BMJ Open Ophthalmology最新文献

{"title":"Estimation of normal and glaucomatous optic nerve morphology from perfusion.","authors":"Eduardo Jerez-Olivera, Marta Gonzalez-Hernandez, Daniel Gonzalez-Hernandez, Manuel Gonzalez de la Rosa","doi":"10.1136/bmjophth-2024-002024","DOIUrl":"10.1136/bmjophth-2024-002024","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the optic nerve head morphology from its haemoglobin (Hb) distribution.</p><p><strong>Methods and analysis: </strong>The optic disc of 189 normal eyes and 292 with confirmed and suspected glaucoma were analysed with Spectralis-OCT and the Laguna ONhE application using the Topcon NW400 fundus camera. Topographic Hb values were correlated with OCT tissue thicknesses from Bruch's membrane. The neuroretinal rim volume (RV), the cup volume (CV) and their relation to the globin distribution function (GDF) index of Laguna ONhE were analysed. The results were applied to 1 163 241 optic nerve images obtained in a glaucoma screening setting. Differences in segmentation and the presence of vessels without local nutritional function are the main limitations of the comparison.</p><p><strong>Results: </strong>The correlation between local Hb density and the tissue thicknesses from Bruch's membrane was R=0.953 (p<0.0001). RV could be estimated from pixel-to-pixel Hb values with an R=0.650 (p<0.0001) and from six Laguna ONhE indices with an R=0.786 (p<0.0001). CV could be estimated with an R=0.762 (p<0.0001). RV had a mean value of 0.396 mm³ (SD=0.187) for positive GDF values and usually below 0.210 mm³ for negative GDF. The distribution of RV values in the screening series was congruent with that found in the prospective series, with a higher value in large nerves.</p><p><strong>Conclusions: </strong>The volume and shape of the optic nerve tissue are closely related to its perfusion and can be deduced from it. The relationship between the RV and GDF is curvilinear and suggests that perfusion measurement may bring the diagnosis forward in earlier stages.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of frequency-doubled Nd-YAG laser photocoagulation of different types of corneal neovascularisation (NLPC): a prospective study.","authors":"Keerti Wali, Shilpa Maled, Ronak Solanki, Apoorva G Ayachit, Aniket N Shastri","doi":"10.1136/bmjophth-2024-001734","DOIUrl":"10.1136/bmjophth-2024-001734","url":null,"abstract":"<p><strong>Purpose: </strong>Frequency doubling of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser results in emission of photocoagulating 532 nm light compared with photolytic 1064 nm emission. The ergonomic benefits of solid-state lasers led to replacement of older coagulating lasers in ophthalmic centres by frequency-doubled Nd-YAG laser. Our study aims to evaluate safety and efficacy of frequency-doubled Nd-YAG laser for photocoagulation of corneal neovascularisation (NLPC).</p><p><strong>Methods: </strong>30 quiet eyes of 28 patients with superficial, mid-stromal and deep stromal inactive corneal neovascularisation were subjected to laser photocoagulation. Resolution of vessels, procedural complications and survival of subsequent corneal grafts were monitored for 3 months. Anterior segment fluorescein angiography (AS-FA) was performed in six eyes to confirm the cessation of blood flow.</p><p><strong>Results: </strong>20 eyes (66.66%) had complete resolution of neovascularisation. 13 cases of superficial (92.86%) and 6 cases of mid-stromal neovascularisation (75%) showed significant resolution, compared with 1 case of deep neovascularisation (12.5%). Minimal corneal burn (n=4, 13.33%), iris holes (n=3, 10%), anterior chamber bubbles (n=5, 16.67%), self-resolving intrastromal bleed (n=2, 6.67%) and graft-host junctional wound leak (n=1 of 12 keratoplasty cases, 8.33%) were noted.</p><p><strong>Conclusion: </strong>NLPC may especially be useful in the eyes with a large vessel arborising within stroma. Lack of comparison with other treatment options leading to inflated safety and efficacy profile of NLPC is the major limitation of this study.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cornea specialists are the highest opioid prescribers at a large academic eye institute in the USA.","authors":"Nikolay Boychev, Lisa Y Lin, Laurel T Tainsh, Sue A Aicher, Anat Galor, Joseph B Ciolino","doi":"10.1136/bmjophth-2024-002012","DOIUrl":"10.1136/bmjophth-2024-002012","url":null,"abstract":"<p><strong>Background/aim: </strong>To evaluate the opioid prescription patterns across ophthalmic subspecialties at a large academic eye centre.