American Journal of Ophthalmology最新文献

{"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}

{"title":"Incidence and Prevalence of Uveitis and Associated Ocular Complications in the United States TriNetX Database.","authors":"Nila Kirupaharan, Rayna F Marshall, Matthew D Spangler, Karen R Armbrust, Meghan K Berkenstock","doi":"10.1016/j.ajo.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.032","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the demographics, immunosuppressant use, associated systemic diseases, ocular comorbidities, and incidence and prevalence of uveitis and associated low vision using the United States TriNetX database from 2013-2023.</p><p><strong>Design: </strong>Retrospective cross-sectional and trend study PARTICIPANTS: Subjects with uveitis in the TriNetX database METHODS: Subjects with uveitis were identified with International Classification for Disease codes and then divided into anatomic subtypes based on the diagnosis. Incidence and prevalence data were collected from 2013-2023. Additional data collected included demographics, use of systemic immunosuppressive medications, presence of an associated systemic disease, and associated ocular complications.</p><p><strong>Main outcome measures: </strong>The primary outcomes were the incidence and prevalence of uveitis (annual and cumulative) with additional analysis by anatomic subtype. Secondary outcomes were the incidence and prevalence of low vision (annual and cumulative).</p><p><strong>Results: </strong>Out of the 109,026,851 subjects in the database, 278,333 (0.26%) had a diagnosis of uveitis. The mean age was 56 years (Standard Deviation=21, 95% Confidence Interval (CI) 55.9-56.1), and the majority were female (n=149,186; 53.6%, 95% CI 53.4-53.8%) and white (n=150,578; 54.1%, 95% CI 53.9-54.3%). Anterior uveitis was the most common subtype (n=209,073, 75.1%). Oral prednisone (n=62,834; 22.6%, 95% CI 22.5-22.8%) was the most used immunosuppressant and methotrexate (n=15,817; 5.7%, 95% CI 5.6-5.8%) was the most prevalent corticosteroid-sparing immunosuppressive agent. Inflammatory spondyloarthropathies (n=18,372; 6.6%, 95% CI 6.5-6.7%) were the most frequently associated systemic disease. The cumulative incidence and prevalence of uveitis from 2013-2023 were 212.5 and 260.8 per 100,000 persons, respectively.</p><p><strong>Conclusions: </strong>This study represents one of the largest uveitis populations analyzed in the United States, revealing a rising incidence of all uveitis subtypes and an increase in low vision among affected patients over the past decade in the database. Prospective studies are needed to identify the factors driving these trends and to develop strategies to prevent vision loss and ocular complications in uveitis patients.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741755","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":"Ocular features of VEXAS syndrome: a systematic review and meta-analysis.","authors":"Clare Quigley, James Pietris, Terence Ang, Lina Zgaga, Dinesh Selva","doi":"10.1016/j.ajo.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.036","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to identify and analyse ocular features seen in Vacuoles, E1-ligase, X-linked Auto-inflammatory, Somatic (VEXAS) syndrome.</p><p><strong>Design: </strong>A systematic literature review was performed following PRISMA guidelines (PROSPERO registration number: ID 566167).</p><p><strong>Methods: </strong>Article inclusion criteria comprised genetic confirmation VEXAS syndrome that included eye involvement. Exclusion criteria included lack of genetic testing, or ocular feature reporting. A systematic search of the PubMed/MEDLINE, Embase and CENTRAL databases was performed from January 2020 to September 2024. Data was collected and risk of bias assessed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. For the meta-analysis specific UBA1 mutation and systemic feature data was also included. An association between severity of ocular features, presence of specific ophthalmic or systemic features, with age or causative mutation was investigated using Kruskal-Wallis rank sum testing and Fisher's exact test respectively using R.