American Journal of Ophthalmology最新文献

{"title":"Long-Term Refractive Changes After Pediatric Cataract Surgery: An Average Follow-up of 15 Years","authors":"Tetsuro Oshika ,&nbsp;Sachiko Nishina ,&nbsp;Sawako Ura ,&nbsp;Mai Miyagi ,&nbsp;Koji Nomura ,&nbsp;Takafumi Mori ,&nbsp;Naoko Matsuki ,&nbsp;Takao Endo ,&nbsp;Daijiro Kurosaka ,&nbsp;Kazuno Negishi ,&nbsp;Shigeo Yoshida ,&nbsp;Toshiyuki Nagamoto","doi":"10.1016/j.ajo.2025.05.035","DOIUrl":"10.1016/j.ajo.2025.05.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate long-term refractive changes following pediatric cataract surgery.</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Methods</h3><div>A total of 451 eyes from 273 patients who had undergone cataract surgery at age 6 years or younger (mean 1.8 ± 1.8 years) were analyzed, with a mean follow-up of 15.0 ± 2.5 years (range: 12-18 years). The cohort included 120 cases with bilateral aphakia, 58 cases with bilateral pseudophakia, 40 cases with unilateral aphakia, and 55 cases with unilateral pseudophakia.</div></div><div><h3>Results</h3><div>In eyes that underwent surgery at or before age 2, the median myopic shift was –8.2 D (interquartile range: –11.0 to –5.0 D) in the bilateral aphakia group and –11.2 D (–16.4 to –6.6 D) in the bilateral pseudophakia group, while the median changes in anisometropia (refractive difference between the operated and healthy contralateral eyes) were –8.0 D (–15.3 to –1.2 D) in the unilateral aphakia group and –10.6 D (–14.8 to –4.4 D) in the unilateral pseudophakia group. In eyes that were operated on after age 2, the median myopic shift was –3.7 D (–6.7 to –0.0 D) in the bilateral aphakia group and –5.7 D (–8.6 to –2.8 D) in the bilateral pseudophakia group, while the median changes in anisometropia were –5.1 D (–8.3 to –2.4 D) in the unilateral aphakia group and –6.5 D (–8.8 to –4.1 D) in the unilateral pseudophakia group.</div></div><div><h3>Conclusions</h3><div>Refractive changes following pediatric cataract surgery were greater in eyes that underwent surgery at a younger age. In cases operated on at or before 2 years of age, median myopic shifts (in bilateral cases) or anisometropic changes (in unilateral cases) ranged from –8 to –11 D in both aphakic and pseudophakic groups over an average follow-up period of 15 years.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 305-312"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186288","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":"The Relationship of Hydroxychloroquine Retinopathy Progression to Stage at Cessation of Therapy","authors":"David J. Browning ,&nbsp;Donnie R. Koonce ,&nbsp;Akshay Mentreddy ,&nbsp;Omar Punjabi","doi":"10.1016/j.ajo.2025.05.030","DOIUrl":"10.1016/j.ajo.2025.05.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the progression of hydroxychloroquine retinopathy (HCR) from the time of drug cessation to the last follow-up.</div></div><div><h3>Design</h3><div>Retrospective, consecutive case series</div></div><div><h3>Subjects</h3><div>17 patients with HCR in whom drug was stopped and follow-up maintained.</div></div><div><h3>Methods</h3><div>Charts, visual fields, and retinal images were reviewed. Four ancillary studies were investigated: 10-2 visual fields (10-2 VF), multifocal electroretinography (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) imaging. Retinopathy was graded as none, early, and advanced.</div></div><div><h3>Main Outcome Measures</h3><div>Progression of retinopathy by the four test methods.</div></div><div><h3>Results</h3><div>Of the 17 patients, the numbers with at least two follow-up studies to allow comparison for progression were 17, 8, 16, and 9 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Median follow-ups were 25, 22, 41, and 37 months for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with no retinopathy at drug cessation that progressed were 0/0, 3/5, 0/0, and 2/6 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with early retinopathy that progressed were 4/6, 0/6, 2/15, and 3/7 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with advanced retinopathy that progressed were 16/20, 0/5, 10/17, and 5/5 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Progression of retinopathy was seen in cases without retinal pigment epithelium loss at the time of drug cessation. Not all ancillary studies show retinopathy at the time of diagnosis of HCR. Multifocal ERG shows a floor effect. Once response densities are low, detecting further progression of toxicity by this modality is not possible. A greater breadth of retinopathy progression is possible with 10-2 VF, SD-OCT, and FAF.