifts.</p><p><strong>Conclusions: </strong>Spaceflight is associated with decreases in AL and ACD and variable changes in K. On average, these changes result in a mild hyperopic shift in SE, although myopic shifts can be observed at the individual level. Prior reports of greater hyperopic shift may be a result of subjects being more myopic at baseline.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comment on: Intraocular Lens Power Calculation - Comparing Big Data Approaches to Established Formulas.","authors":"Liam D Redden, Birgit Grubauer, Peter Hoffmann, Achim Langenbucher, Kamran M Riaz, Damien Gatinel, Helga Wagner, Jascha A Wendelstein","doi":"10.1016/j.ajo.2025.03.045","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.045","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Intraocular Lens Power Calculation - Comparing Big Data Approaches to Established Formulas.","authors":"Mohammad Reza Baghiyan Zarchi, Mohammad Erabi, Ali Hosseini","doi":"10.1016/j.ajo.2025.03.047","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.047","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Properties Measured with Dynamic Scheimpflug Analyzer in Myopic Maculopathy.","authors":"Kazuki Yashiro, Shuichiro Aoki, Kohdai Kitamoto, Takahiro Arai, Keiko Azuma, Tatsuya Inoue, Ryo Asaoka, Ryo Obata","doi":"10.1016/j.ajo.2025.03.046","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.046","url":null,"abstract":"<p><strong>Purpose: </strong>Corneal biomechanical properties are associated with axial elongation. We aimed to characterize corneal biomechanical properties in highly myopic eyes with myopic maculopathy (MM).</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Methods: </strong>We included patients examined between June 2022 and August 2023, who underwent corneal visualization Scheimpflug technology (Corvis ST) measurements. MM in highly myopic eyes (axial length >26.0 mm) was evaluated using META-PM classification based on fundus photographs with subfoveal choroidal thickness measured via spectral domain OCT. A linear mixed model was used to analyze the association of MM features with axial length (AL) and corneal biomechanical parameters, followed by model selection using the second order-corrected Akaike Information Criterion.</p><p><strong>Results: </strong>We included 189 eyes from 109 participants. A significant correlation was observed between AL and biomechanical parameters that characterize maximal corneal deformation (deflection amplitude max and peak distance) and stiffness parameter (stress-strain index) (P < 0.05). Model selection revealed that both AL and deflection amplitude max were independently associated with MM with category ≥2 severe, as well as with subfoveal choroidal thickness in highly myopic eyes (AL > 26.0 mm).</p><p><strong>Conclusion: </strong>In highly myopic eyes, a greater deflection amplitude max was identified as a risk factor for MM. Corneal biomechanical properties may serve as biomarkers for predicting the development and progression of MM.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size Matters.","authors":"Sanjay Asrani, Ki Ho Park","doi":"10.1016/j.ajo.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.042","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the ideal size of a laser iridotomy and discuss its importance.</p><p><strong>Design: </strong>Perspective.</p><p><strong>Methods: </strong>Articles in ophthalmology literature on this topic were reviewed, and commentary is provided based on the authors' experiences.</p><p><strong>Results: </strong>An ideal laser iridotomy size is 200 microns and larger, especially in eyes with uveitis. The final size of an iridotomy must be confirmed after the effects of the pilocarpine has worn off and the pupil is not being constricted by light. A location of the iridotomy furthest from the lid margin may reduce the chances of dysphotopsias and thus allow for an adequately sized iridotomy.</p><p><strong>Conclusion: </strong>An iridotomy of an ideal size is needed to reduce the pressure differential on both sides of the iris so as to be effective in eliminating pupillary block.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant transformation of ocular melanocytoma to uveal melanoma: a clinicopathologic review of three novel unsuspected cases of a likely under-recognized phenomenon, with review of the literature and molecular genetic data.","authors":"Fabliha A Mukit, Nicole Terfloth, Ivana K Kim, Frances Wu, Anna M Stagner","doi":"10.1016/j.ajo.2025.03.044","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.044","url":null,"abstract":"<p><strong>Purpose: </strong>To describe 3 cases of, and review the current knowledge regarding, malignant transformation of ocular melanocytoma (OM) to uveal melanoma (UM).