</p><p><strong>Methods: </strong>A single site, retrospective cross-sectional study. Electronic medical records from the year 2018 were screened. Ophthalmology patients ≥18 years of age were included. The main outcome measures were patient demographics, outpatient opioid prescriptions, ophthalmic procedure and prescriber details, including department and training level.</p><p><strong>Results: </strong>1654 opioid prescriptions were written, accounting for 2.2% of all ophthalmic procedures in a calendar year. Of the patients who received prescriptions, 51.4% were female (n=851) with a mean age of 52.3±18.5 (range 18-95 years). In general, the morphine equivalent dose was low, with an average of 12.4±6.75 pills dispensed (range 1-60) with 0.0±0.01 refills (range 0-3). Cornea specialists were the highest opioid prescribers (22.7% of all providers who wrote a prescription), followed by oculoplastics (22.2%) and retina (18.4%). The most common procedure for which an opioid was prescribed was cornea crosslinking (14.3% of all opioid prescriptions).</p><p><strong>Conclusions: </strong>While opioid prescriptions are generally low for ophthalmic procedures across departments, cornea specialists accounted for nearly a third of opioid prescriptions. Over half of corneal crosslinking patients received opioid prescriptions; there remains an unmet need for opioid-sparing therapy for these patients and others with severe eye pain.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory actions of ripasudil ameliorate experimental autoimmune uveoretinitis in the acute phase.","authors":"Kozo Harimoto, Yoshiaki Nishio, Hideaki Someya, Tomohito Sato, Masataka Ito, Masaru Takeuchi","doi":"10.1136/bmjophth-2024-001981","DOIUrl":"10.1136/bmjophth-2024-001981","url":null,"abstract":"<p><strong>Introduction: </strong>Rho-associated protein kinases (ROCKs) are a key regulator of T cell function, influencing a wide range of processes from activation to differentiation. Experimental autoimmune uveoretinitis (EAU) is an animal model of human non-infectious uveitis. This study aimed to evaluate the suppressive effects of ripasudil, a ROCK inhibitor, on ocular inflammation when administered from the onset of EAU and to elucidate the underlying mechanisms of its inhibitory effects.</p><p><strong>Methods: </strong>EAU was induced in wild-type C57BL/6 mice by immunisation with IRBP peptide. Ripasudil or its vehicle, PBS, was intraperitoneally administered daily starting from 8 days post-immunisation. Clinical and histopathological examinations and analysis of T cell activation state were conducted. In addition, T cell gene expression profiles in the relevant immune functions were identified using single-cell RNA sequencing (scRNA-seq).</p><p><strong>Results: </strong>The development of EAU was significantly attenuated and T cell activation and Th1 cell differentiation were significantly inhibited in mice with ripasudil (RIP-EAU) compared with mice with PBS (PBS-EAU), scRNA-seq using splenic T cells indicated that genes involved in the ROCK signalling pathway were highly expressed in low-differentiated Th1/Th17 cells, intermediate Th1 cells and differentiated Th1 cells. In addition, although differentiated Th1 and Th17 cells constituted similar proportions between PBS-EAU and RIP-EAU mice, RIP-EAU mice exhibited fewer low-differentiated Th1/Th17 cells and intermediate Th1 cells compared with PBS-EAU mice.</p><p><strong>Conclusion: </strong>Ripasudil suppressed EAU when administered from the onset of the disease by inhibiting cells that strongly express genes involved in the ROCK signalling pathway and differentiate into Th1 cells.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New insights into changes in ocular structural parameters in simulated hypobaric hypoxia.","authors":"Yuchen Wang, Anqi Guo, Xinli Yu, Yihe Liu, Zesong Wang, Jiaxing Xie, Xinzuo Zhou, Siru Liu, Jiaxi Li, Chengkai Zhou, Yuanhong Li, Chao Sun, Jing Zhang, Ziyuan Liu, Xuemin Li, Li Ding","doi":"10.1136/bmjophth-2024-001928","DOIUrl":"10.1136/bmjophth-2024-001928","url":null,"abstract":"<p><strong>Purpose: </strong>High altitude is the main area for human exploration, and human eye is an important organ for obtaining visual signals. The changes of ocular structural parameters in a simulated hypobaric hypoxia environment need to be clarified.