British Journal of Ophthalmology最新文献

{"title":"Impact of teleophthalmology on early referral of infectious keratitis patients in South India: a prospective comparative study","authors":"Mevis Phongolo, Neha Sapar, Nedunchezian Vasanthakumar, Balagiri Sundar, Josephine Christy, Naveen Radhakrishnan","doi":"10.1136/bjo-2025-327377","DOIUrl":"https://doi.org/10.1136/bjo-2025-327377","url":null,"abstract":"Background Infectious keratitis (IK) predominantly affects patients from rural agrarian regions with limited access to medical care, leading to delayed presentation associated with poorer visual outcomes. This study aims to determine if tele-ophthalmology-based primary care vision centres (VC) can reduce barriers to care and facilitate IK patients to present earlier to tertiary care hospitals, thus preventing vision-threatening consequences. Methods This prospective study, conducted at a tertiary hospital in South India, compared the clinical features, microbial profiles and outcomes of IK patients referred from teleophthalmology-based vision centres with those presenting directly to tertiary care centres (DTC). Descriptive statistics, univariate analysis and multivariable regression models were used. Results A total of 228 patients were included: 115 from VCs and 113 from DTC. There were no significant demographic or microbial differences between the groups. However, DTC patients presented late (median time to presentation from onset of symptom: VC 3 days, DTC 7 days, p=0.002) with more severe disease, including poorer visual acuity (Median LogMAR UCVA: VC 0.60, DTC 1.08, p=0.0002), deeper ulcers (VC 14.8%, DTC 29.2%, p=0.03) and larger infiltrates (VC 4 mm², DTC 9 mm², p=0.009). The need for therapeutic penetrating keratoplasty (TPK) was significantly greater in DTC patients (p=0.001). Multivariable analysis showed that DTC patients and those with larger ulcers had significantly higher odds of requiring TPK. Conclusion This study highlights the impact of primary care in improving access to timely care of IK. By facilitating early treatment, VCs can help prevent severe complications, demonstrating their vital role in resource-limited settings. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"66 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse infiltrating retinoblastoma: a multicentre, international, data-sharing study","authors":"Ankit Singh Tomar, Paul T Finger, Brenda Gallie, Tero T Kivelä, Ashwin Mallipatna, Chengyue Zhang, Junyang Zhao, Matthew W Wilson, Rachel C Brennan, Michala Burges, Jesse L Berry, Rima Jubran, Vikas Khetan, Suganeswari Ganesan, Andrey Yarovoy, Vera Yarovaya, Elena Kotova, Denis Volodin, Yacoub A Yousef, Kalle Nummi, Tatiana L Ushakova, Olga V Yugay, Vladimir G Polyakov, Marco A Ramirez-Ortiz, Elizabeth Esparza-Aguiar, Guillermo Chantada, Paula Schaiquevich, Adriana Fandiño, Jason C Yam, Winnie W Lau, Carol P Lam, Phillipa Sharwood, Sonia Moorthy, Quah Boon Long, Vera Adobea Essuman, Lorna A Renner, Ekaterina Semenova, Jaume Catala-Mora, Genoveva Correa-Llano, Elisa Carreras","doi":"10.1136/bjo-2024-326778","DOIUrl":"https://doi.org/10.1136/bjo-2024-326778","url":null,"abstract":"Background To determine the unique clinical characteristics and treatment outcomes of diffuse infiltrating retinoblastoma (DIR). Methods This international, multicentre, registry-based retrospective case series analysed pooled data from January 2001 to December 2013, including 132 eyes from 132 patients with DIR. Results Among 2854 eyes with retinoblastoma, 132 (4.6%; 95% CI, 3.9 to 5.5) had DIR. The median age at diagnosis for DIR patients was 24 months (IQR, 15–33), with no bilateral cases of DIR. The American Joint Committee on Cancer staging showed 4.5% cT2 and 95.5% cT3 categories, with no cT1 or cT4 cases. Clinical features associated with DIR included secondary glaucoma (67%), retinal detachment (38%), diffuse vitreous seeds (37%), anterior segment involvement (24%), vitreous haemorrhage (50%) and hyphema (6%). Primary enucleation was the predominant treatment (81%), while 19% initially received systemic chemotherapy, with 6% requiring subsequent enucleation. The 5-year Kaplan-Meier survival rate for cT3 DIR was 82% (95% CI, 78 to 86), significantly lower than the 94% (95% CI, 93 to 95) for cT3 non-DIR cases (p<0.001). Cox proportional hazards regression returned a higher risk of metastatic death for DIR cT3 compared with non-DIR cT3 (HR, 3.3; 95% CI, 1.8 to 5.9; p<0.001). High-risk pathological features were more frequent in DIR (41% vs 28%, p=0.004). There was no association between DIR and local treatment failure. Conclusions Approximately 1 in 20 patients with retinoblastoma had DIR, which often presented with glaucoma, anterior segment involvement or intraocular bleeding. DIR was more lethal than non-DIR cT3, with enucleation revealing high-risk pathology. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"20 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced maternal reproductive age elevates myopia risk in offspring.","authors":"Jiao Qi,Jing Lin,Keke Zhang,Pengyan Zhang,Chao Chen,Yi Lu,Xiangjia Zhu","doi":"10.1136/bjo-2025-327367","DOIUrl":"https://doi.org/10.1136/bjo-2025-327367","url":null,"abstract":"AIMSTo evaluate the associations of parental reproductive age with the risk of myopia and high myopia in adult offspring.METHODSThis cross-sectional study included 14 044 UK Biobank participants. Myopia and high myopia were defined as a mean spherical equivalent (spherical power+1/2 cylindrical power) of both eyes ≤-0.5 dioptres (D), and ≤-6.0 D, respectively. Parental age was categorised as <25, 25-29, 30-34 and ≥35 years. Logistic regression was conducted after adjusting for age, sex, race, time spent outdoors, Townsend Index, income, education, body mass index, smoking and drinking. Interaction terms between parental age and outdoor activity were further added to the logistic regression models.RESULTSThe prevalence of myopia and high myopia among adult offspring generally increased with parental reproductive age. Logistic regression analysis revealed that advanced maternal age significantly increased the risk of myopia and high myopia. Maternal age over 35 years was associated with the highest risk of myopia (OR, 1.42; p<0.001) and high myopia (OR, 1.56; p=0.029). However, no significant effect was observed for advanced paternal age on the risk of myopia and high myopia. Interaction analysis indicated that compared with spending 0-2 hours outdoors daily, more than 2 hours attenuated the effect of maternal age on progression of myopic refractive error.CONCLUSIONAdvanced maternal reproductive age had a detrimental effect on the risk of myopia and high myopia in offspring, which could be mitigated by engaging in daily outdoor activity.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of daily disposable Defocus Incorporated Soft Contact lens on myopia control: a 1-year multicentre randomised controlled trial.","authors":"Lin Liu,Jinghui Wang,Dennis Yan-Yin Tse,Bing Zuo,Desheng Song,Bei Du,Zhi Chen,Chi Ho To,Rachel Ka Man Chun,Jun Jiang,Ruihua Wei","doi":"10.1136/bjo-2025-327471","DOIUrl":"https://doi.org/10.1136/bjo-2025-327471","url":null,"abstract":"AIMTo investigate the effect of the Defocus Incorporated Soft Contact (DISC) lenses on myopia progression and choroidal thickness (ChT) of Chinese mainland children over a period of 12 months.METHODSThis was a prospective double-blind randomised controlled trial involving 84 myopic children. Subjects were randomly assigned to use of either DISC or single vision contact lens (SVL). Cycloplegic spherical equivalent refraction (SER), axial length (AL) and ChT were measured at 6 and 12 months.RESULTSFor 12 months, the average changes in SER and AL in the DISC group were (-0.50±0.41) D and (0.22±0.13) mm. Corresponding values in the SVL group were (-1.23±0.50) D and (0.49±0.15) mm. Myopia control efficacy in SER was 59% and 55% in AL. For those aged under 10, myopia control efficacy in SER is higher at 95% in 6 months and 71.4% in 12 months. ChT increased by 0.16±24.46 µm in the DISC group, while in contrast, it thinned in the SVL group (-9.11±32.25 µm) after 12 months. ChT changes demonstrated a significant negative association with AL over 12 months in the DISC group but not in the SVL group. In contrast, ChT change over 12 months was significantly negatively associated with initial ChT in the SVL group, but not in the DISC group.CONCLUSIONSDISC lenses effectively slowed myopia progression and AL compared with SVL, especially for younger children. Myopia defocus treatment changes the original intrinsic relationship between ChT and myopia progression, providing strong evidence that myopia defocus design controls myopia progression by changing ChT.