American Journal of Ophthalmology最新文献

{"title":"Retinal vascularization rate predicts retinopathy of prematurity and remains unaffected by low-dose bevacizumab treatment.","authors":"Emer Chang, Amandeep Josan, Ravi Purohit, Sher A Aslam, Caroline Hartley, Chetan K Patel, Kanmin Xue","doi":"10.1016/j.ajo.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.02.040","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the rate of retinal vascularisation derived from ultra-widefield (UWF) imaging-based retinopathy of prematurity (ROP) screening as predictor of type 1 ROP and characterise the effect of anti-VEGF therapy on vascularisation rate.</p><p><strong>Design: </strong>Retrospective, consecutive cohort study.</p><p><strong>Subjects: </strong>132 eyes of 76 premature infants with mean gestational age (GA) of 26.0(±2.0SD) weeks and birth weight (BW) of 815(±264) g, who underwent longitudinal UWF imaging for ROP screening.</p><p><strong>Setting/venue: </strong>Level 3 neonatal unit in Oxford, United Kingdom METHODS: The extent of retinal vascularisation on each UWF image was measured as the ratio between 'disc-to-temporal vascular front' and 'disc-to-fovea' distance along a straight line bisecting the vascular arcades. Measurements from ≥3 timepoints plotted against post-menstrual age (PMA) enabled calculation of temporal vascularisation rate (TVR) for each eye. Using TVR, GA and BW as predictors, a machine learning model was created to classify eyes as either Group AB (no ROP and type 2 ROP) or Group C (type 1 ROP). The model was validated in a withheld cohort of 32 eyes (19 infants) of which 8 eyes (5 infants) required treatment. TVR in 37 eyes (20 infants) was compared before and after ultra-low-dose (0.16 mg) intravitreal bevacizumab treatment.</p><p><strong>Main outcome measures: </strong>Rate of retinal vascularisation.</p><p><strong>Results: </strong>Slower retinal vascularisation correlated with increasing ROP severity, with TVR being 29% slower in Group C eyes (n=50) than Group AB eyes (n=33 no ROP and n=49 type 2 ROP) (p=0.04). Our model correctly predicted ROP outcomes of 30/32 eyes, achieving a balanced accuracy of 95.8%. No significant change in TVR was found before and after bevacizumab treatment with mean post-treatment imaging follow-up of 7.7(±7.9) weeks (p=0.60 right eyes, p=0.71 left eyes).</p><p><strong>Conclusions: </strong>UWF imaging-based ROP screening enables quantification of retinal vascularisation rate, which can provide early prediction of type 1 ROP independent of BW and GA. Rate of physiological retinal vascularisation does not appear to be significantly affected by ultra-low-dose anti-VEGF treatment, which has significant implications for the development of peripheral avascular retina and timing of anti-VEGF intervention to prevent disease progression in high risk infants.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584372","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":"Increasing Incidence of Posterior Uveal Melanoma in Scandinavia 1960-2022: A Tri-National Study","authors":"KRISTOFFER NISSEN ,&nbsp;JENS FOLKE KIILGAARD ,&nbsp;MARIA FILI ,&nbsp;STEFAN SEREGARD ,&nbsp;JESINTHA NAVARATNAM ,&nbsp;JØRGEN KROHN ,&nbsp;THOMAS PEDERSEN BÆRLAND ,&nbsp;TRUDE EID ROBSAHM ,&nbsp;NILS EIDE ,&nbsp;GUSTAV STÅLHAMMAR","doi":"10.1016/j.ajo.2025.03.002","DOIUrl":"10.1016/j.ajo.2025.03.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate temporal trends in the incidence of posterior uveal melanoma in Scandinavia (Sweden, Denmark, and Norway) between 1960 and 2022 and explore potential associations with changes in tumor size and patient age at diagnosis.</div></div><div><h3>Design</h3><div>Retrospective, registry‐based cohort study utilizing nationwide data from the 3 Scandinavian countries.</div></div><div><h3>Participants</h3><div>All patients diagnosed with posterior uveal melanoma (choroid or ciliary body) in Sweden (1960-2022), Denmark (1960-2022), and Norway (1993-2022), totaling 10,154 cases. Iris melanomas were excluded.