</p><p><strong>Methods: </strong>Measurements were taken at five altitudes ((1) ground, (2) 3500 m, (3) 4000 m, (4) 4500 m and (5) ground). Refractive values were measured with the IOL Master (Carl Zeiss Shanghai Co. Ltd.). Data analysis was performed using the Kolmogorov-Smirnov (K-S) test, paired sample T-test and Wilcoxon test.</p><p><strong>Results: </strong>Subjects' axial length (AL) increased with altitude, peaking at 4500 m, then decreased. Significant AL differences were observed across altitudes (p<0.05), except between 2-5 and 3-5. Central corneal thickness (CCT) thickened then thinned with elevation changes, significantly thicker at altitudes 2-5 compared with the baseline (p<0.05). Lens thickness (LT) followed a similar pattern, increasing up to altitude 4, then decreasing at 5. Correlations were found between AL and LT at altitudes 1 (r=0.375, p<0.05) and 5 (r=0.341, p<0.05), and between AL and CCT at altitude 4 (r=0.337, p<0.05), but not elsewhere.</p><p><strong>Conclusions: </strong>As altitude increases and acute low-pressure hypoxia worsens, changes in AL, CCT and LT may affect pilots' visual function, information acquisition, decision-making and flight safety.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of dry eye disease among children: a systematic review and meta-analysis.","authors":"Yuhao Zou, Dongfeng Li, Virgili Gianni, Nathan Congdon, Prabhath Piyasena, S Grace Prakalapakorn, Ruifan Zhang, Zixiang Zhao, Ving Fai Chan, Man Yu","doi":"10.1136/bmjophth-2024-002014","DOIUrl":"10.1136/bmjophth-2024-002014","url":null,"abstract":"<p><strong>Background: </strong>Dry eye disease (DED) is a multifactorial disorder of the tear film and ocular surface instability that causes ocular discomfort and visual impairment. The increasing use of digital devices and changing lifestyle patterns have raised concerns about a potential rise in DED among children. Understanding the prevalence of paediatric DED is crucial for developing effective diagnostic and management strategies tailored to this vulnerable population.</p><p><strong>Method: </strong>An exhaustive literature search was performed on several databases covering the period from 1 January 2001 to 1 April 2024. Prevalence estimates of DED were combined using random effects models, and heterogeneity sources were explored through subgroup and regression analyses.</p><p><strong>Results: </strong>Our literature search identified 7309 articles, of which 41 articles, representing 42 study cohorts (48 479 participants) included in the systematic review. The estimated prevalence of DED among children was 23.7% (95% CI 18.5% to 28.9%). The prevalence of DED by different diagnostic criteria (clinical signs vs reported symptoms by questionnaire) was 16.6% (95% CI 13.7% to 19.5%; 26 studies; 27 107 children) vs 34.6% (95% CI 23.7% to 45.6%; 16 studies; 21 372 children; p<0.01), respectively. The prevalence of DED after the COVID-19 pandemic outbreak was 44.1% (95% CI 25.5% to 62.7%; 8 studies; 9163 children), which was significantly higher than the 18.7% (95% CI 15.6% to 21.9%; 34studies, 39 316 children; p=0.01) before the COVID-19 outbreak. High between-study heterogeneity was noted (I²>92%). In meta-regression analysis, the prevalence of DED among children increased by 7.1% with each 10° decrease in latitude (p=0.015), and by 10.2% with each 10° increase in mean annual temperature (p=0.024).</p><p><strong>Conclusions: </strong>DED is common in children up to 18 years of age and poses a significant disease burden. Standardisation of the diagnosis of DED in children and further study of other risk factors are needed to fully explain the epidemiology of DED in children.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world efficacy and safety of 8 mg aflibercept in neovascular AMD: a case series.","authors":"Deepak Sambhara, Priya Vakharia, David A Eichenbaum","doi":"10.1136/bmjophth-2024-002091","DOIUrl":"10.1136/bmjophth-2024-002091","url":null,"abstract":"<p><strong>Objective: </strong>This real-world retrospective case series evaluates the safety and efficacy of aflibercept 8 mg in patients diagnosed with neovascular age-related macular degeneration (nAMD).