</p><p><strong>Results: </strong>52 articles were included, amounting to 204 individuals (1 female). Mean age of VEXAS symptom onset was 67 ± 5 years (range: 46-87). Orbital inflammation was the most common ocular manifestation, comprising periorbital oedema (n=83, 40.7%), orbital myositis (n=14, 6.9%), dacryoadenitis (n=6, 2.9%), and orbital compartment syndrome (n=1, 0.5%). Other features included episcleritis (n=28, 13.7%), scleritis (n=28, 13.7%), uveitis (n=25, 12.3%), and retinal vasculitis (n=2, 1%), among others. Visual acuity reporting was limited (n=4, 2%). Meta-analysis was conducted on 32 articles (n=48) with genotype and ocular feature data. The most common reported UBA1 mutation was the missense mutation p.Met41Thr (n=24, 50%), followed by p.Met41Val (n=17, 35%), p.Met41Leu (n=4, 8%) and splice site mutations or deletions (n=3, 6%). There was an association for more severe ophthalmic features in the splice site mutation group versus methionine 41 missense mutations (p=0.04). The most commonly associated systemic features included dermatologic manifestations (n=41, 85%), recurrent fever (n=38, 79%), and pulmonary involvement (n=30, 63).</p><p><strong>Conclusion: </strong>There is notable variation in the ophthalmic features of VEXAS. Ophthalmic review is advised for VEXAS patients who develop eye symptoms, given the risk of sight-threatening disease.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741825","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":"Characterization of Visual Field Loss Over 4 Years in the Rate of Progression in USH2A-related Retinal Degeneration (RUSH2A) Study.","authors":"Jacque L Duncan, Maureen G Maguire, Lee S McDaniel, Nicole R Doucet, Isabelle Audo, Allison R Ayala, Janet K Cheetham, Peiyao Cheng, Todd A Durham, Rachel M Huckfeldt, Robert B Hufnagel, K Thiran Jayasundera, Naheed Khan, Brett Malbin, Ramiro S Maldonado, Michel Michaelides, Mark E Pennesi, Christina Y Weng, Alex Zmejkoski, Shobana Aravind, Hiroshi Ishikawa, David G Birch","doi":"10.1016/j.ajo.2025.03.039","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.039","url":null,"abstract":"<p><strong>Purpose: </strong>To report visual field loss using static perimetry (SP) and kinetic perimetry (KP) over 4 years in the Rate of Progression of USH2A-related Retinal Degeneration (RUSH2A) study.</p><p><strong>Design: </strong>Prospective, observational cohort study.</p><p><strong>Subjects, participants, and/or controls: </strong>Participants had USH2A-related rod-cone degeneration, visual acuity ≥ 20/80, and KP III4e ≥ 10° at baseline in the study eye. Preserved cohorts with baseline visual fields sufficient to detect progression were identified.</p><p><strong>Methods: </strong>Participants were examined annually through 4 years. Mixed effects models were used to estimate the annual, standardized rate, and percentage rates of change.</p><p><strong>Main outcome measures: </strong>SP measures included hill of vision (total: V_TOT, central 30°: V₃₀, and peripheral: V_PERIPH) and centrally weighted mean sensitivity (MScw). Percentages with 4-year progression exceeding the coefficient of repeatability (CoR) and with change meeting FDA-recommended criteria were estimated. KP seeing area (dB-steradian (sr)/degree) for I4e, III4e, and V4e isopters was calculated.</p><p><strong>Results: </strong>The average decline with SP (95% CI) was 1.94 (1.62, 2.25) dB-sr/year for V_TOT, 0.54 (0.45, 0.62) dB-sr/year for V₃₀, 1.37 (1.11, 1.63) dB-sr/year for V_PERIPH, and 0.56 (0.48, 0.64) dB/year for MS_cw. Average percentage decline per year was 8.6% (7.2, 10.0) for V_TOT, 6.4% (5.3, 7.5) for V₃₀, 13.6% (10.4, 16.7) for V_PERIPH, and 5.6% (4.7, 6.4) for MS_cw. The standardized rate of change was greatest at -1.35 for MS_cw. Rates were higher in the preserved cohorts. Progression exceeding the CoR was 18% (11, 28) for V_TOT, 21% (13, 31) for V₃₀, 21% (13, 31) for V_PERIPH and 17% (10, 27) for MS_cw. Progression exceeding an FDA-recommended threshold was 5% (2%, 12%) for all SP points and 45% (35%, 55%) for functional transition points. Average KP annual percentage decline was 13.1% (7.5, 18.5) for I4e, 12.1% (8.1,15.9) for III4e, and 9.2% (6.3,12.0) for V4e.</p><p><strong>Conclusions: </strong>All quantitative perimetry measures declined over 4 years. Progression was greater than the CoR in a relatively low percentage of eyes (17-21%); 45% exceeded the FDA-recommended threshold when only functional transition points were considered. Standardized rate of change was greatest for MS_cw. These measures are useful characterizations of vision loss in USH2A-related retinal degeneration.