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of retinal thickness fluctuations with ranibizumab versus aflibercept in neovascular age-related macular degeneration (SALT): 12-month results from a multicentre, randomised, phase IV trial.","authors":"Hansjuergen T Agostini,Rufino Silva,Frank G Holz,Michael Larsen,Lebriz Altay,Eric H Souied,Claudia Quiering,Uwe Rose,Sandra Liakopoulos, ","doi":"10.1136/bjo-2024-326526","DOIUrl":"https://doi.org/10.1136/bjo-2024-326526","url":null,"abstract":"BACKGROUND/AIMSTo compare fluctuations of central subfield retinal thickness (CSRT) in patients with neovascular age-related macular degeneration undergoing ranibizumab pro re nata versus aflibercept bimonthly treatment in a prospective 12 month, phase IV, randomised, multicentre study.METHODSRanibizumab was administered according to best-corrected visual acuity (BCVA) and/or disease activity detected on spectral domain optical coherence tomography. Aflibercept was administered at three initial monthly visits followed by bimonthly treatment. CSRT stability was evaluated between months 3 and 6. CSRT stability was compared between groups and correlated with functional outcomes at month 12.RESULTSFluctuations of CSRT showed a least-squares (LS) mean (95% CI) difference of -4.12 (-10.22 to 1.98) µm between ranibizumab (25.16 (20.09 to 30.24) µm) and aflibercept groups (29.28 (24.14 to 34.43) µm) (p=0.1850). A predefined analysis of retinal stability, adjusted for baseline CSRT, showed a LS mean (95% CI) difference of -6.53 (-12.47 to -0.58 µm) in favour of ranibizumab (23.53 (18.58 to 28.49) µm) versus aflibercept (30.06 (25.04 to 35.07) µm) (p=0.0315). Pearson's correlation coefficient demonstrated no correlation between the mean amplitude of CSRT fluctuation between months 3 and 6, and BCVA at month 12 (r = -0.0888). Adverse event rates were low.CONCLUSIONSNumerical differences in retinal thickness fluctuations between months 3 and 6 were detected between treatment regimens. While the presence of fluctuations has previously been shown to have a negative impact on functional outcomes, our data showed no correlation between the mean amplitude of fluctuations and functional outcomes at month 12.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"79 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of DeepSeek-R1 in ophthalmology: an evaluation of clinical decision-making and cost-effectiveness","authors":"David Mikhail, Andrew Farah, Jason Milad, Wissam Nassrallah, Andrew Mihalache, Daniel Milad, Fares Antaki, Michael Balas, Marko Popovic, Alessando Feo, Rajeev H Muni, Pearse A Keane, Renaud Duval","doi":"10.1136/bjo-2025-327360","DOIUrl":"https://doi.org/10.1136/bjo-2025-327360","url":null,"abstract":"Background/aims To compare the performance and cost-effectiveness of DeepSeek-R1 with OpenAI o1 in diagnosing and managing ophthalmology clinical cases. Methods In this cross-sectional study, a total of 300 clinical cases spanning 10 ophthalmology subspecialties were collected from StatPearls, each with a multiple-choice question on diagnosis or management. DeepSeek-R1 was accessed through its public chat interface, while OpenAI o1 was queried via its Application Programming Interface with a standardised temperature of 0.3. Both models were prompted using plan-and-solve+. Performance was calculated as the proportion of correct answers. McNemar’s test was employed to compare the two models’ performance on paired data. Intermodel agreement for correct diagnoses was evaluated via Cohen’s kappa. Token-based cost analyses were performed to estimate the comparative expenditures of running each model at scale, including input prompts and model-generated output. Results DeepSeek-R1 and OpenAI o1 achieved an identical overall performance of 82.0% (n=246/300; 95% CI: 77.3 to 85.9). Subspecialty-specific analysis revealed numerical variation in performance, though none of these comparisons reached statistical significance (p>0.05). Agreement in performance between the models was moderate overall (κ=0.503, p<0.001), with substantial agreement in refractive management/intervention (κ=0.698, p<0.001) and moderate agreement in retina/vitreous (κ=0.561, p<0.001) and ocular pathology/oncology (κ=0.495, p<0.01) cases. Cost analysis indicated an approximately 15-fold reduction in per-query, token-related expenses when using DeepSeek-R1 vs OpenAI o1 for the same workload. Conclusions DeepSeek-R1 shows strong diagnostic and management