BMJ Open Ophthalmology最新文献

{"title":"Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis","authors":"Faisal Aljahdali, Waleed Khayyat, Abdulelah T BinYamin, Sultan A Al-Qahtani, Mohammed D Alghamdi, Ali Saleh Alsudais, Husain A Alalgum, Halah Bin Helayel, Mohammed AlMutlak","doi":"10.1136/bmjophth-2023-001621","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001621","url":null,"abstract":"Background Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery. Methods A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively. Results 11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD −3.704, 95% CI −5.122 to −2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema. Conclusion Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient’s blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"53 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-guided orbital surgery: a preclinical validation study using a high-resolution physical model","authors":"Rizwana I Khan, Kealan McElhinney, Andrew Dickson, Ronan P Kileen, Conor Murphy, Donncha F O’Brien","doi":"10.1136/bmjophth-2023-001568","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001568","url":null,"abstract":"Objective Preclinical validation study to assess the feasibility and accuracy of electromagnetic image-guided systems (EM-IGS) in orbital surgery using high-fidelity physical orbital anatomy simulators. Methods EM-IGS platform, clinical software, navigation instruments and reference system (StealthStation S8, Medtronic) were evaluated in a mock operating theatre at the Royal Victoria Eye and Ear Hospital, a tertiary academic hospital in Dublin, Ireland. Five high-resolution 3D-printed model skulls were created using CT scans of five anonymised patients with an orbital tumour that previously had a successful orbital biopsy or excision. The ability of ophthalmic surgeons to achieve satisfactory system registration in each model was assessed. Subsequently, navigational accuracy was recorded using defined anatomical landmarks as ground truth. Qualitative feedback on the system was also attained. Results Three independent surgeons participated in the study, one junior trainee, one fellow and one consultant. Across models, more senior participants were able to achieve a smaller system-generated registration error in a fewer number of attempts. When assessing navigational accuracy, submillimetre accuracy was achieved for the majority of points (16 landmarks per model, per participant). Qualitative surgeon feedback suggested acceptability of the technology, although interference from mobile phones near the operative field was noted. Conclusion This study suggests the feasibility and accuracy of EM-IGS in a preclinical validation study for orbital surgery using patient specific 3D-printed skulls. This preclinical study provides the foundation for clinical studies to explore the safety and effectiveness of this technology. Data are available upon reasonable request.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"45 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red filter meibography by smartphones in patients with meibomian gland dysfunction: a validity and reliability study","authors":"Gisela Haza Anissa, Rina La Distia Nora, Syska Widyawati, Ratna Sitompul, Prasandhya Astagiri Yusuf, Aria Kekalih","doi":"10.1136/bmjophth-2023-001266","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001266","url":null,"abstract":"Objective The objective of this study is to determine the validity and reliability of the red filter meibography by smartphone compared with infrared in assessing meibomian gland drop-out. Methods and analysis An analytical cross-sectional study was done with a total of 35 subjects (68 eyes) with suspected MGD based on symptoms and lid morphological abnormalities. Meibomian glands were photographed using two smartphones (Samsung S9 and iPhone XR) on a slit-lamp with added red filter. Images were assessed subjectively using meiboscore by the two raters and drop-out percentages were assessed by ImageJ. Results There was no agreement in meiboscore and a minimal level of agreement in drop-out percentages between red filter meibography and infrared. Inter-rater reliability showed no agreement between two raters. Intra-rater reliability demonstrated weak agreement in rater 1 and no agreement in rater 2. Conclusion Validity of the red filter meibography technique by smartphones is not yet satisfactory in evaluating drop-out. Further improvement on qualities of images must be done and research on subjective assessment was deemed necessary due to poor results of intrarater and inter-rater reliability. No data are available.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of beta parapapillary atrophy in primary angle-closure suspect","authors":"Fei Xiang, Ye Zhang, Qing Zhang, Xiaohua Pan, Hui Feng, Meijuan Zhang, Caixia Li, Qianqian Ji, Zhi Li, Shuning Li","doi":"10.1136/bmjophth-2023-001529","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001529","url":null,"abstract":"Objective To investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS). Methods and analysis In total, 215 and 259 eyes with PACS and non-PACS (NPACS), respectively, were enrolled in this observational, cross-sectional study. Stereoscopic fundus and optical coherence tomography images were used to characterise β-PPA; the former was also used to measure the major β-PPA parameters. Univariate and multiple logistic regression analyses were used to identify the factors correlated with the presence of β-PPA and with β-PPA parameters. Results The β-PPA occurrence rates were 