American Journal of Ophthalmology最新文献

{"title":"How should the results of glaucoma surgical studies be presented?","authors":"Paul Palmberg","doi":"10.1016/j.ajo.2025.06.050","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.050","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"37 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565765","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":"Evaluating High Intraocular Pressure Criteria for Failure in Glaucoma Surgery: Impact on Estimated Success and Visual Field Rates.","authors":"Alessandro Rabiolo,Giacinto Triolo,Andrea Servillo,Daniela Khaliliyeh,Sang Wook Jin,Esteban Morales,Luca Rossetti,Nitin Anand,Giovanni Montesano,Gianni Virgili,Joseph Caprioli,Stefano De Cillà","doi":"10.1016/j.ajo.2025.05.054","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.054","url":null,"abstract":"PURPOSEReview high intraocular pressure (IOP) thresholds used as failure criteria in glaucoma surgical outcome studies, evaluate their impact on success rates, and examine the relationship between surgical success criteria and visual field (VF) progression rates.DESIGNSystematic literature review and application of high IOP failure criteria to two retrospective cohorts.PARTICIPANTSTwo cohorts of 934 and 1,765 eyes underwent trabeculectomy and deep sclerectomy (DS), respectively, with a median follow-up of 41.4 months for trabeculectomy and 45.4 months for DS. Visual field analysis was conducted on patients in the trabeculectomy cohort with ≥4 VFs in ≥2 years post-surgery.METHODSWe applied literature-based high IOP failure criteria to the patient cohorts, defining failure as exceeding these IOP thresholds, loss of light perception, or need for additional IOP-lowering surgery. Success rates were estimated with Kaplan-Meier statistics, and Cohen's kappa statistic assessed the agreement among criteria in defining failure at 5 years. Linear mixed models estimated VF mean deviation (MD) progression rates based on success or failure status.MAIN OUTCOME MEASURESKaplan-Meier success rates, Cohen's kappa, and MD progression rates RESULTS: From 2,503 initial studies, 277 were included, identifying 144 high IOP failure criteria. The 21-mmHg criterion variations showed success rates at 5 years ranging from 8.7% to 74.0% for trabeculectomy and 22.1% to 89.9% for DS. The median Cohen's kappa for 21-mmHg criteria indicated fair agreement (0.39 for trabeculectomy, 0.42 for DS). A subset of 199 trabeculectomy eyes were eligible for the VF analysis. Overall, the median (interquartile range) postoperative progression rate was -0.36 (-0.09 to -0.74) dB/year. Distributions of progression rates greatly overlapped between failure and success groups as defined by the various criteria.CONCLUSIONSThe criteria for defining high IOP failure in glaucoma surgery are highly heterogeneous in the current literature. Varying high IOP criteria has a large impact on glaucoma surgery success rates, highlighting the need for standardized failure criteria to enable consistent interpretation and comparison across studies. IOP-based classifications are poor surrogates for postoperative VF progression rates. Long-term visual field rates provide a more consistent primary outcome measure and may be incorporated into composite success criteria.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"8 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565628","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 Patients with Observed High-Risk Choroidal Nevi That Evolved into Melanomas vs. Patients with Immediately Treated Uveal Melanomas.","authors":"Ankit B Kadakia, Amna M Ali, Alice Z Chuang, Amy C Schefler","doi":"10.1016/j.ajo.2025.06.049","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.049","url":null,"abstract":"<p><strong>Purpose: </strong>Patients who present with high risk choroidal nevi, typically with thickness < 2.0 mm, are thought to have a better prognosis than patients who present with larger tumors. Large scale studies have not explored the differences in genetics between melanocytic lesions that were initially observed (IO) and those immediately treated (IT). The primary objective of this study is to compare genetics and metastatic rate between high risk nevi initially observed and treated upon growth vs. immediately treated uveal melanoma (UM). The secondary objective is to evaluate the growth rate of high-risk lesions in the IO group that eventually triggered treatment, and to assess whether this growth rate threshold was sufficient to maintain a low rate of metastasis DESIGN: Retrospective clinical cohort study SUBJECTS: 272 patients with uveal melanoma (UM) who underwent treatment at a large ocular oncology practice in Houston, Texas between 2013 and 2022 with at least 18 months follow-up.