BMJ Open Ophthalmology最新文献

{"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 Ike 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}

{"title":"Willingness to donate eyes and associated factors among adults in Addis Ababa City, Ethiopia: a mixed-methods approach.","authors":"Wubalem Addis Tefera, Hirut Gebremeskel Mengistu, Ejigu Gebeye Zeleke, Merkineh Markos Lorato","doi":"10.1136/bmjophth-2024-002022","DOIUrl":"10.1136/bmjophth-2024-002022","url":null,"abstract":"<p><strong>Objective: </strong>This study intended to assess willingness to donate eyes and associated factors among adults in Addis Ababa City, Ethiopia.</p><p><strong>Methods and analysis: </strong>This study used a triangulated phenomenological mixed-methods design, involving 1293 adults and eight key informants selected through multistage and purposive sampling. Data collection involved a pretested, semistructured questionnaire for quantitative data and an open-ended guiding questionnaire for qualitative insights. Ethical approval was granted by the University of Gondar, School of Medicine ethics review committee. The data were entered into Epi Info V.7 and analysed using SPSSV.22, with bivariable and multivariable binary logistic regression employed to identify significant factors, defined as those with a p value under 0.05. Qualitative data were analysed through thematic content analysis using code software, which included transcription, translation, coding and thematisation, ultimately enriching the quantitative findings.</p><p><strong>Results and conclusion: </strong>The study found that 47.2% (95% CI 44.7, 50.0) participants were willing to donate their eyes. Significant factors influencing willingness included being male (adjusted OdR (AOR)=1.55; 95% CI 1.18, 2.03), being a Christian (AOR=2.08; 95% CI 1.42, 3.04), having a family or friends awaiting for corneal transplantation (AOR=1.78; 95% CI: 1.18, 2.68), completing higher education (AOR=2.63; 95% CI 1.88, 3.69), completing secondary education (AOR=1.77; 95% CI 1.03, 3.04), having a favourable attitude towards eye donation (AOR=4.97; 95% CI 3.70, 6.66) and being aware of eye donation (AOR=3.12; 95% CI 2.23, 4.36). Qualitative analysis indentified barriers such as lack of information, poor attitudes and religious restrictions.Overall, willingness to donate eyes was moderate compared to previous studies. The findings emphasise the need for community education to improve public attitudes and awareness about eye donation to enhance willingness to donate eyes.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058012","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":"Association of arterial stiffness and eye disease: a systematic review and meta-analysis.","authors":"Angela L Beros, John D Sluyter, Robert Scragg","doi":"10.1136/bmjophth-2024-001980","DOIUrl":"10.1136/bmjophth-2024-001980","url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis assesses the association of arterial stiffness with age-related macular degeneration (AMD), glaucoma, retinal vein occlusion (RVO) and retinopathy (diabetic and hypertensive).</p><p><strong>Methods: </strong>Medline and Embase were systematically searched for observational studies of arterial stiffness and eye disease. Cohort studies were included if they estimated arterial stiffness using any measures based on the arterial waveform, with cross-sectional and case-control studies limited to measures of pulse wave velocity. We assessed the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation.</p><p><strong>Results: </strong>The systematic review of 61 studies (six for AMD, ten for glaucoma, six for RVO and 39 for retinopathy) showed that arterial stiffness overall was higher in people with eye disease than people without eye disease. Forty-four cross-sectional and case-control studies were included in the meta-analysis. Arterial stiffness estimated by way of pulse wave velocity was associated with AMD (mean difference: 0.92 m/s, 95% CI 0.37 to 1.46; 2 studies; n=381; low certainty evidence), glaucoma (mean difference: 0.97 m/s, 95% CI 0.31 to 1.64; 7 studies; n=3418; low certainty evidence), RVO (mean difference: 2.79 m/s, 95% CI 2.02 to 3.55; 5 studies; n=414; very low certainty evidence) and retinopathy (1.48 m/s, 95% CI 0.1.16 to 1.81; 22 studies; n=10 074; low certainty evidence). The 19 cohort studies identified (five for AMD, three for glaucoma, one for RVO and 10 for retinopathy) indicated overall that increased arterial stiffness was associated with the future development of eye disease.</p><p><strong>Conclusions: </strong>Higher arterial stiffness is associated with AMD, glaucoma, RVO and retinopathy PROSPERO REGISTRATION NUMBER: CRD42019129563.