</div></div><div><h3>Conclusions</h3><div>If HC is stopped when decreased reflectivity of the parafoveal ellipsoid zone is detected by SD-OCT, the probability of retinopathy progression is low. The cut point at which progression of retinopathy is acknowledged to be likely despite drug cessation needs to be moved earlier to discontinuity of the ellipsoid zone.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 335-348"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186290","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":"Explainable Deep Learning System for Automatic Detection of Thyroid Eye Disease Using Facial Images","authors":"Xiaodan Sui ,&nbsp;Kenneth Ka Hei Lai ,&nbsp;Richard Wai Chak Choy ,&nbsp;Han Wang ,&nbsp;Karen Kar Wun Chan ,&nbsp;Fatema Mohamed Ali Abdulla Aljufairi ,&nbsp;Yuanjie Zheng ,&nbsp;Wilson Wai Kuen Yip ,&nbsp;Alvin Lerrmann Young ,&nbsp;Clement Chee Yung Tham ,&nbsp;Chi Pui Pang ,&nbsp;Hongsheng Li ,&nbsp;Kelvin Kam Lung Chong","doi":"10.1016/j.ajo.2025.05.022","DOIUrl":"10.1016/j.ajo.2025.05.022","url":null,"abstract":"<div><h3>Purpose</h3><div>To report an explainable deep learning (XDL) system to automatically detect thyroid eye disease (TED) using facial images.</div></div><div><h3>Design</h3><div>Prospective study to develop and evaluate a deep-learning diagnostic algorithm.</div></div><div><h3>Methods</h3><div>A dataset consisting of 302 and 289 facial images of newly diagnosed, treatment-naïve, TED patients and healthy subjects were compiled, annotated, and applied to train the XDL model. It consisted of a periocular landmarks localization network that identified the periocular landmarks on facial images, and the TED detection network (TDN) that uses a binary classification to detect TED using facial images. The generalizability of the XDL system was evaluated using a threefold cross-validation strategy and further validated using 100 facial images of TED patients from an independent thyroid eye clinic.</div></div><div><h3>Results</h3><div>The area under the receiver operating characteristic curve was 99.7%, sensitivity 99.7%, and specificity 94.5% (95% confidence interval: 99.6%-99.9%). Heatmaps demonstrated upper and lower eyelids as key regions of interest. The validation cohort achieved area under the receiver operating characteristic curve of 98.9%, sensitivity 92%, and specificity 93%.</div></div><div><h3>Conclusions</h3><div>This XDL system detected TED using facial images with excellent accuracy and explainability. It should be further evaluated in prospective Graves’ disease cohorts at nonspecialist setting for early detection and referral of progressive TED.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 323-334"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180045","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":"Catering to the Era of Gene Therapy: An Objective Staging Strategy for Bietti Crystalline Dystrophy using Principal Component Regression","authors":"Chenyue Hang ,&nbsp;Ting Zhang ,&nbsp;Zhixuan Chen ,&nbsp;Tianyuan Zhao ,&nbsp;Junran Sun ,&nbsp;Tong Li ,&nbsp;Xiaoling Wan ,&nbsp;Yuanyuan Gong ,&nbsp;Suqin Yu ,&nbsp;Huixun Jia ,&nbsp;Jieqiong Chen ,&nbsp;Xiaodong Sun","doi":"10.1016/j.ajo.2025.05.018","DOIUrl":"10.1016/j.ajo.2025.05.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To devise a novel and objective staging strategy of Bietti crystalline dystrophy (BCD) for gene therapy.</div></div><div><h3>Design</h3><div>Development and validation of severity and staging assessments.