BMJ Open Ophthalmology最新文献

{"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}

{"title":"Effectiveness and safety of the XEN45 gel stent compared to trabeculectomy in primary open-angle glaucoma: the Gold-Standard Pathway Study.","authors":"Iqbal K Ahmed, Vanessa Vera, Ingeborg Stalmans, Antonio Maria Fea, Kaweh Mansouri, Xuemin Gu, Earl Randy Craven, Herbert A Reitsamer","doi":"10.1136/bmjophth-2024-001696","DOIUrl":"10.1136/bmjophth-2024-001696","url":null,"abstract":"<p><strong>Aim: </strong>To compare the gel stent to trabeculectomy in the Gold-Standard Pathway Study (GPS) patients with primary open-angle glaucoma (POAG).</p><p><strong>Methods: </strong>In the GPS, patients with elevated intraocular pressure (IOP) poorly controlled with IOP-lowering medication were randomised (2:1, gel stent:trabeculectomy). Aggregate primary endpoint: patients (%) at month 12 achieving ≥20% IOP reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers or secondary surgical intervention (SSI). Secondary endpoints included changes in mean IOP and medication count from baseline; postoperative interventions; visual recovery; postoperative complications; and the Symptom and Health Problem Checklist (SHPC-18) questionnaire.</p><p><strong>Results: </strong>Of 130 eyes with POAG treated/analysed (gel stent, n=88; trabeculectomy, n=42); 61.4% and 69.0% met the primary endpoint, respectively (p=0.394). At month 12, the change from baseline in mean IOP was statistically greater post-trabeculectomy (by 2.8 mm Hg; p=0.028) than post-gel stent. Postoperative intervention and postoperative complication rates were 39.8% and 75.0% (gel stent) versus 76.2% and 92.9% (trabeculectomy), respectively. Hypotony (IOP ≤6 mm Hg at two consecutive visits) rates were 14.8% (gel stent) and 28.6% (trabeculectomy). Visual recovery was faster/better (per the mean and time to first return to baseline best corrected visual acuity) and SHPC-18-related improvements were greater post-gel stent than post-trabeculectomy.</p><p><strong>Conclusion: </strong>Similar proportions of eyes with POAG achieved the primary endpoint post-gel stent and post-trabeculectomy. The mean IOP reduction was statistically greater post-trabeculectomy. The gel stent resulted in fewer postoperative interventions, faster/better visual recovery, favourable patient-reported outcomes and fewer specific adverse events, although more SSIs and IOP elevations were observed.</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/PMC11804186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363667","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":"Trabeculectomy versus stepwise treatment for breaking the attack of acute primary angle closure in patients with long attack duration: study design and protocol for a multicentre randomised controlled trial (LAAAC).","authors":"Zhi Li, Chao Dai, Su Jie Fan, Guangxian Tang, Chi Liu, Bo Qu, Xinqi Chang, Jing Jiang, Yanyan Cheng, Ye Zhang, Qing Zhang, Ning-Li Wang, Mingguang He, Shuning Li","doi":"10.1136/bmjophth-2024-001934","DOIUrl":"10.1136/bmjophth-2024-001934","url":null,"abstract":"<p><strong>Introduction: </strong>Acute primary angle closure (APAC) is a common ophthalmic emergency for Chinese patients causing potential visual disabilities. According to current guidelines published by developed countries, a stepwise protocol (medication laser or paracentesis surgery) is recommended for emergency management of APAC. However, patients with APAC in China and developed countries differ in disease characteristics as the Chinese have longer attack duration and lower success rate in breaking the attack with solely medication or laser therapy. It has been proved that long attack duration is a risk factor for failed medical or laser therapies in subsiding APAC. Since prompt and effective treatment is pivotal in preserving visual function as well as avoiding APAC-induced blindness, direct trabeculectomy may largely benefit long-attacking patients with APAC in China.</p><p><strong>Purpose: </strong>The Long-Attacking Acute Angle Closure study aims to compare long-term visual function and safety after different initial treatment strategies: direct surgery (trabeculectomy) or stepwise protocol for patients with APAC with attack duration longer than 72 hours.</p><p><strong>Methods and analysis: </strong>This is a pragmatic, multicentre, randomised controlled trial targeting Chinese patients with APAC duration longer than 72 hours. Eligible participants will be identified at either emergency department or glaucoma clinics, then randomised into stepped treatment group or trabeculectomy group using a computer central randomisation service. The patients will be followed up for 1 year after initial treatment.</p><p><strong>Main outcomes and measures: </strong>The primary outcome is logMAR BCVA 1 year post initial treatment. Secondary outcomes consist of complete success rate in breaking the attack, intraocular pressure value, mean deviation on Humphrey visual field testing and vision-related quality of life collected using the National Eye Institute Visual Function Questionnaire (25 items) 1 year post initial treatment.</p><p><strong>Trial registration number: </strong>ChiCTR2200057289.</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/PMC11804192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363677","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":"Outcomes of cataract surgery training among ophthalmology trainees in the independent sector and within the NHS.","authors":"Yunzi Chen, Oonagh Crothers, Darren Shu Jeng Ting, Philip Severn, Qasim Mansoor","doi":"10.1136/bmjophth-2024-001716","DOIUrl":"10.1136/bmjophth-2024-001716","url":null,"abstract":"<p><strong>Objective: </strong>The surge in National Health Service (NHS) cataract procedures in the independent sector (IS) has reduced opportunities for cataract surgical training among ophthalmology trainees. This study aims to analyse IS cataract surgery training outcomes and explore its potential as a supplement to NHS-based training by comparing IS outcomes with NHS and National Ophthalmology Database (NOD) standards.</p><p><strong>Methods and analysis: </strong>Two trainees (ST5 and ST3) trained in IS high volume and standard NHS lists. A comprehensive IS training programme included modular cataract training, structured feedback framework and non-technical skills development. Prospective data concerning case numbers, complexity, take-over, outcomes and complication rates were collected and compared.</p><p><strong>Results: </strong>In total, 161 IS and 62 NHS cases were analysed. On average, trainees did 6 cases/12 patient lists in IS versus 3 cases/6 patient lists in NHS. IS cases had similar complexity to NHS cases (43% IS vs 35% in NHS, p=0.32, adjusted p=1). Intraoperative complications (3% IS vs 5% NHS, p=0.53, adjusted p=1) and posterior capsule ruptures (1% IS vs 0% NHS, p=0.38, adjusted p=1) were similar, aligning with NOD standards. Based on cases without any ocular comorbidity, the proportion of eyes achieving a good visual outcome (≥6/12 Snellen vision) was similar between IS (100%) and NHS (96%) (p=0.12, adjusted p=1). Surgical efficiency was maintained with all lists completed within 4 hours.</p><p><strong>Conclusion: </strong>A structured training programme on high-volume lists within IS setting provided two trainees with valuable exposure to diverse cataract cases while ensuring safety and efficiency, producing training outcomes comparable to the NHS and NOD standards. This is a pilot study, and a much larger multicentre study will be required before the widespread introduction of training in cataract surgery in the IS can be recommended.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188373","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}