48.80% and 44.40% in the PACS and NPACS groups, respectively, with no significant difference between groups. Compared with that in the NPACS group, the β-PPA area was significantly larger (p=0.005) in the PACS group, but the angular extent and maximum radial length did not differ between groups (p=0.110 and 0.657, respectively) after adjusting for age and axial length. The presence of β-PPA was associated with older age (OR 1.057, 95% CI 1.028 to 1.088, p<0.001) and larger disc area (OR 1.716, 95% CI 1.170 to 2.517, p=0.006). A larger β-PPA area was associated with older age (p=0.014), greater vertical cup-to-disc ratio (p=0.028), larger disc area (p<0.001) and PACS diagnosis (p=0.035). Conclusion 48.80% of participants with PACS had β-PPA, which is slightly larger than NPACS. The area of β-PPA was larger in PACS, while the angular extent and maximum radial length did not differ between groups. Data are available on reasonable request.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"162 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversing the paradigm on the urgency of acute retinal detachments defined by their foveal status: when off may be more urgent than on","authors":"Carmen Baumann, Stephen B Kaye, David H Steel","doi":"10.1136/bmjophth-2024-001668","DOIUrl":"https://doi.org/10.1136/bmjophth-2024-001668","url":null,"abstract":"The visual prognosis is good for what is generally termed ‘macula-on’ rhegmatogenous retinal detachments (RRDs) but often less favourable for ‘macula-off’ RRDs. The longer the fovea is detached and the higher the detachment is from the retinal pigment epithelium, the worse the visual outcome.1–5 Indeed, it is the exquisitely engineered fovea that is the key determinant of good visual recovery, and as such, we need to be more precise with the terminology and replace the traditional terms of ‘macula-on/off’ with ‘fovea-on/off’.6 While posturing and/or immobility induced by bilateral eye patching may temporarily reduce or prevent the spread of subretinal fluid (SRF) under the fovea prior to surgery,7–11 prompt surgical intervention is key for improving visual outcomes. As soon as retinal detachment occurs, inflammatory and wound healing changes start. In animal models, photoreceptor apoptosis has been shown to occur as early as 12 hours after retinal detachment, followed by extensive remodelling with functional and morphological changes eventually involving all retinal layers. Photoreceptor outer segments progressively degenerate, inner segments reorganise, rod and cone opsins are redistributed, and rod axons retract while cones undergo changes in shape.12 The longer the retina remains detached, the more extensive these changes become and the less likely there is to be complete or near complete recovery of visual function following surgical repair. Furthermore, the damage to cellular functions in fovea-off RRDs also affect other qualities of vision besides acuity, including contrast sensitivity, colour vision and stereopsis.13 14 Although the exact relationships between these RRD-induced changes in retinal anatomy and recoverable function are unclear, they appear to be time critical, with irrecoverable loss occurring within 24 hours. Studies analysing the effect of the duration of loss of central vision (LCV) prior to surgery have shown a deleterious effect of duration on postoperative visual …","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140630307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark—an observational registry study of 30 100 Danish patients with glaucoma","authors":"Miriam Kolko, Rikke Faergemann Hansen, Louise G Dal, Emma Sabelström, Magnus Brandel, Andreas Hoiberg Bentsen, Anne Cathrine Falch-Joergensen","doi":"10.1136/bmjophth-2023-001607","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001607","url":null,"abstract":"Background Self-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss. Objective To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence. Methods and analysis This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs. Results High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts. Conclusion Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts. Data may be obtained from a third party and are not publicly available.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population-based survey of the prevalence and types of glaucoma in Bangladesh.","authors":"Sheikh M A Mannaf, Md Shafiqul Islam, M Nazrul Islam, Md Mizanur Rahman, Salma Parvin, Siddiqur Rahman, Bipul Kumer De Sarker","doi":"10.1136/bmjophth-2023-001609","DOIUrl":"10.1136/bmjophth-2023-001609","url":null,"abstract":"<p><strong>Background: </strong>To delineate the epidemiological landscape of glaucoma using a population-based sample representative of Bangladesh.</p><p><strong>Methods: </strong>Using multistage stratified cluster random sampling, households were selected to identify individuals ≥35 years across all 8 divisions of Bangladesh. Sampling frames were derived from the 2011 national census. Fifty-eight study examination sites were set up for comprehensive eye evaluations, including intraocular pressure, gonioscopy and visual field testing when indicated. International Society for Geographic and Epidemiological Ophthalmology definitions were used to define glaucoma and glaucoma suspect cases.