</p><p><strong>Design: </strong>Retrospective clinicopathological case series and review of the literature.</p><p><strong>Methods: </strong>Clinical records and histopathology from 3 patients diagnosed with UM arising from a previously unsuspected OM were critically reviewed at a single academic institution. The patients' demographic information, medical history, presenting clinical signs and symptoms, laboratory results, ancillary (including molecular genetic) testing, and management were collected. A literature review was conducted.</p><p><strong>Results: </strong>Three novel cases were identified, totaling 18 reported cases of malignant transformation of an OM to UM. The three novel cases were diagnosed histopathologically on enucleation specimens for UM, without prior clinical history of OM. Where demographic information was available, 10 patients were female and 6 males, and the average age at presentation was 45.75 years (range 15-69 years). For patients with an initial clinical diagnosis of OM, the interval to diagnosis of melanoma was between 0.25 years and 33 years, with the most common symptoms of evolution to UM being progressive vision loss, ocular pain, and elevated intraocular pressure. Six total cases did not have a previously known history of melanocytoma.</p><p><strong>Conclusion: </strong>OM is rare; malignant transformation of OM to UM is also very uncommon. The incidental histopathological observation of darkly pigmented, polyhedral, magnocellular cells adjacent to or admixed with frank melanoma resulted in immunohistochemical confirmation of a precursor OM in 3 novel cases, mimicking somewhat the appearance of UM with abundant admixed melanophages. OM may be a precursor to UM in more instances than previously suspected, and further data, as well as attention by pathologists, is needed to refine diagnosis and clinical management strategies regarding patients with known OM, especially outside of the optic nerve head.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Medicine Approach to Navigating Barriers to the Diagnosis of Pediatric Neurotrophic Keratopathy.","authors":"Shadia Tannir, Chilando Mulenga, Khoa Tran, Asim Ali, Charline Boente, Gregory H Borschel","doi":"10.1016/j.ajo.2025.03.043","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.043","url":null,"abstract":"<p><strong>Objective: </strong>Neurotrophic keratopathy (NK) is a rare disease characterized by the loss of corneal innervation and increased vulnerability to injury. The diagnosis and treatment of NK can be challenging for pediatric patients and their caregivers. This study explores the experiences of caregivers navigating the diagnostic and treatment journey of pediatric patients with neurotrophic keratopathy.</p><p><strong>Design: </strong>This study is a qualitative study using semi-structured interviews.</p><p><strong>Subjects: </strong>Ten caregivers of pediatric patients with NK who had undergone corneal neurotization (CN) surgery.</p><p><strong>Methods: </strong>Caregivers were interviewed about their experiences related to the diagnostic process, treatment challenges, lifestyle changes, and the impact of CN surgery. Interviews were recorded, transcribed, and analyzed using an inductive-deductive approach to identify recurring themes.</p><p><strong>Main outcomes: </strong>Caregiver experiences and perceptions of diagnostic delays, information-seeking behaviors, lifestyle changes, and the effects of CN surgery on corneal health and quality of life.</p><p><strong>Results: </strong>Five key themes emerged from the analysis: (1) Delays in diagnosis due to insufficient specialist knowledge; (2) Caregivers' proactive efforts in seeking information; (3) Substantial lifestyle changes required by NK; (4) The impact of CN surgery on corneal health and quality of life; and (5) Variability in healthcare experiences, highlighting the need for effective communication. Caregivers expressed frustration with diagnostic delays and highlighted their reliance on external support networks.</p><p><strong>Conclusions: </strong>This study illustrates the need for enhanced awareness among clinicians about NK and the benefits of narrative medicine in fostering caregiver-provider relationships. The challenges reported by families navigating NK inform strategies that may improve diagnosis and treatment of NK.