</div></div><div><h3>Methods</h3><div>Crude, age-standardized, and log-transformed age-standardized incidence rates were calculated using direct standardization (1970-1974 population). Linear regression was applied to assess trends in incidence, largest basal diameter (LBD), tumor thickness, and patient age at diagnosis. A multivariate linear regression model tested whether tumor size or patient age accounted for the time-dependent increase in incidence. <em>P</em> values were Bonferroni-adjusted for multiple comparisons.</div></div><div><h3>Main Outcome Measures</h3><div>Crude, age-standardized, and log-transformed age-standardized incidence rates of posterior uveal melanoma.</div></div><div><h3>Results</h3><div>Crude, age-standardized, and log-transformed age-standardized incidence rates increased significantly in all 3 countries. Combined Scandinavian age-standardized rates rose from 5.2 to 6.8 per million inhabitants and year in the 1960s to 6.1-8.7 in the 2010s (slope 0.033; 95% CI: 0.022-0.044). Log-transformed rates showed a similar upward trend (slope 0.002; 95% CI: 0.002-0.003). Tumor size (diameter and thickness) decreased, while patient age at diagnosis increased over time. Multivariate analysis confirmed a time-dependent increase in incidence, independent of tumor size or patient age.</div></div><div><h3>Conclusions</h3><div>Posterior uveal melanoma incidence in Scandinavia has increased since 1960. The linear trend is independent of changes in tumor size or patient age.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 131-141"},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Impairment and Cognitive Function in Aging Adults: Sex and Age Differences in Mediating Effect of Social Isolation and Depression","authors":"D. DIANE ZHENG ,&nbsp;DAVID J. LEE ,&nbsp;TATJANA RUNDEK ,&nbsp;BYRON L. LAM ,&nbsp;NINEL Z GREGORI ,&nbsp;ROSIE E. CURIEL ,&nbsp;DAVID A. LOEWENSTEIN","doi":"10.1016/j.ajo.2025.02.043","DOIUrl":"10.1016/j.ajo.2025.02.043","url":null,"abstract":"<div><h3>Purpose</h3><div>Visual impairment (VI) is prevalent in older adults and associated with cognitive decline. However, the mechanisms through which visual impairment affects cognitive functioning during the aging process are poorly understood. Our study aims to estimate the direct effect of visual acuity on cognitive function and its indirect effect through social isolation and depressive symptoms by sex and age.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Participants</h3><div>117,231 individuals aged 40-70 participated in the UK Biobank baseline and ocular assessment. Of these, 81% were white, 54% were female, and 45.6% were aged 60-70. The mean age was 56.8 (SD 8.1) years.</div></div><div><h3>Methods</h3><div>Path analyses with multiple equations were conducted to examine the direct and indirect effects of visual acuity (VA). Stratified analyses by gender and age were performed.</div></div><div><h3>Main Outcome Measures</h3><div>LogMAR VA was the exposure, with social isolation and depressive symptoms as mediators. Cognitive functions, including visual memory, verbal-numerical reasoning, processing speed, and prospective memory, were the outcomes.</div></div><div><h3>Results</h3><div>VA had a direct effect on cognitive function (β = -0.979 for reasoning and OR = 0.67 for prospective memory). VA also influenced cognition indirectly through social isolation and depressive symptoms. The direct effect of VA on cognitive function was similar in men vs. women and middle-aged vs. older. However, there is a marked difference in the mediating effect via social isolation and depressive symptoms by age and sex. The mediating effect of VI on cognition via social isolation was stronger in older adults than middle-aged and in men than women; while the mediating effect via depressive symptoms was stronger in women and middle-aged individuals. VI had the largest mediating effect via social isolation in older males.</div></div><div><h3>Conclusion and Relevance</h3><div>Vision, social isolation, and depressive symptoms are modifiable factors and can be treated to preserve cognition. Encouraging social engagement among male and older adults with VI and promoting mental health awareness in women and middle-aged individuals with VI will reduce the negative impact of VI on cognition, lower dementia risk, and improve the well-being of aging adults.