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741749","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":"Correlation between length of interdigitation zone with severity and progression of diabetic retinopathy.","authors":"Feiyan Liang, Shuya Tao, Yimeng Zhang, Siyuan Liu, Wenyong Huang, Chang He, Shuxin Fan, Xialin Liu","doi":"10.1016/j.ajo.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.034","url":null,"abstract":"<p><strong>Purpose: </strong>To objectively evaluate the alteration of interdigitation zone (IZ) length in diabetic patients and to determine its relationship with diabetic retinopathy (DR) progression.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Method: </strong>Two hundred and thirty-one diabetic patients (231 eyes) were included. DR was graded according to the modified Airlie House classification system. The high-resolution spectral-domain optical coherence tomography (SD-OCT) images were obtained to calculate the length of IZ using Image-pro plus. Linear regression analysis and logistic regression analysis were performed to determine the associations between IZ length with DR severity and DR progression.</p><p><strong>Result: </strong>IZ length was significantly reduced in DR patients compared to that in diabetic patients without DR (NDR) (3.758±1.653mm vs. 5.722±0.865mm, P < 0.001). After adjusting for confounding factors, IZ length showed a negative association with DR severity, and longer IZ length correlated with better best corrected visual acuity (BCVA) (ß -0.021, 95%CI -0.030 to -0.011, P < 0.001). Forty eyes (21.98%) developed DR progression over 3-year follow-up. Notably, longer IZ length at baseline was associated with lower risk of DR progression over 3-year follow-up (OR 0.039, 95%CI 0.011 to 0.139, P < 0.001). The logistic regression models predicted DR progression with area under the curve (AUC) of 0.917 (95%CI 0.872 to 0.962) and 0.953 (95%CI 0.917 to 0.989) respectively based only on IZ length and IZ length combined with established risk factors.</p><p><strong>Conclusion: </strong>IZ length decreased with DR severity and significantly correlated with DR progression, potentially serving as a new predictor for disease progression.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741751","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":"Visual and topographic outcomes after Corneal Allogeneic Intrastromal Ring Segments (CAIRS) for keratoconus: a systematic review and meta-analysis.","authors":"Maximilian Friedrich, Gerd Uwe Auffarth, Uri Soiberman, Victor Aristide Augustin, Ramin Khoramnia, Hyeck-Soo Son","doi":"10.1016/j.ajo.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.028","url":null,"abstract":"<p><p>Purpose Corneal allogeneic intrastromal ring segments (CAIRS) are a novel therapeutic approach to treat ectatic diseases such as keratoconus and improve visual acuity as well as corneal topography. This analysis aimed to evaluate the visual outcomes and corneal topography changes after CAIRS implantation for keratoconus. Design Systematic Review and Meta-Analysis Methods In this systematic literature review and meta-analysis (ID: CRD42024612508) original peer-reviewed clinical studies on the effect of CAIRS in eyes with keratoconus were included. Exclusion criteria were pre-implanted ring segments, ectatic diseases other than keratoconus, as well as no reported pre- or postoperative outcome parameters. Cochrane, Embase, PubMed and Web of Science libraries were screened in November 2024 by two researchers independently. The risk of bias was assessed using the Evidence Project risk of bias tool. The primary effect measure was the difference in corrected distance visual acuity (CDVA) before and after CAIRS. Additionally, changes in uncorrected distance visual acuity (UDVA), spherical equivalent (SE), cylinder, flat keratometry, steep keratometry, maximum keratometry (Kmax), mean keratometry, thinnest corneal thickness, and higher order aberrations (HOAs) due to CAIRS were analyzed and compared using a random effects model. In addition, postoperative complications were