</p><p><strong>Results: </strong>One hundred forty clusters (89 rural and 51 urban) were randomly selected, and 13 791 residential households were visited. We invited 17 002 individuals ≥35 years for on-site examination, of which 12 000 (71%) complied, with a male-to-female ratio of 1:1. The prevalence of glaucoma was 3.2% (95% CI 2.79% to 3.64%), and glaucoma suspect was 10.1% (95% CI 9.05% to 11.12%). The majority (78%) had primary open-angle glaucoma (POAG), while angle closure was seen in 16%. Of the POAG, 83% (n=251) were normal-tension glaucoma. Multivariable logistic regression showed increasing age (OR=1.01 for every 5-year increment, 95% CI 1 to 1.01) and male gender (OR=1.43, 95% CI 1.15 to 1.77) to be associated with an increased risk of glaucoma.</p><p><strong>Conclusions: </strong>The prevalence of glaucoma in Bangladesh is 3.2% in ≥35-year-old individuals with older men most at risk. Extrapolating the results, we estimate about 2 million patients with glaucoma. Though normal-tension variety was the most common type, caution should be exercised in generalising these results to other populations.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304946","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 and environmental sustainability: a comparative analysis of single-use versus reusable cassettes in phacoemulsification.","authors":"Oscar Kallay, Rayane Sadad, Ahmed Zafzafi, Elie Motulsky","doi":"10.1136/bmjophth-2023-001617","DOIUrl":"10.1136/bmjophth-2023-001617","url":null,"abstract":"<p><strong>Objective: </strong>To compare sustainability, financial implications and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones.</p><p><strong>Methods: </strong>Observational study involving retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-l'Alleud, Belgium, a tertiary eye care centre. Information on cassette weight, quantities and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department.</p><p><strong>Results: </strong>We found significant differences across comparisons. The reusable cassette machine, when compared with the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2494 m³ less storage per 1000 surgeries (67.7% decrease) and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases.</p><p><strong>Conclusions: </strong>Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume and priming time, as well as enhanced efficiency and cost-savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10966808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140292965","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 proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus.","authors":"Olga Araújo, Ricardo P Casaroli-Marano, José Hernández-Rodríguez, Marc Figueras-Roca, Vanesa Budi, Montse Morató, Halbert Hernández-Negrín, José Ríos, Alfredo Adan, Gerard Espinosa, Laura Pelegrín, Ricard Cervera","doi":"10.1136/bmjophth-2023-001608","DOIUrl":"10.1136/bmjophth-2023-001608","url":null,"abstract":"<p><strong>Objective: </strong>To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.</p><p><strong>Methods: </strong>A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), <i>en face</i> OCT, <i>en face</i> OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.</p><p><strong>Results: </strong>Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both <i>en face</i> OCT and <i>en face</i> OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). <i>En face</i> OCT and <i>en face</i> OCTA structural findings showed better concordance, with a <i>kappa</i> index >0.8, and both identified the same cases of toxicity as FAF.</p><p><strong>Conclusion: </strong>Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, <i>en face</i> OCT and <i>en face</i> OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140157608","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 sildenafil use with age-related macular degeneration: a retrospective cohort study.","authors":"Ji Eun Diana Han, Anuradhaa Subramanian, Wen Hwa Lee, Jesse Coker, Alastair K Denniston, Krishnarajah Nirantharakumar, Nicola Jaime Adderley","doi":"10.1136/bmjophth-2023-001525","DOIUrl":"10.1136/bmjophth-2023-001525","url":null,"abstract":"<p><strong>Objective: </strong>Despite significant advances in clinical care and understanding of the underlying pathophysiology, age-related macular degeneration (AMD)-a major cause of global blindness-lacks effective treatment to prevent the irreversible degeneration of photoreceptors leading to central vision loss. Limited studies suggest phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, may prevent AMD by increasing retinal blood flow. This study explores the potential association between sildenafil use and AMD risk in men with erectile dysfunction using UK data.</p><p><strong>Methods and analysis: </strong>Using the UK's IQVIA Medical Research Data, the study analysed 31 575 men prescribed sildenafil for erectile dysfunction and no AMD history from 2007 to 2015, matched with a comparator group of 62 155 non-sildenafil users in a 1:2 ratio, over a median follow-up of approximately three years.</p><p><strong>Results: </strong>The primary outcome was the incidence of AMD in the two groups. The study found no significant difference in AMD incidence between the sildenafil users and the non-users, with an adjusted hazard ratio (HR) of 0.99 (95% CI 0.84 to 1.16), after accounting for confounders such as age, ethnicity, Townsend deprivation quintile, body mass index category, and diagnosis of hypertension and type 2 diabetes.</p><p><strong>Conclusion: </strong>The study results indicated no significant association between sildenafil use and AMD prevention in UK men with erectile dysfunction, suggesting sildenafil's protective effect on AMD is likely insignificant.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140136515","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}