performance comparable to OpenAI o1 across ophthalmic subspecialties, while significantly reducing costs. These results support its use as a cost-effective, open-weight alternative to proprietary models. Data are available on reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"706 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of macrophage-like cells and retinal ganglion cells in healthy eyes.","authors":"Matteo Belletti,Ester Carreño,Yanny Perez Jimenez,Francesco Pichi","doi":"10.1136/bjo-2025-327813","DOIUrl":"https://doi.org/10.1136/bjo-2025-327813","url":null,"abstract":"BACKGROUND/AIMSMacrophage-like cells (MLCs) contribute to retinal immune homeostasis and support neuronal function. This study aimed to investigate the relationship between MLCs and ganglion cell layer (GCL) thickness in healthy eyes, assessing potential influences of age and sex.METHODSThis retrospective study included 97 eyes of 49 healthy individuals. GCL thickness was measured using spectral-domain optical coherence tomography (OCT), while MLCs were identified and counted from 6×6 mm swept-source OCT-angiography images processed with FIJI software. MLCs were quantified in four macular quadrants (superior, inferior, nasal and temporal). Correlation, stratified analyses and quadratic regression models were applied to explore associations between GCL thickness and MLC count, incorporating age and sex as covariates.RESULTSCorrelation coefficients between GCL thickness and MLC count were negative but weak. ANOVA revealed significant differences across GCL quartiles for MLC count in the inferior (p=0.013) and temporal (p=0.005) quadrants. Post hoc analyses demonstrated that MLC count peaked at moderate GCL thickness and declined at lower or higher thicknesses. Quadratic regression confirmed a bell-shaped relationship. Including age and sex-improved model fit: older age correlated with higher MLC count in the inferior quadrant, and sex differences were observed in the temporal quadrant. However, model R² values remained modest (<10%).CONCLUSIONIn healthy eyes, MLC distribution shows a non-linear, bell-shaped association with GCL thickness, peaking at moderate GCL values. Age and sex further modulate MLC count. These findings suggest a tightly regulated neuroimmune environment in the healthy retina and may provide a baseline for detecting early neuroinflammatory or neurodegenerative changes.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary acquired melanosis with spill over periocular lentigo maligna: 19-year outcomes at a specialist eyelid and ocular oncology centre.","authors":"Mumta Kanda, Allan Zhifa Nghiem, Fariha Shafi, Shirin Hamed Azzam, Tarang Gupta, Claire Daniel","doi":"10.1136/bjo-2024-326691","DOIUrl":"10.1136/bjo-2024-326691","url":null,"abstract":"<p><strong>Background/aims: </strong>There is a paucity in the literature on the presentation, management and outcomes of cases where primary acquired melanosis (PAM) is associated with spill over/contiguous periocular lentigo maligna (LM). We describe experience of such cases at our eyelid and ocular oncology specialist centre.</p><p><strong>Methods: </strong>We conducted a retrospective consecutive case review of adult patients with PAM and periocular LM between 2005 and 2024 at Moorfields Eye Hospital in London. Demographic data, diagnosis, histology, imaging, treatment, surgical notes, outcomes and follow-up were collected from the electronic patient record.</p><p><strong>Results: </strong>Of 21 patients identified, 100% were Caucasian, 13 (62%) were women and the average age of diagnosis was 67 years. Grade of PAM atypia was mild in 5 (24%), moderate in 2 (9%) and severe in 14 (67%) patients. 16 (76%) patients developed melanoma (all types) and 12 (57%) patients developed conjunctival melanoma. Of those with PAM with severe atypia, 93% developed melanoma. The average time interval from diagnosis of PAM and LM to melanoma was 72 months. Melanoma recurrence occurred in 7 (44%) and metastases developed in 4 (25%) patients. Four patients died, including two from metastatic melanoma. Average follow-up length was 129 months.</p><p><strong>Conclusions: </strong>PAM with atypia, particularly severe atypia, when associated with spill over periocular LM, may have significant risk of progression to melanoma. Patients with PAM require careful eyelid examination to identify LM. Management requires multidisciplinary input, urgent biopsy and confocal microscopy if available, lower threshold for treatment and lifelong monitoring.