</div></div><div><h3>Methods</h3><div>We screened out 127 BCD patients from a cohort of 2146 patients with inherited retinal diseases (IRDs). Our study analyzed 6 critical indicators: age, LogMAR BCVA, absent autofluorescence (AF) area, mottled AF area, and average retinal thickness in ETDRS 1 mm circle and 3 mm ring. Using Principal Component Regression (PCR), we developed a quantitative model termed the Bietti Crystalline Dystrophy Score for Severity Assessment (BCD-SA Score), integrating indicators for disease severity. Additionally, a corresponding staging system (BCD-SA Stage) was derived from this model. We assessed the efficacy of the BCD-SA Stage, comparing it to the traditional staging strategy through a paired-sample t-test and Cohen's Kappa (κ) for agreement evaluation.</div></div><div><h3>Results</h3><div>The patients’ mean age was 47.96 ± 10.1 years. Spearman correlation analysis and univariate linear regression demonstrated a strong correlation between all indicators and the disease stages defined by the traditional method (<em>P</em> &lt; .001). Principal Component Analysis (PCA) addressed the multicollinearity among indicators, extracting 2 linear uncorrelated principal components (PCs, Factor 1 and Factor 2). These PCs were then used in a multiple linear regression model to develop the BCD-SA Score. Subsequently, a novel and objective staging system (BCD-SA Stage) was created, providing a more precise disease delineation.</div></div><div><h3>Conclusions</h3><div>We developed an innovative and objective scoring and staging strategy for BCD by integrating 6 variables and utilizing the PCR approach. This strategy advances BCD assessment and serves as a benchmark for the natural history evaluation and staging of other IRDs.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 269-279"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180535","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":"Deep Anterior Lamellar Keratoplasty With Manual Stromal Dissection for Descemetocele: A Technique for Endothelium Preservation.","authors":"Nilay Kandemir Besek, Sibel Ahmet","doi":"10.1016/j.ajo.2025.05.026","DOIUrl":"10.1016/j.ajo.2025.05.026","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179618","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":"Hormonal Contraception and Retinal Vascular Occlusion Risk","authors":"SIAR NIAZI ,&nbsp;FILIP GNESIN ,&nbsp;BAKER NAWFAL JAWAD ,&nbsp;ZIA NIAZI ,&nbsp;ELLEN LØKKEGAARD ,&nbsp;LINA MØRCH ,&nbsp;CHRISTIAN TORP-PEDERSEN ,&nbsp;YOUSIF SUBHI ,&nbsp;AMANI MEAIDI","doi":"10.1016/j.ajo.2025.05.027","DOIUrl":"10.1016/j.ajo.2025.05.027","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the association between hormonal contraceptive use and the risk of retinal vascular occlusions in women of reproductive age.</div></div><div><h3>Design</h3><div>Register-based, nationwide cohort study.</div></div><div><h3>Participants</h3><div>A total of 2,208,172 women aged 15-49 years were followed from January 1, 1996, to June 30, 2021, excluding those with prior venous or arterial thrombosis, thrombophilia, cancer (except non-melanoma skin cancer), liver disease, chronic kidney disease, hysterectomy, bilateral oophorectomy, hormone therapy, infertility treatment, endometriosis, or polycystic ovary syndrome.</div></div><div><h3>Methods</h3><div>Women were followed until study end, age 50, emigration, death, or occurrence of exclusion criteria. Individual-level, time-updated hormonal contraception use was identified through prescription records; retinal vascular occlusion events were detected through hospital diagnoses. Poisson regression models estimated incidence rate ratios of retinal vascular occlusion by duration, dosage, and type of hormonal contraceptives, adjusting for age, educational level, hypertension, diabetes, hypercholesterolemia, atrial fibrillation/flutter during observation.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted incidence rate ratios (AIRR) and standardized incidence rate differences (SIRD) of retinal vein occlusion and retinal artery occlusion with hormonal contraceptive use compared to non-use.