</p><p><strong>Methods and analyses: </strong>Treatment-naïve or treatment-experienced patients with nAMD receiving aflibercept 8 mg with at least 6 months of follow-up were assessed.</p><p><strong>Results: </strong>40 eyes from 33 patients were included, of which 36/40 eyes were previously treated. The mean age of subjects is 79.84 years. At baseline, 29/36 eyes had intraretinal fluid (IRF)/subretinal fluid (SRF) at an average interval of 40.97 days, logMAR VA of 0.346, and average central subfield thickness (CST) of 341.53 µm. At final follow-up, average logMAR VA was 0.315 and average CST decreased by 39.39 µm, with an average number of days since last treatment of 52.9. Of the 32 eyes with IRF, SRF, or both at the time of switch, 12 eyes achieved anatomical quiescence without IRF/SRF after the first injection of aflibercept 8 mg, including three of four treatment-naive patients.</p><p><strong>Conclusions: </strong>This early case series suggests that patients treated with aflibercept 8 mg may achieve greater duration between treatments while preserving and, in some cases, improving visual acuity and anatomical outcomes in a real-world clinic setting. In this retrospective study, the patient population primarily consisted of treatment-experienced cases with recalcitrant disease or high treatment burdens, potentially using aflibercept 8 mg as salvage therapy. This selection bias limits generalisability to broader real-world populations. The small sample size precludes formal statistical conclusions. Multiple investigators made unstandardised treatment decisions based on individual clinical judgement, including whether to continue aflibercept 8 mg or revert to prior therapy, sometimes after just one injection.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive glaucoma surgery: comparison of Hydrus microstent with iStent <i>inject</i> in primary open-angle glaucoma.","authors":"Krishna Komzak, Penelope L Allen, Tze'Yo Toh","doi":"10.1136/bmjophth-2024-001946","DOIUrl":"10.1136/bmjophth-2024-001946","url":null,"abstract":"<p><strong>Background: </strong>To evaluate and compare the efficacy of a single Hydrus and double iStent <i>inject</i> both combined with cataract surgery for the treatment of primary open-angle glaucoma (POAG).</p><p><strong>Methods: </strong>The study was designed as a prospective comparative case series. Patients with POAG undergoing trabecular microbypass stent insertion in addition to cataract surgery were recruited and consent was obtained. Baseline demographic information and preoperative, intraoperative and postoperative outcomes including intraocular pressure (IOP), visual acuity and topical glaucoma medication use were recorded and analysed. Treatment outcomes were analysed after propensity score matching to adjust for baseline differences between the two groups. Primary success was defined as an IOP of ≤18 and ≥20% IOP reduction at 12 months; other outcomes included IOP ≤15 mm Hg and ≤21 mm Hg. These were measured against complete success (no medications) and qualified success (one or more medications).</p><p><strong>Results: </strong>The study comprised 85 eyes in the Hydrus group and 100 eyes in the iStent <i>inject</i> group at commencement, with 12-month follow-up for 85 and 78, respectively. When correcting for baseline differences between the two groups using propensity score matching, Hydrus eyes were not more likely to achieve primary success (average treatment effect -0.79, p=0.15).</p><p><strong>Conclusion: </strong>After adjusting for baseline differences, there was no statistically significant difference between combined Hydrus microstent implantation and cataract surgery when compared with the iStent <i>inject</i> in reducing IOP at 12-month follow-up. This study was limited by statistically significant baseline differences between the two study groups, adjusted for with propensity score matching.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the restrictive technique on outcomes in Baerveldt-350 implant surgery.","authors":"Gloria Segura-Duch, David Oliver-Gutierrez, Susana Duch, Mar Schilt, Carlos Arciniegas-Perasso","doi":"10.1136/bmjophth-2024-001879","DOIUrl":"10.1136/bmjophth-2024-001879","url":null,"abstract":"<p><strong>Background: </strong>Different aqueous restrictive manoeuvres in non-valved devices affect intraocular pressure (IOP) levels in the first postoperative month. This study compares tube ligature (TL) alone to TL plus rip cord stent (TLS) on the efficacy of the Baerveldt 350.