documented. Results In total, fourteen clinical studies with a total of 442 eyes were included in the meta-analysis. The mean improvement in CDVA was 0.37 logMAR (95% CI: 0.28, 0.46; 14 studies; n = 442 eyes). UDVA improved by 0.43 logMAR (95% CI: 0.34, 0.55; 11 studies; n = 427 eyes). SE was improved by 4.59 D (95% CI: 3.35, 5.84; 12 studies; n = 430 eyes). Kmax was reduced by -4.49 D (95% CI: -6.05, -2.92; 13 studies; n = 439 eyes) and total HOAs decreased by -0.33 µm (95% CI: -0.62, -0.03; 6 studies; n = 171 eyes). One severe adverse event (0.2%) reported was an acute rejection, which necessitated explantation. Conclusions This meta-analysis demonstrates that CAIRS implantation is an effective procedure that can significantly improve UDVA, CDVA, and topographic outcomes in keratoconus eyes with low complication rates.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741936","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":"Giant Conjunctival Melanoma.","authors":"Chunxiao Wang, Jianjun Gu","doi":"10.1016/j.ajo.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.033","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741754","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":"Association of Age With Glaucoma and Visual Acuity Outcomes 10.5 Years After Unilateral Congenital Cataract Surgery.","authors":"Claudia K Wong, He Forbes, Taylor Kolosky, Urjita Das, Euna Cho, Shaiza Mansoor, Sera Chase, Madi Kore, Moran Roni Levin, Larry Magder, Carolyn Drews-Botsch, Scott R Lambert, Janet L Alexander","doi":"10.1016/j.ajo.2025.03.035","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.035","url":null,"abstract":"<p><strong>Importance: </strong>Age at the time of unilateral congenital cataract surgery is a well-established risk factor for glaucoma and visual acuity. The impact of gestational age on risk of glaucoma or poor vision in patients who have undergone cataract removal in infancy remains unknown.</p><p><strong>Objective: </strong>To determine the association among age, gestational age, glaucoma-related adverse events, and visual acuity following unilateral cataract surgery.</p><p><strong>Design: </strong>Post hoc follow-up of a multicenter randomized clinical trial.</p><p><strong>Setting and participants: </strong>An analysis of 112 infants who had unilateral congenital cataract surgery between 1-6 months of chronological age. Data on long-term glaucoma-related status were collected when children were 10.5 years old.</p><p><strong>Main outcomes and measures: </strong>Glaucoma and visual acuity at 10.5 years of age.</p><p><strong>Results: </strong>Chronological and adjusted age were highly correlated (Pearson correlation, r = 0.98, p < 0.001). Gestational age was not significantly associated with glaucoma (p=0.08) nor visual acuity (p=0.6). Younger adjusted age had a significant association with glaucoma (p=0.04) and with better visual acuity (p=0.03). Younger chronological age was not significantly associated with glaucoma (p=0.06) but had a significant association with better visual acuity (p=0.02).</p><p><strong>Conclusions and relevance: </strong>Age adjusted for gestation and chronological age are important risk factors for glaucoma and visual acuity in patients who have undergone cataract removal in infancy. Among the IATS participants, age adjusted for gestation significantly predicted glaucoma related adverse events at 10.5 years. Conversely, chronological age was significantly associated with visual acuity at 10.5 years. Adjusted age should be considered in addition to chronological age when determining age of cataract surgery to minimize risk of glaucoma and maximize visual acuity.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741738","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":"Outcomes of Nishida Muscle Transposition Procedure for Abducens Nerve Palsy.","authors":"Sara Maher, Ahmed Awadein, Christina Farag, Jylan Gouda, Shaimaa Arfeen","doi":"10.1016/j.ajo.2025.03.037","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.037","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the motor outcomes after Nishida procedure for unresolving sixth nerve palsy (SNP).