</div></div><div><h3>Results</h3><div>The cohort contributed 23,882,016 person-years with a median follow-up time of 10 years (1st to 3rd quartile: 4 to 17). Compared to non-use, current hormonal contraception use was associated with a 40% increased rate of retinal vein occlusion (AIRR 1.4, 95% Confidence Interval (95% CI): 1.1-1.8), corresponding to SIRD of 4.6 (95% CI: 0.9-8.4) additional cases per 1,000,000 person-years. AIRR of retinal artery occlusion was 1.2 (95% CI: 0.8-1.7) with current hormonal contraception use compared to non-use.</div><div>The increased rate of retinal vein occlusion persisted with use of combined oral contraceptives containing 30-40 µg of estrogen (AIRR 1.6, 95% CI: 1.2-2.3), while no increased rate was observed with the low-dose 20 µg combined contraceptives (AIRR 0.7, 95% CI: 0.3-1.5). No increase observed with use of hormonal intrauterine devices.</div></div><div><h3>Conclusion</h3><div>Combined oral contraceptives containing 30-40 µg estrogen were associated with an increased rate of retinal vein occlusion compared to non-use, although the absolute increase was low. No increased rate was observed for retinal artery occlusions.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 286-294"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180537","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":"RPGR-Related Retinal Dystrophy in Latin America—A Collaborative Study","authors":"Malena Daich Varela ,&nbsp;Rene Moya ,&nbsp;José D. Luna ,&nbsp;Marcela Ciccioli ,&nbsp;M. Eugenia Inga ,&nbsp;Julieta Gras ,&nbsp;Pedro J. Nuova ,&nbsp;Luciana Capalbo ,&nbsp;Alejandra Antacle ,&nbsp;Laura Echandi ,&nbsp;Angelica Moussali ,&nbsp;Alejandro Sanders Villa ,&nbsp;Marcela Pérez Araya ,&nbsp;Tamara Muhlberger ,&nbsp;Rocio A. Villafuerte-de la Cruz ,&nbsp;Adda Villanueva ,&nbsp;Tania Barragán Arévalo ,&nbsp;Olivia Araujo Zin ,&nbsp;Thiago Carvalho Barros de Oliveira ,&nbsp;Fernanda Belga Ottoni Porto ,&nbsp;Juliana Maria Ferraz Sallum","doi":"10.1016/j.ajo.2025.05.025","DOIUrl":"10.1016/j.ajo.2025.05.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide the first genetic and clinical characterization of <em>RPGR</em>-associated inherited retinal diseases (IRDs) in Latin America and assess their genetic, clinical, and socioeconomic landscape.</div></div><div><h3>Design</h3><div>Multicenter, international, retrospective, observational cohort study.</div></div><div><h3>Methods</h3><div>Patients with genetically confirmed <em>RPGR</em>-IRD from Brazil, Argentina, Chile, Mexico, Colombia, and Panama were included in this study. Demographic, clinical, genetic, and socioeconomic data were collected and analyzed to characterize disease prevalence and severity, assess rate of progression, and draw genotype-phenotype correlations. A socioeconomic evaluation analyzed healthcare costs and employment.</div></div><div><h3>Results</h3><div>The study describes the largest cohort to date of patients with <em>RPGR</em>-associated IRD, with 314 individuals from 205 families carrying likely disease-causing variants. Of these, 276 individuals (88%) had retinitis pigmentosa, with a mean age of disease onset at 10.9 ± 7.6 years. Analyzed cross-sectionally at the baseline visit (age 27.3 ± 17.2 years), there was a statistically significant association between age and best-corrected visual acuity (BCVA, <em>P</em> &lt; .0001, R² = 0.3). Kaplan–Meier analysis showed that more than 90% of patients would maintain binocular BCVA better than 1.0 logMAR until age 40 years, decreasing to 50% by age 57 years, and by 58 years of age 50% of patients would have discernible subfoveal ellipsoid zone. The mean age of male patients whose BCVA was 1.0 logMAR or worse in their better-seeing eye was 48.3 ± 9.5 years (median, 49 years). Fourteen previously unreported variants in <em>RPGR</em> are described. Among patients who declared employment status (n = 122), 43% reported being unemployed or in part-time employment due to their visual impairment; among those who reported mental health well-being (n = 133), 45% reported depression or anxiety.</div></div><div><h3>Conclusions</h3><div>This study provides the first genetic and clinical characterization of <em>RPGR</em>-IRD in Latin America, contributing previously unreported variants, natural history details, genotype-phenotype correlations, and an estimated regional prevalence. By providing data on potentially eligible patients, their clinical status, and the socioeconomic impact of <em>RPGR</em>-IRDs, this study lays the foundation for potential access to <em>RPGR</em> future therapies in Latin America.