</p><p><strong>Methods: </strong>We conducted a retrospective consecutive case-series observational study to assess efficacy by measuring IOP, success rates and the reduction of antiglaucoma medication usage over 3 years.</p><p><strong>Results: </strong>The study included 43 eyes in the TL group and 29 in the TLS group. Initial IOPs were 26.67 mm Hg for TL and 28.21 mm Hg for TLS. After 1 year, IOP decreased to 13.03 mm Hg and 12.11 mm Hg, respectively. Over 3 years, TLS consistently achieved greater reductions in IOP compared with TL, with significant differences of 3.56 mm Hg in the second year (p=0.01) and 3.34 mm Hg in the third year (p=0.01). Mean antiglaucoma medication use decreased from 3.03 (SD 1.29) to 0.72 (SD 0.47) over 3 years, representing a 76.24% reduction, with no differences between the TL and TLS groups. Failure rate at 1 year was significantly lower for TLS under the success criteria of IOP=(6-18) mm Hg (TL: 33.33%, TLS: 7.14%, p=0.02). Rates of transient hypotension and hypertensive phase were higher in the TL group: 93.02% vs 34.48% (p<0.001) and 58.14% vs 32.14% (χ²=4.59, p=0.03), respectively.</p><p><strong>Conclusion: </strong>Adding the rip cord stent to the Baerveldt implant significantly enhances long-term IOP control and reduces failure rates compared with TL alone. The lower incidence of hypertensive phases could be due to sequential tube opening. Small sample size, lack of randomisation and follow-up discrepancies may introduce bias and limit statistical power, highlighting the need for further research to confirm these conclusions.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract surgery in Australia: a review of the regional literature and outcomes from 5018 cases at a tertiary teaching hospital.","authors":"Muhammad A Khan, Brendon W H Lee, Lauren Sartor, Chameen Samarawickrama","doi":"10.1136/bmjophth-2024-001765","DOIUrl":"10.1136/bmjophth-2024-001765","url":null,"abstract":"<p><strong>Objectives: </strong>To report visual and surgical outcomes of phacoemulsification cataract surgery from 5018 consecutive cases from Sydney, Australia. A review of the Australian and New Zealand literature was undertaken to provide a benchmark of outcomes from the region.</p><p><strong>Methods: </strong>The electronic medical record system was used to review three time-points for all phacoemulsification cataract surgeries at a tertiary-referral centre between May 2017 and August 2020: preoperative, intraoperative and one month postoperatively. Variables collected included uncorrected distance visual acuity (UDVA) and pinhole visual acuity, surgeon seniority and ocular pathology.</p><p><strong>Results: </strong>Of the 5018 eyes, 37.3% were operated on by consultants, 47.1% by trainees and 15.6% by fellows. Ocular pathology was seen in 48.9% of eyes (n=1709). The mean preoperative and one month postoperative UDVA was 6/48 and 6/12, respectively. There was an intraoperative complication in 7.6% of eyes (n=379) and posterior capsular rupture (PCR) occurred in 2.7% (n=136). PCR rates between consultants (3.1%, n=56), trainees (2.6%, n=61) and fellows (2.1%, n=16) showed no statistically significant difference (p≥0.355). The key risk factors for PCR were advanced cataract, alpha-antagonist use, small pupil size and the presence of glaucoma.</p><p><strong>Conclusion: </strong>We present visual and surgical outcomes from the largest study on phacoemulsification cataract surgery in Australia and New Zealand, acknowledging the study's retrospective nature preventing inter-eye correlations, subdivision of cataract subspecialist versus not and trainee rank, and the minority of missing data. Our findings were comparable to regional and international benchmarks despite a high rate of ocular pathology and trainee case load. The lack of a regional cataract surgery registry represents a critical need in assessing and claiming key performance indicators, capturing emerging trends and identifying region-specific risk factors to deliver the best patient outcomes.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}