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 196-208"},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143583796","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":"Comparative Analysis of Lamina Parameters in Nonglaucomatous Eyes With and Without Pseudoexfoliation Syndrome","authors":"YOUNG HOON JUNG ,&nbsp;JOON MO KIM ,&nbsp;EUN JI LEE ,&nbsp;TEA-WOO KIM ,&nbsp;SO YOUNG HAN ,&nbsp;YONGWOO LEE ,&nbsp;JI EUN SONG","doi":"10.1016/j.ajo.2025.02.041","DOIUrl":"10.1016/j.ajo.2025.02.041","url":null,"abstract":"<div><h3>Objective</h3><div>To compare lamina cribrosa (LC) parameters in nonglaucomatous eyes with pseudoexfoliation syndrome (PXFS) and healthy control eyes to assess structural alterations that may contribute to early glaucoma pathophysiology.</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>Participants</h3><div>Fifty eyes with non-glaucomatous PXFS and 50 healthy, age-matched control eyes.</div></div><div><h3>Methods</h3><div>All participants underwent spectral-domain optical coherence tomography with enhanced-depth imaging. LC parameters were measured at the superior mid-peripheral, central, and inferior mid-peripheral regions. Comparisons between groups were assessed with paired <em>t</em>-tests for continuous data and the McNemar test for categorical data. Mixed effects model analysis was utilized to identify factors associated with lamina cribrosa thickness (LCT).</div></div><div><h3>Main Outcome Measures</h3><div>Measurements of LCT, lamina cribrosa curvature depth (LCCD), curvature index (LCCI), and prelaminar tissue thickness (PLTT).</div></div><div><h3>Results</h3><div>Eyes with PXFS exhibited significantly thinner LCT than controls across all regions: superior mid-peripheral (163.85 ± 39.13 µm vs. 222.18 ± 38.03 µm), central (172.95 ± 40.63 µm vs. 220.17 ± 51.77 µm), and inferior mid-peripheral (165.58 ± 35.18 µm vs. 217.73 ± 44.00 µm). No significant differences were observed in PLTT, LCCD and LCCI between the 2 groups. Multivariable mixed effects model analysis identified the presence of PXFS (β = -50.687) as an independent factor associated with LCT.</div></div><div><h3>Conclusion</h3><div>PXFS eyes show significant LC thinning, potentially representing early structural changes preceding glaucoma. Monitoring LC parameters in PXFS eyes may facilitate early detection of patients at risk of disease progression.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 163-170"},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571824","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":"Neurofibromatosis type 1 (NF1)-related ocular signs: new insights on their prevalence, incidence and genotype-phenotype correlation in NF1 children.","authors":"Edoardo Midena, Eleonora Cosmo","doi":"10.1016/j.ajo.2025.02.044","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.02.044","url":null,"abstract":"<p><strong>Purpose: </strong>To assess, in a large pediatric population affected by neurofibromatosis type 1 (NF1): prevalence, incidence, age of onset and genotype correlation of the main NF1-related ocular signs, including: optic pathway glioma (OPG), Lisch nodules (LNs), choroidal abnormalities (CAs) and retinal vascular abnormalities (RVAs).</p><p><strong>Methods: </strong>NF1 patients ≤16 years old followed at our Institution between 2010 and 2022 were included. Presence of NF1-related ocular signs was assessed at baseline and during follow-up evaluations through slit lamp observation (LNs), near-infrared (NIR) imaging (CAs and RVAs) and neuroimaging revision (OPG). Patients were categorized according to their genetic variant.</p><p><strong>Results: </strong>237 patients were enrolled. 204 underwent at least one follow-up and genetic test was available for 210. Prevalence of OPG, LNs, CAs and RVAs, at baseline, was respectively 20.7%, 43.5%, 46.8% and 6.8%. Their incidence during follow up was 6.4%, 22.4%, 21.4% and 5.4% respectively, and mean age of onset was 6.3±3.6, 7.1±3.0, 6.4±3.0 and 6.6±2.9 years old. Patients with truncating mutations presented a higher number of ocular signs than those with non-truncating mutations (1.7±1.0 vs 0.9±0.9, P=.0019).