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 313-322"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179487","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":"Physician Burden and Time Delays in Initiating Immunomodulatory Therapy for Noninfectious Uveitis and Inflammatory Eye Diseases","authors":"Munevver N. Duran ,&nbsp;Karen Beltran ,&nbsp;Jennifer H Cao","doi":"10.1016/j.ajo.2025.05.029","DOIUrl":"10.1016/j.ajo.2025.05.029","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To assess the additional time and effort required and resultant delays imposed by insurance-mandated prior authorization for medications treating uveitis and ocular inflammatory disease.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort study.</div></div><div><h3>PARTICIPANTS</h3><div>Patients with uveitis and ocular inflammatory disease at the University of Texas Southwestern Medical Center requiring approval for new systemic immunomodulatory therapy between February 2023 and January 2024. Infusion-related medications were excluded.</div></div><div><h3>METHODS</h3><div>Electronic medical records were reviewed to assess prior authorization requests, appeals, and related data for initiating therapy.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>Success rate of obtaining requested medications, time to initiation, additional steps required (eg, appeals, peer-to-peer consultations), factors influencing approval (eg, insurance subtype, medication class), and reliance on patient assistance programs.</div></div><div><h3>RESULTS</h3><div>A total of 83 patients had 107 requests for new immunomodulatory therapy. Uveitis subtypes included pemphigoid (38%), anterior uveitis (13%), intermediate uveitis (8%), posterior uveitis (1%), panuveitis (35%), and scleritis (5%). Medications included methotrexate (20.6%), mycophenolate mofetil (12.1%), adalimumab (34.6%), tocilizumab (1.9%), baricitinib (16.8%), and tofacitinib (9.3%), with 75% considered “off-label.” Approval rates were 100% for on-label and 52.3% for off-label medications (<em>P</em> = .033). Off-label requests were twice as likely to be denied, requiring more appeals (1.07 vs 0.50; <em>P</em> = .01). Average time to initiation was 28 days for on-label and 41 days for off-label medications (<em>P</em> = .01). Private insurance had higher approval rates than Medicare for off-label requests (59.5% vs 36.4%; <em>P</em> = .05). Patient assistance programs were required in 63% of cases.</div></div><div><h3>CONCLUSION</h3><div>Prior authorization creates significant administrative burdens and delays, disproportionately affecting off-label therapies and delaying critical vision-preserving treatments.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 280-285"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180588","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":"Screening Corneal Tomography for the Diagnosis of Keratoconus in Pediatric Patients With Trisomy 21","authors":"Casey G. Smith ,&nbsp;Rebecca G. Edwards Mayhew ,&nbsp;Jasleen K. Singh ,&nbsp;Jennifer L. Patnaik ,&nbsp;Brandie D. Wagner ,&nbsp;Ronald E. Wise ,&nbsp;Jennifer L. Jung ,&nbsp;Michael A. Puente ,&nbsp;Francis Hickey ,&nbsp;Cheryl Fonteh ,&nbsp;Emily A. McCourt","doi":"10.1016/j.ajo.2025.05.014","DOIUrl":"10.1016/j.ajo.2025.05.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The goal of this study is to describe the rates of successful corneal tomography in children with Down Syndrome (DS) and to determine whether high levels of astigmatism or myopia are reliable indicators of keratoconus in children with DS.</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>Subjects and controls</h3><div>Patients aged 4 to 18 years old with and without DS who underwent corneal tomography to evaluate for keratoconus at a tertiary pediatric hospital from July 2018-January 2020.