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037243","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":"Effect of ethnicity and other sociodemographic factors on attendance at ophthalmology appointments following referral from a Diabetic Eye Screening Programme: a retrospective cohort study.","authors":"James Banks, Abraham Olvera-Barrios, Matilda Pitt, Daisy Williams, Michael Seltene, Celestine Rutowska, Mumina Khatun, Josef Huemer, Yasir Khan, Zoe Ockrim, Ling Zhi Heng, Alicja R Rudnicka, Adnan Tufail, Catherine A Egan, Christopher G Owen","doi":"10.1136/bmjophth-2024-001969","DOIUrl":"10.1136/bmjophth-2024-001969","url":null,"abstract":"<p><strong>Background/aims: </strong>To examine the association between sociodemographic characteristics and attendance at Hospital Eye Service (HES) referrals from the Diabetic Eye Screening Programme (DESP), in a large, ethnically diverse urban population.</p><p><strong>Methods: </strong>Retrospective cohort study (4 January 2016-12 August 2019) of people with diabetic retinopathy (DR) referred from an English DESP to a tertiary referral eye hospital. We conducted a multivariable logistic regression with attendance as the primary outcome, controlling for age, sex, ethnicity, Index of Multiple Deprivation, best eye visual acuity and baseline DR grade.</p><p><strong>Results: </strong>Of 7793 people referred (mean age 64 years, 62.6% male, 13.9% white, 12.5% black, 25.3% South Asian, 6.5% any other Asian background, 19.3% no recorded ethnicity and 20.9% of 'Other' ethnic origin), 69% attended. Compared with white individuals, people of black ethnic origin were similarly likely to attend. South Asians and those of other Asian backgrounds were more likely, and people with 'Other' or missing ethnicity were less likely to attend. Those with higher levels of deprivation, younger (aged 18-45 years) and older (76-90 years) age groups and worse visual acuity were less likely to attend, whereas people identified as having proliferative DR in both eyes were more likely to attend.</p><p><strong>Conclusion: </strong>Sociodemographic patterns in attendance after referral from the DESP to the HES exist, and these do not appear to explain ethnic differences in more severe sight-threatening DR, suggesting other explanations. More work is needed to understand and reduce inequalities in HES attendance.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022051","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":"Comparative evaluation of funduscopy, PCR and serology in the diagnosis of ocular toxoplasmosis at ECWA Eye Hospital, Kano.","authors":"Biodun Bintu Adebakin, Jamilu Abubakar Bala, Mayor Orezime Atima, Ugbede Idakwo, Bilkisu Ahmed, Alhasan Sharif Abdullahi, Isah Abubakar Aliyu, Jah Douglas Pam, Lawal Dahiru Rogo, Emeka John Dingwoke, Florence Olufunke Darda, Auwal Bello Muhammad, Halliru Hassan Abdullahi, Abdulhadi Sale Kumurya","doi":"10.1136/bmjophth-2024-002023","DOIUrl":"10.1136/bmjophth-2024-002023","url":null,"abstract":"<p><strong>Objective: </strong>Ocular toxoplasmosis, caused by <i>Toxoplasma gondii</i>, is a significant cause of posterior uveitis and vision impairment globally. Accurate diagnosis is essential to prevent retinal damage and optimise treatment. This study aimed to compare three diagnostic methods funduscopy, serology (ELISA), and PCR in detecting ocular toxoplasmosis in patients at ECWA Eye Hospital, Kano, Nigeria.</p><p><strong>Methods and analysis: </strong>A total of 264 patients suspected of having ocular toxoplasmosis were enrolled. Funduscopy was performed to identify retinal lesions typical of <i>T. gondii</i>. Serological analysis was conducted using ELISA to detect anti-<i>Toxoplasma</i> IgG antibodies. Additionally, PCR was used to confirm the presence of <i>T. gondii</i> DNA in blood samples. The results from these methods were compared with assess their sensitivity, specificity and diagnostic value.</p><p><strong>Results: </strong>Funduscopy detected <i>T. gondii</i> in 25.4% (67/264) of the patients, while ELISA showed a higher detection rate of 36.7% (97/264). PCR, the most specific method, confirmed infection in only 3.8% (10/264) of cases, with 60% (6/10) of these being male and 40% (4/10) female. <i>T. gondii</i> detected had 196 base pairs. The study found that ELISA had the highest sensitivity (90.0%) but lower specificity (64.9%), whereas funduscopy showed high specificity (74.4%) but low sensitivity (20.0%). PCR had the highest specificity but a low detection rate, emphasising its role in confirming diagnosis.</p><p><strong>Conclusion: </strong>Although ELISA and funduscopy detected more positive cases, PCR remains the gold standard for confirming <i>T. gondii</i> infection due to its high specificity. In resource-limited settings like ECWA Eye Hospital, combining serology and PCR offers a practical approach for improving diagnostic accuracy and ensuring timely treatment of ocular toxoplasmosis.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000539","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}