</p><p><strong>Conclusions: </strong>Data on prevalence and incidence of NF1-related ocular signs in pediatric patients evidences that the development of these signs seems negligible after 7 years old. LNs and CAs seem to develop independently, and as consequence may be considered as two separate diagnostic criteria. Truncating mutations correlate with a higher numbers of NF1-related ocular signs phenotype.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584371","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 and Structural Characterization of a Novel TGFBI Mutation Linked to a Lattice Corneal Dystrophy Variant in a Greek Family","authors":"Margarita Zacharogianni ,&nbsp;Nikos C. Papandreou ,&nbsp;Nikolaos M. Marinakis ,&nbsp;Faidon-Nikolaos Tilemis ,&nbsp;Joanne Traeger-Synodinos ,&nbsp;Sotiria Palioura","doi":"10.1016/j.ajo.2025.03.003","DOIUrl":"10.1016/j.ajo.2025.03.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe a novel pathogenic <em>TGFBI</em> variant identified in a Greek family and investigate its structural impact on the TGFBI protein, focusing on clinical significance and genotype-phenotype correlations.</div></div><div><h3>Design</h3><div>Single-family case-control study with computational structural analysis.</div></div><div><h3>Methods</h3><div>Three generations of a Greek family, including the proband, her brother, and their mother were clinically evaluated using slit-lamp examination and anterior segment optical coherence tomography. Whole exome sequencing was performed on the proband, followed by targeted sequencing of family members. Bioinformatics tools, including DynaMut2, PROVEAN, and AlphaFold2, were used to predict the mutation's impact on protein structure and stability.</div></div><div><h3>Results</h3><div>A novel heterozygous variant, c.1517_1518insCCCCCCCAAGGG, was identified. This 12-nucleotide insertion replaces methionine at position 506 with isoleucine, proline, proline, lysine, and glycine (p.M506delinsIPPKG). Clinically, this mutation was associated with geographic subepithelial and anterior stromal opacities without discernible lattice lines and presented as recurrent corneal erosions in the second decade. Structural analysis revealed disruption of the first α-helix of the FAS1-4 domain, destabilizing the protein and potentially exposing amyloidogenic regions. Previously reported mutations within this α-helix consistently produce a phenotype of geographic subepithelial opacities and a similar age of onset.</div></div><div><h3>Conclusions</h3><div>M506delinsIPPKG represents a novel pathogenic <em>TGFBI</em> variant associated with an autosomal dominant lattice corneal dystrophies variant. The structural disruption of the FAS1-4 domain's α-helix likely underlies the disease mechanism and links structural changes to specific phenotypic traits. These findings contribute to our understanding of genotype-phenotype correlations in <em>TGFBI</em>-related corneal dystrophies and highlight the importance of structural analysis in such cases.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 112-121"},"PeriodicalIF":4.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571821","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 Nomogram Based on Ocular Hemodynamics for Predicting Ischemic Stroke","authors":"Zhuo-hua Zhou,&nbsp;Xue-ru Cheng,&nbsp;Jia-xin Guan,&nbsp;Lu Zhao,&nbsp;Yan-ling Wang,&nbsp;Jia-lin Wang","doi":"10.1016/j.ajo.2025.02.034","DOIUrl":"10.1016/j.ajo.2025.02.034","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Ischemic stroke is a cerebrovascular disease with high mortality and disability. Due to similar physiological characteristics, ocular vascular characteristics are important indicators for monitoring cerebrovascular diseases. This study aimed to develop a nomogram prediction model for ischemic stroke based on ocular hemodynamic characteristics.</div></div><div><h3>DESIGN</h3><div>Retrospective clinical cohort study.</div></div><div><h3>METHODS</h3><div>A total of 337 patients were included in this study and randomly divided into 235 training and 102 validation cohorts. The general data were collected, and the hemodynamic parameters of ophthalmic artery, central retinal artery and posterior ciliary artery were detected by ultrasound. The retinal vascular diameter was extracted from the color fundus image, and the relevant laboratory indexes of the patients were collected. Logistic regression analysis was used to determine the risk factors of ischemic stroke. A nomogram was constructed based on the identified risk factors, and the accuracy and clinical applicability of the model were analyzed using the receiver operating curve (ROC), Hosmer-Lemeshow test, and decision curve analysis (DCA).