</p><p><strong>Study design: </strong>Retrospective case series METHODS: A retrospective chart review was conducted on patients who underwent Nishida procedure with prior or simultaneous medial rectus recession (Mrc) for SNP and completed >3 months follow-up. Operative details including the position of sutures, ductions, versions, and angles of misalignment were tabulated. Success was defined as orthophoria within 8Δ.</p><p><strong>Results: </strong>Thirty-four patients were identified. Mean age was 24.4±19.2 years. Trauma was the most common cause (24 patients, 70.5%). Mean preoperative angle of deviation was 44.7±7Δ (range, 25 to 60Δ) in unilateral cases (n=32) and 90Δ in bilateral cases. One case had prior Mrc. Simultaneous Mrc and Nishida procedure was performed in all other cases (33) (mean recession, 4.6±1.2 mm). The Nishida sutures were placed 12 mm from the limbus in all cases. Mean follow-up was 10.3±9.1 months. Initial overcorrection >8Δ occurred in 8 cases (23.5%) and resolved spontaneously in 6 cases in the first 2-3 weeks after surgery. Residual esotropia >8Δ occurred in 4 cases (11.7%), all had sutures placed 5-7 mm from the lateral rectus borders versus <5 mm in successful cases. There was no relationship between the amount of Mrc and undercorrection. Final success rate was 82.3%. Mean postoperative angle was 1±6.5Δ (range, XT 15Δ to ET 20Δ). Induced vertical deviation occurred in 2 patients but resolved completely in 1 patient. Mean postoperative abduction deficit was -2.7±0.8.</p><p><strong>Conclusions: </strong>Nishida procedure is an effective and self-adjusting procedure for the management of SNP. Care should be taken to properly place the sutures to reduce the risk of undercorrection.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741905","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":"Short Term Treatment of Syphilitic Uveitis with Intravitreal Ceftazidime.","authors":"Emily C Davis, Akshay S Thomas","doi":"10.1016/j.ajo.2025.03.038","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.03.038","url":null,"abstract":"<p><strong>Objective: </strong>To review the clinical outcomes of patients with ocular syphilis that were treated in the short-term with intravitreal ceftazidime when definitive treatment with penicillin was delayed due to a variety of extenuating circumstances.</p><p><strong>Design: </strong>Retrospective interventional case series.</p><p><strong>Participants: </strong>45 patients diagnosed and treated for syphilitic posterior or panuveitis between January 2, 2019, and July 1, 2024, at a tertiary referral private practice. Of these, 10 patients (n = 14 eyes) were treated short-term with intravitreal ceftazidime before initiating penicillin therapy. Three of these patients are presented as cases to highlight factors that might contribute to treatment delays.</p><p><strong>Intervention: </strong>One or more intravitreal injections of 2.25mg/0.1 mL ceftazidime.</p><p><strong>Main outcome measures: </strong>Visual acuity (VA), inflammatory grade based on Standardization for Uveitis Nomenclature (SUN) criteria, causes for delay in systemic antibiotic treatment, changes in aqueous bacterial polymerase chain reaction (PCR) following ceftazidime administration, changes in multimodal imaging.</p><p><strong>Results: </strong>Following treatment with intravitreal ceftazidime and prior to penicillin treatment, all eyes (n = 14) had improved inflammatory parameters. Of the 9 eyes with measurable baseline Snellen vision, all improved by an average of 5.4 lines (range = + 1-9). In the two eyes of patients for whom aqueous bacterial PCR was initially positive for T. pallidum, subsequent PCR was negative prior to initiation of penicillin. All patients eventually received definitive systemic antibiotic therapy and had resolution of their syphilitic uveitis.</p><p><strong>Conclusion: </strong>Patients experienced improvements in VA and inflammation when treated with intravitreal ceftazidime before the initiation of penicillin, suggesting that ceftazidime could be leveraged in care for those with syphilitic uveitis. With the increasing number of cases of syphilis nationally over the last decade, combined with the growing shortages of penicillin, it is vital to consider adjunctive therapies for treatment of syphilitic uveitis to help improve visual outcomes.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741933","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}