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"909-916"},"PeriodicalIF":3.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and incidence of juvenile idiopathic arthritis-associated uveitis and medication trends in the TriNetX database.","authors":"Rayna Marshall,Jennifer Thorne,Meghan K Berkenstock","doi":"10.1136/bjo-2024-327087","DOIUrl":"https://doi.org/10.1136/bjo-2024-327087","url":null,"abstract":"AIMSTo investigate the prevalence and incidence of juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U) in the USA from 2013 to 2023 by analysing the TriNetX database. Secondary outcomes analysed included disease demographics, associated ocular complications and immunosuppressive prescription trends.METHODSPatients with JIA-U were identified in the TriNetX database, a large, multicentre research network, through International Classification of Diseases, 10th Edition codes. Data collected included patient demographics, concurrent uveitic ocular complications, incidence, prevalence and cumulative prevalence of JIA-U in the 11-year period and immunosuppressive utilisation in the JIA population.RESULTS4510 patients with JIA-U were included in this study. The cumulative prevalence and incidence of JIA-U over the 11-year period were 4.4 and 1.2 per 100 000 cases, both of which decreased over the study period. 5.5% of patients with JIA had a diagnosis of uveitis and 36.1% of patients with JIA-U had an associated uveitic ocular adverse event, including glaucoma, band keratopathy, low vision and blindness. The prevalence of immunosuppressive drug therapy in patients with JIA increased over the years 2013-2023.CONCLUSIONIn this large US database, the JIA-U prevalence and incidence rates decreased between 2013 and 2023. This may be partially attributed to the increasing prevalence of immunosuppressive drug use in patients with JIA.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"212 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for bleeding and perioperative bleeding complications in oculoplastic surgery: a prospective pilot study.","authors":"Nike Annika Christensen,Nicolas Feltgen,Maren Horn,Sabine Naxer,Christian van Oterendorp,Jürgen Koscielny,Christoph Sucker,Sebastian Pfeiffer,Fabian Kück,Michael P Schittkowski","doi":"10.1136/bjo-2024-326553","DOIUrl":"https://doi.org/10.1136/bjo-2024-326553","url":null,"abstract":"BACKGROUND/AIMSClear guidelines for managing patients on antiplatelet (AP) or anticoagulant (AC) therapy undergoing oculoplastic surgery are lacking. This study investigates bleeding risk factors and evaluates the effectiveness of a standardised bleeding risk assessment in extraocular surgery.METHODSIn this prospective study, a standardised questionnaire (SQ) was employed to gather patients' bleeding histories. Associations between SQ scores and preoperative/demographic factors (AP/AC use, age, sex, comorbidities), and surgical factors (blood pressure, surgery type, primary vs revision surgery, anaesthesia type, duration, pain management) were assessed. A scoring system quantified bleeding severity. Patients were monitored postoperatively for 24 hours (eyelid procedures) to 3 or 4 days (orbital/nasolacrimal surgery).RESULTSA total of 324 patients (aged 18-92) were included (252 eyelid, 56 orbital and 16 nasolacrimal surgeries). 87 patients were using AP, AC and/or herbal supplements. Severe bleeding occurred in 35 patients, four required revision surgery, though none suffered permanent damage. Bleeding complications were significantly associated with higher SQ scores (p=0.048), acetylsalicylic acid use in eyelid surgery (p=0.038), diabetes mellitus (p=0.016), renal disease (p=0.044), general anaesthesia (p=0.001) and longer surgery duration (p=0.007). Local anaesthesia, AC use and systolic hypertension were not significantly associated with bleeding risk.CONCLUSIONThe SQ is a valuable tool for assessing bleeding risk in oculoplastic patients. Findings support future multicentre studies to develop evidence-based perioperative guidelines for AP and AC management. Limitations include cohort heterogeneity, small sample size, non-blinded design and subjective bleeding scores affecting comparability.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"45 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}