</div></div><div><h3>RESULTS</h3><div>Independent risk factors for ischemic stroke including hypertension (OR 2.17, 95% confidence interval [CI] 1.16 to 4.08; <em>P</em> = .016), hyperlipidemia (OR 2.21, 95% CI 1.18 to 4.14; <em>P</em> = .013), and resistance index of ophthalmic artery (OR 5.98, 95% CI 3.27 to 10.93; <em>P</em> &lt; .001) were identified by multivariate regression analysis. The area under the ROC curve of the training cohort was 0.790 (95% CI 0.733 to 0.847) and that of the validation cohort was 0.773 (95% CI 0.679 to 0.866), revealing the consistent ability of the nomogram to predict ischemic stroke. The mean absolute error of the training and validation cohorts were 0.020 and 0.013, respectively. In addition, the DCA curve showed good clinical benefit.</div></div><div><h3>CONCLUSIONS</h3><div>The nomogram combining traditional factors and ophthalmic artery resistance index has a preferable predictive performance for ischemic stroke. This suggests that the model combined with ocular hemodynamics can effectively promote the early diagnosis and intervention of ischemic stroke.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 91-100"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple parallel lines endotheliitis: A rare cause of transient visual loss.","authors":"Jean-Baptiste Amatu, Paul Bastelica, Christophe Baudouin","doi":"10.1016/j.ajo.2025.02.036","DOIUrl":"10.1016/j.ajo.2025.02.036","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536528","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":"Prevalence and Risk Factors of Primary Angle Closure Disease in an Adult Chinese American Population: The Chinese American Eye Study","authors":"Benjamin Y. Xu ,&nbsp;Grace M. Richter ,&nbsp;Bruce S. Burkemper ,&nbsp;Dandan Wang ,&nbsp;Xuejuan Jiang ,&nbsp;Mina Torres ,&nbsp;Roberta McKean-Cowdin ,&nbsp;Nathan Dhablania ,&nbsp;Rohit Varma","doi":"10.1016/j.ajo.2025.02.037","DOIUrl":"10.1016/j.ajo.2025.02.037","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To assess the prevalence and risk factors of primary angle closure disease (PACD) among adult Chinese Americans.</div></div><div><h3>DESIGN</h3><div>Cross-sectional population-based study.</div></div><div><h3>PARTICIPANTS</h3><div>Total 4582 Chinese Americans 50 years and older from 15 census tracts in Monterey Park, CA.</div></div><div><h3>METHODS</h3><div>Participants received complete eye exams, including gonioscopy, fundus photography, and standard automated perimetry. Primary angle closure suspect (PACS) was defined as non-visible posterior trabecular meshwork for ≥270° on gonioscopy. Primary angle closure (PAC) was defined as PACS with peripheral anterior synechiae (PAS) and/or IOP≥21 mmHg without glaucomatous neuropathy (GON). PACG was defined as PACS or PAC with GON. Suspected PACG (sPACG) was defined as GON without PACS or PAC but with evidence of prior laser iridotomy or cataract surgery with residual PAS. Multivariable logistic regression models were developed to identify risk factors for PACS, PAC, and PACG.</div></div><div><h3>Main Outcome Measures</h3><div>Prevalence and risk factors of PACS, PAC, and PACG.</div></div><div><h3>Results</h3><div>Data from 4,310 CHES participants were included in the analysis. The prevalence of PACS, PAC, and PACG were 8.1% (95% CI: 7.3%-9.0%; <em>N</em> = 351), 3.1% (95% CI: 2.6%-3.6%; <em>N</em> = 132), and 1.1% (95% CI: 0.8%-1.4%; <em>N</em> = 46), respectively. Prevalence of PACG and sPACG combined was 1.8% (95% CI: 1.4%-2.2%; <em>N</em> = 76). Older age (OR=1.06 per year), positive family history of glaucoma (OR=3.21), higher IOP (OR=1.17 per mmHg), and shorter axial length (OR=1.67 per mm) were significant risk factors (<em>P</em> &lt; .003) for PACG on multivariable analysis. 75.0% of PACG cases were previously undiagnosed. There was one case of PACG with unilateral blindness and no cases with bilateral blindness.