</p><p><strong>Main outcome measures: </strong>Tumor Gene Expression Profile (GEP), Tumor PReferentially Expressed Antigen in MElanoma (PRAME) status, Tumor height and largest base diameter (LBD) growth rate [millimeters (mm)/year], presence of metastasis (yes or no) METHODS: Patients were categorized as IO or IT. Patients in the IO group were initially diagnosed with high risk choroidal nevi and monitored until clinical criteria for UM were met. In contrast, patients in the IT group were diagnosed with UM upon their first visit by the ocular oncologist. Metastatic outcomes, genetic expression, and tumor growth rates were analyzed.</p><p><strong>Results: </strong>213 patients in IT and 59 in IO were included. Compared to IO patients, IT patients had higher percentages of metastasis (p=0.009), Gene Expression Profile (GEP) Class 2 tumors (p=0.010), and PReferentially Expressed Antigen in MElanoma (PRAME) expression (p=0.044). Mean tumor growth rate in the IO group increased just before treatment decision by 0.65 and 1.00 mm/year for height and largest base diameter, respectively (p<0.01).</p><p><strong>Conclusions: </strong>Genetic profiles and metastatic potential evolve alongside tumor growth, indicating a transition from high risk nevi to UM. Monitoring the growth rate of high risk nevi serves as a reliable noninvasive biomarker for identifying nevus transformation to UM and for guiding clinical decision-making, without resulting in a high rate of Class 2 tumors and metastatic disease.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564247","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":"Aravind Pseudoexfoliation Study (APEX): 10 Year Postoperative Results.","authors":"Aravind Haripriya,Shivkumar Chandrashekharan,Emily M Schehlein,Madhu Shekhar,Rengaraj Venkatesh,Kalpana Narendran,Mohammed Sithiq Uduman,Ravilla D Ravindran,Alan L Robin","doi":"10.1016/j.ajo.2025.06.043","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.043","url":null,"abstract":"PURPOSETo compare long-term (10-year) best corrected visual acuity (BCVA) and complication rates of intraocular lens (IOL) decentration and Nd:YAG capsulotomy for posterior capsule opacification (PCO) in eyes with and without pseudoexfoliation (PEX) after undergoing cataract surgery.DESIGNClinical cohort study using RCT data.SUBJECTS AND CONTROLSNine hundred thirty eyes with cataract and pseudoexfoliation without phacodonesis, clinically shallow anterior chambers, or pupil size <4 mm and 476 controls with cataract but without pseudoexfoliation.METHODSWe randomized both groups separately to receive either a single-piece acrylic IOL or a 3-piece acrylic IOL. We further randomized the pseudoexfoliation group to receive or not receive capsular tension rings. We performed phacoemulsification using experienced surgeons with the insertion of an (IOL) on all eyes and we followed all at 1 day, 1 month, 3 months, 1 year, and yearly thereafter for 10 years.MAIN OUTCOME MEASURESThe association of pseudoexfoliation with IOL decentration, posterior capsular opacification requiring capsulotomy, and best corrected visual acuity.RESULTSThe 10-year follow-up was 82.2% for the PEX group and 85.6% in the control group excluding those who died in the interim. 24.1% and 16.8% respectively died before completion. IOL decentration rates (2.4% vs 1.7%, respectively, p=0.4) and Nd:YAG capsulotomy rates (5.7% vs 5.67%, respectively, p=0.98) were similar in PEX and control groups. Capsular phimosis (p=0.001) and capsulorhexis that did not overlap the edge of the IOL optic (p<0.001) were risk factors for IOL decentration and Nd:YAG capsulotomy. At 10 years, logMAR BCVA was better in the control than the PEX group (0.08 vs 0.12 respectively; p=0.035). Capsular phimosis (p=0.001) and a capsulorhexis that did not overlap the IOLs optic (p<0.001) were each independently associated with decentration and need for a capsulotomy.CONCLUSIONSThis is the only long-term large-scale prospective comparative study using experienced surgeons evaluating both CTRs and IOL types in eyes with PEX, without preoperative and intraoperative zonular weakness and small pupils. At 10 years post-operative (most of a life expectancy) we found no differences between eyes with and without uncomplicated PEX and having either 1- or 3-piece IOLs, or CTRs.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"5 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547781","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":"Female reproductive factors in relation to risk of exfoliation glaucoma or glaucoma suspect.","authors":"Jae H Kang,Zhiyu Wu,Megan Yu,Hannah H Hwang,Namuunaa Juramt,Bernard A Rosner,Louis R Pasquale,Janey L Wiggs","doi":"10.1016/j.ajo.2025.06.046","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.046","url":null,"abstract":"PURPOSEIncidence studies have reported higher rates of exfoliation syndrome and glaucoma (XFG) in women, implicating female-specific factors. We evaluated associations between female reproductive factors and incident XFG.DESIGNProspective cohort study of 121,098 females in the Nurses' Health Study (NHS; 1980-2018) and NHSII (1991-2019).METHODSEligible participants were ≥40 years old, postmenopausal, had no history of XFG or cataract extraction, had data on reproductive factors, and reported ophthalmic examinations. Incident XFG or exfoliation glaucoma suspect (XFGS) cases (n=440 affected eyes) were