</div></div><div><h3>Methods</h3><div>Main observation performed was identifying keratoconus and the success of tomography in patients with down syndrome.</div></div><div><h3>Main Outcome Measures</h3><div>Refractive error at the time of keratoconus diagnosis.</div></div><div><h3>Results</h3><div>358 patients with DS were seen during the study period, and 96 patients without DS were evaluated for keratoconus. Among the patients with DS screened for keratoconus, useful images were obtained in at least 1 eye in 75.9% of patients. We compared patients with and without DS who were diagnosed with keratoconus or keratoconus suspect. At the time of keratoconus diagnosis, children with DS had less astigmatism and myopia than children without DS. Within the group of patients with DS, there was no significant difference in refractive error in the patients who were diagnosed with keratoconus versus those who were not.</div></div><div><h3>Conclusions</h3><div>Children with DS diagnosed with keratoconus often have lower amounts of astigmatism and less myopic spherical equivalents than children with keratoconus without DS at the time of diagnosis; therefore, relying on high astigmatism as a clinical indicator for disease in patients with DS is likely inadequate. Tomographic screening should be employed even when the patient with DS is young or has low amounts of refractive error as earlier detection and treatment is crucial to favorable outcomes in children with DS.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 349-355"},"PeriodicalIF":4.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145911","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":"Practice Patterns, Diagnostic Utility, and Safety of Anterior Chamber Paracentesis","authors":"Charlene H. Choo ,&nbsp;Punyanuch Pisitpayat ,&nbsp;Daisy Yan ,&nbsp;Aaron Chang ,&nbsp;Sarah Lopez ,&nbsp;Shreya Malli ,&nbsp;Gerami D. Seitzman ,&nbsp;John Gonzales ,&nbsp;Nisha Acharya ,&nbsp;Thuy Doan ,&nbsp;Jessica G. Shantha","doi":"10.1016/j.ajo.2025.05.017","DOIUrl":"10.1016/j.ajo.2025.05.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the safety and diagnostic utility of anterior chamber (AC) paracentesis in patients with ocular inflammation at the University of California, San Francisco (UCSF).</div></div><div><h3>Design</h3><div>This was a 2-part study including a cross-sectional survey study to assess practice patterns on AC paracentesis and a retrospective diagnostic and safety study of all outpatient AC paracentesis performed between April 2012 and March 2023 at UCSF.</div></div><div><h3>Participants</h3><div>The participants of the practice patterns survey study were ophthalmologists in the Proctor Foundation listserv. All patients who underwent at least 1 outpatient AC paracentesis at UCSF from 2012 to 2023 were included in the retrospective diagnostic and safety investigation.</div></div><div><h3>Main Outcomes and Measures</h3><div>For the diagnostic and safety study, the main outcomes included the frequency of adverse events and positive results for pathogens on various aqueous fluid testing.</div></div><div><h3>Results</h3><div>In our survey study, most providers had fellowship training in cornea and/or uveitis (68%) and performed AC paracentesis with the patient at the slit lamp (75%).</div><div>Our retrospective diagnostic and safety study included 386 patients (51.3% female, mean age 56.7 years) and 528 AC paracentesis. Complications occurred in 5.7% of AC paracentesis. The overall PCR-positivity was 24.2% (97/401) and highest for cytomegalovirus (56/386; 14.5%). On multivariable analysis, topical corticosteroids increased the odds of PCR-positivity for viral pathogens (<em>P</em> = .01-.02). High AC cell levels were also associated with increased odds of PCR-positivity for HSV/VZV (<em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>Results of our study demonstrated the safety and diagnostic utility of AC paracentesis. This procedure facilitated the diagnosis of infectious causes of uveitis in almost 25% of cases.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 260-268"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136787","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}