</div></div><div><h3>Conclusion</h3><div>PACG prevalence was not substantially lower among Chinese Americans compared to mainland Chinese. Older age, higher IOP, positive family history of glaucoma, and smaller AL conferred higher risk. While the majority of PACG cases were undetected, blindness was rare. Improved access to eye care and cataract surgery appears to mitigate severe visual morbidity associated with PACG.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 32-41"},"PeriodicalIF":4.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536452","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":"Efficacy of Customized Photorefractive Keratectomy With Cross-Linking Versus Cross-Linking Alone in Progressive Keratoconus: A Systematic Review and Meta-Analysis","authors":"Hao Zhang ,&nbsp;Mario Cantó-Cerdán ,&nbsp;Beatriz Félix-Espinar ,&nbsp;Jorge L. Alió del Barrio","doi":"10.1016/j.ajo.2025.02.038","DOIUrl":"10.1016/j.ajo.2025.02.038","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;TOPIC&lt;/h3&gt;&lt;div&gt;This review evaluates the effectiveness and safety of combining cPRK with CXL versus CXL alone in improving visual outcomes for patients with progressive keratoconus.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DESIGN&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CLINICAL RELEVANCE&lt;/h3&gt;&lt;div&gt;Keratoconus leads to vision loss and affects quality of life. While CXL is the current standard for halting progression, it does not correct the visual impairment. This review explores whether adding cPRK to CXL offers better visual outcomes while maintaining the same safety, potentially refining treatment approaches.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A systematic search of MEDLINE, PubMed, Cochrane Library and EMBASE was conducted through September 2024, following PRISMA guidelines. The initial study design aimed to include randomized controlled trials (RCTs) as well as comparative nonrandomized prospective or retrospective studies evaluating CXL+cPRK versus CXL alone, with a minimum follow-up of six months. However, only nonrandomized studies were retrieved. As a result, all included studies were assessed for the risk of bias using the ROBINS-I tool. The primary outcomes were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). Secondary outcomes included refraction, corneal structure, and higher-order aberrations (HOA). Meta-analysis was performed using standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity was assessed using a random-effects model where necessary. Sensitivity analysis was conducted using a leave-one-out approach to assess the robustness of the results. This study is registered in the PROSPERO database (CRD42024594757).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Eight nonrandomized studies involving 731 eyes from 706 patients were analyzed. Compared to CXL alone, the combination of CXL+cPRK significantly improved postoperative UDVA (SMD = −0.39, 95% CI: −0.69 to −0.08, &lt;em&gt;P&lt;/em&gt; = .01) and CDVA (SMD = −0.57, 95% CI: −0.96 to −0.18, &lt;em&gt;P&lt;/em&gt; = .004), while also reducing refractive cylinder error. Additionally, CXL+cPRK led to reductions in coma, total HOA, coma-like aberrations, mean keratometry (KM), and central corneal thickness (CCT). No significant differences were observed between the groups in endothelial cell count (ECC). The rate of postoperative ectasia progression was comparable between both groups. All included studies exhibited at least one ROBINS-I domain at high risk of bias, particularly related to confounding. The heterogeneity observed in this analysis was primarily attributed to differences in surgical techniques, patient selection criteria, and study designs across the included studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Customized PRK combined with CXL provides superior postoperative visual acuity (UDVA, CDVA) and visual quality compared to CXL alone while maintaining the same corneal stability in the management of progressive k","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 9-23"},"PeriodicalIF":4.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536466","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}