confirmed with medical records. Per-eye Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (MVHRs) and 95% confidence intervals (CIs). False discovery rate (FDR) was used to correct for multiple comparisons.RESULTSOverall, reproductive history indicative of a greater lifetime estrogen exposure was suggestively associated with higher XFG/XFGS risk. Each 1-year increase in age at menarche was associated with 9% lower risks (MVHR=0.91; 95%CI: 0.85, 0.97; FDR-corrected p-trend=0.047). Parity was not associated, longer durations of oral contraceptive use and breastfeeding were inversely associated, and earlier age at menopause and duration of menopausal hormone therapy was adversely associated, although no FDR-corrected p-trends were significant. Among those with high genetic susceptibility for XFG, surgical menopause (bilateral oophorectomy) was inversely associated with XFG/XFGS compared to natural menopause (MVHR=0.37; 95% CI: 0.15, 0.92; FDR-corrected p-interaction=0.0007).CONCLUSIONLater age at menarche was associated with a lower XFG/XFGS risk. Surgical versus natural menopause was inversely associated with XFG/XFGS risk only among those with high genetic susceptibility. These results need confirmation.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"641 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547672","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":"5-Year Trifocal IOL Outcomes in Chinese Cataract Patients: Visual Performance, Stability, and Satisfaction","authors":"Lulu Chen, Lu Sun, Yongxiang Tang, Wenda Sui, Ailing Bian, Xia Zhang, Zaowen Wang, Yong Zhong, Shunhua Zhang","doi":"10.1016/j.ajo.2025.06.047","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.047","url":null,"abstract":"To evaluate the 5-year visual outcomes, refractive stability, IOL centration, patient satisfaction, and complications following trifocal intraocular lens (IOL) implantation in a Chinese cohort.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"116 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515610","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":"Clinical nomogram for determining expected choroidal thickness in children with myopia","authors":"Ian Flitcroft, Gareth Lingham, Eoin Kerin, Ernest Kyei Nkansah, David A Mackey, Samantha Sze-Yee Lee, Emmanuel Kobia-Acquah, James Loughman","doi":"10.1016/j.ajo.2025.06.041","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.041","url":null,"abstract":"A thin choroid is a recognised risk factor for myopia-associated complications and visual impairment in later life. This study aims to develop a clinical tool to identify individuals whose choroidal thickness varies from that expected for their age, sex and refraction, and who might therefore be at higher or lower risk of future myopic complications.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515611","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":"Burnout Among US Uveitis Specialists – An Assessment of Prevalence and Contributing Factors","authors":"Akshay S. Thomas, Edmund Tsui, Karen R. Armbrust, Shilpa Kodati, Meghan K. Berkenstock, Emily C. Davis, Mridul K. Thomas, Sapna Gangaputra","doi":"10.1016/j.ajo.2025.06.042","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.042","url":null,"abstract":"To assess the prevalence of burnout among United States (US) uveitis specialists, identify contributing factors and propose interventions to reduce risk of burnout.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515609","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 novel comparative study of inflammatory cytokines through non-invasive tear analysis in children with myopia versus emmetropia","authors":"Shruti Nishanth, Noël JC Bauer, Rohit Shetty, Swaminathan Sethu, Arkasubhra Ghosh, G Kumaramanickavel, Thiruchelvi S, Suvetha S, Marlies Gijs, Tos TJM Berendschot","doi":"10.1016/j.ajo.2025.06.044","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.044","url":null,"abstract":"Childhood myopia is a complex disorder with rising prevalence. Given that progressive myopia has been observed in inflammatory conditions such as keratoconus and uveitis, we conducted non-invasive tear film analyses on emmetropes, myopes, and hyperopes to compare their inflammatory cytokine profiles.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"24 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515613","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":"Early structural changes in keratoconic eyes after corneal crosslinking detected by polarization sensitive optical coherence tomography","authors":"J Lammer, J Aschauer, F Beer, N Pircher, S Holzer, G Schmidinger, CK Hitzenberger, M Pircher","doi":"10.1016/j.ajo.2025.06.045","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.06.045","url":null,"abstract":"To assess early structural changes in keratoconic corneas secondary to epi-off corneal crosslinking (CXL) using polarization sensitive optical coherence tomography (PS-OCT).","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515612","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}