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choroidal Vascular Occlusion after Fat Injection into the Temple Area.","authors":"Chuanzhen Zheng, Chunxiu Li, Jie Zhong","doi":"10.1016/j.ajo.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.041","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of corneal power assessment methods for true corneal power after myopic small-incision lenticule extraction.","authors":"Xiaoling Fang, Chunxia Yu, Wenwen Xue, Jinhua Tao, Wenbo Yao, Liquan Zhao, Yulan Wang","doi":"10.1016/j.ajo.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.026","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to compare the accuracy of different corneal curvature parameters in estimating corneal power change in eyes that underwent myopic small-incision lenticule extraction (SMILE).</p><p><strong>Design: </strong>Prospective cross-sectional trial.</p><p><strong>Methods: </strong>89 eyes of 48 patients who had undergone SMILE at Shanghai Eye Disease and Prevention&Treatment Center were enrolled. Total corneal refractive power (TCRP) and total keratometry (TK) values, along with corrected parameters calculated using the Haigis, Shammas, Maloney, and Actual Ka+p methods, were compared with data obtained using the clinical history method (CHM). We also compared the surgically induced changes in TCRP (ΔTCRP) and TK (ΔTK) to changes in the spherical equivalent on the corneal plane (ΔSEco).</p><p><strong>Results: </strong>After SMILE, differences were smallest between values of TK (0.41± 0.48 D) and CHM. The width of the 95% limits of agreement of TK (1.88 D) was narrowest, followed by that of Ka+p (1.94 D). Pearson analysis showed that each parameter had a good correlation with CHM data. The differences between ΔTK and ΔSEco was 0.42D, when between ΔTCRP and ΔSEco was 0.62D. The width of the 95% limits of agreement of ΔTK (1.88 D) and the correlation coefficient of ΔTK (0.964) were greater than those of ΔTCRP. A separate case of cataract surgery following SMILE confirmed the validity of the above points in our study (the absolute error was 0.005 D).</p><p><strong>Conclusion: </strong>The TK parameter of the IOLMaster 700 can provide accurate and objective corneal power evaluation after SMILE.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends in Central Retinal Artery Occlusion Presentations and Stroke Workup in United States Emergency Department.","authors":"Sinan Akosman, Sean Yuan, Arnold Leigh, Renxi Li, Renjie Luo, Masumi G Asahi, Kapil Mishra","doi":"10.1016/j.ajo.2025.03.040","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.040","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate trends in acute central retinal artery occlusion (CRAO) diagnostic assessments and sociodemographic characteristics of patients in the United States (US) emergency department (ED).</p><p><strong>Design: </strong>Retrospective trend study.</p><p><strong>Subjects: </strong>Adult patients with CRAO presenting to ED from 2016 through 2021.</p><p><strong>Methods: </strong>The National Emergency Department Sample (NEDS) was queried with International Classification of Diseases, Tenth Revision (ICD-10) codes with a primary diagnosis of CRAO. Stroke workup modalities assessed included brain imaging (CT/CTA and MRI/MRA), carotid imaging (US, CTA, MRA), cardiac diagnostics (Echocardiogram/ECG), and laboratory workup (ESR/CRP).</p><p><strong>Main outcome measure: </strong>Proportion of studied participants receiving stroke workup modalities.</p><p><strong>Results: </strong>3,736 patients were identified with mean age of 69 [13.72] years, majority were male (53.02%), and predominantly insured by Medicare (62.77%). Comorbidities included hypertension (75.45%), hyperlipidemia (44.67%), coronary artery disease (20.26%), diabetes (27.38%), and obesity (11%). CRAO incidence significantly increased over the five-year period from 1,698 to 3,526 (p=0.024). Utilization rates of all workup modalities including brain imaging, carotid imaging, heart, and laboratory tests showed a linear increase from 2016 through 2021. The proportion of patients receiving no stroke workup decreased from 66.75% to 57.87% (p=0.259).</p><p><strong>Conclusions: </strong>The US has increased the screening and stroke workup of CRAO in the ED over time, yet greater than 50% of patients continue to not receive any type of stroke workup imaging. Greater awareness of these trends and current guidelines could result in improved screening and patient outcomes.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}