Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

{"title":"Association between immune checkpoint inhibitors and uveitis in patients with lung cancer, renal cell carcinoma, or malignant melanoma.","authors":"Chikako Iwai, Taisuke Jo, Akira Okada, Asahi Fujita, Takaaki Konishi, Koji Oba, Yohei Hashimoto, Hideo Yasunaga","doi":"10.1016/j.jcjo.2025.02.010","DOIUrl":"10.1016/j.jcjo.2025.02.010","url":null,"abstract":"<p><strong>Objective: </strong>Immune checkpoint inhibitors (ICIs) reportedly have a potential risk of general ocular complications; however, whether ICIs have a risk of uveitis remains unclear. Therefore, we assessed whether ICI use has a higher risk of uveitis than chemotherapy alone.</p><p><strong>Methods: </strong>Using a large administrative claims database in Japan, we identified 26 474 patients with lung cancer, renal cell carcinoma, or malignant melanoma, who initiated ICI or chemotherapy between April 2014 and November 2022. The patients were divided into 2 groups: those receiving ICI with and without chemotherapy (ICI group: n = 8103) and those receiving chemotherapy alone (non-ICI group: n = 18 371). After propensity score-overlap weighting to adjust for background factors, we estimated the incidence of uveitis and performed Cox regression analyses. We also conducted subgroup analyses stratified by age (<75 and ≥75 years).</p><p><strong>Results: </strong>The overlap-weighted incidence of uveitis in the ICI group was higher than that in the non-ICI group (85.1 vs 55.9/10,000 person-years; number needed to harm: 343). The hazard ratio (HR) for uveitis in the ICI group was 1.49 (95% confidence interval, 1.11 to 2.01) in comparison with the non-ICI group. The age-stratified analysis showed that the ICI group had an increased risk among individuals aged <75 years (HR 1.65 [1.15 to 2.41]), while the risk did not differ among individuals aged ≥75 years (HR 1.35 [0.84 to 2.18]).</p><p><strong>Conclusions: </strong>ICI use was associated with a higher risk of uveitis compared to non-ICI use, particularly among patients aged <75 years.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with disease relapse in healing/healed arterial injury and biopsy-proven giant cell arteritis.","authors":"Wei Sim, Jack Mouhanna, Danah Albreiki","doi":"10.1016/j.jcjo.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.jcjo.2025.03.008","url":null,"abstract":"<p><strong>Objective: </strong>To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) arterial injury on temporal artery biopsy (TAB).</p><p><strong>Design: </strong>Single-centre, retrospective cohort study.</p><p><strong>Participants: </strong>One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.</p><p><strong>Methods: </strong>Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.</p><p><strong>Results: </strong>Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (p = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (p = 0.050) and with earlier relapse rates (p = 0.007). Aortitis (HR 7.96; p = 0.007) and jaw claudication (HR 5.08; p = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (p = 0.044 and p = 0.047, respectively) and were associated with disease relapses on univariable analysis (p = 0.044 and p = 0.047, respectively) but not on multivariable analysis.</p><p><strong>Conclusions: </strong>The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peaked pupils associated with iris posterior pigment epithelium detachment.","authors":"Jozef Van Eyken, Elke O Kreps","doi":"10.1016/j.jcjo.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jcjo.2025.03.004","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year reoperation rates after Schlemm's canal-based glaucoma surgery versus trabeculectomy.","authors":"Keyu Hu, Jin Wang, Qing Sang, Dapeng Mou, Ye Zhang, Ningli Wang","doi":"10.1016/j.jcjo.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jcjo.2025.02.016","url":null,"abstract":"<p><strong>Objective: </strong>To compare 5-year reoperation rates between Schlemm's canal (SC)-based glaucoma surgery and trabeculectomy (Trab), and to identify risk factors for reoperations.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent glaucoma surgery between January 2017 and December 2021. Propensity score matching was used to identify comparable participants among groups. SC-based glaucoma surgery included gonioscopy-assisted transluminal trabeculotomy, microcatheter-assisted trabeculotomy, ab-interno canaloplasty, canaloplasty, and trabectome. The primary outcome was unanticipated reoperations after the original procedure. Kaplan-Meier survival analysis compared reoperation rates between groups. Univariate and multivariate Cox regression analyses identified risk factors for reoperation.</p><p><strong>Results: </strong>The final analysis included 112 eyes (106 patients) in the SC-based glaucoma surgery group and 147 eyes (137 patients) in the Trab group. The 5-year cumulative reoperation rate was significantly higher in the Trab group compared to the SC-based glaucoma surgery group (15.4% [93/604] vs 11.9% [72/604], respectively, and p = 0.045). Uncontrolled intraocular pressure (IOP) was the primary indication for reoperations in both groups. Trab surgery, higher preoperative IOP, greater number of preoperative medications, and previous glaucoma surgery history were independent risk factors for reoperation.</p><p><strong>Conclusions: </strong>SC-based glaucoma surgery showed a significantly lower 5-year reoperation rate than Trab, indicating a more favourable long-term safety profile. Trab surgery, higher preoperative IOP, more preoperative medications, and previous glaucoma surgery history were identified as independent risk factors for reoperation, which may help identify patients at higher risk for reoperation and potentially improve postoperative management.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging in preseptal ferromagnetic foreign bodies.","authors":"Tu-An Ma, Khizar Rana, Jessica Y Tong, Katja Ullrich, Sandy Patel, Dinesh Selva","doi":"10.1016/j.jcjo.2025.02.019","DOIUrl":"10.1016/j.jcjo.2025.02.019","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature on safety of magnetic resonance imaging (MRI) in patients with preseptal ferromagnetic foreign bodies.</p><p><strong>Methods: </strong>We describe 3 cases of MRI in patients with preseptal ferromagnetic foreign bodies (FFBs) from our institution.</p><p><strong>Results: </strong>The FFBs were all preseptal, adjacent to the medial canthus (n = 2) and lateral canthus (n = 1). None of the patients had any ocular complications post-MRI. The literature review identified an additional 7 cases with intraocular and preseptal FFBs that underwent MRI. The FFBs ranged in size from 1.0 mm to 3.5 mm. The FFBs were intraocular (n = 6), or preseptal (n = 1). The MRI field strength ranged from 0.35 T to 1.5 T. Five (83.3%) of the patients with intraocular FFBs had ocular complications, which included hyphema (n = 2), cataract (n = 3), vitreous haemorrhage (n = 1), and corneal scar (n = 1). The patient with preseptal FFB did not have post-MRI complications.</p><p><strong>Conclusions: </strong>There is some evidence to suggest that patients with preseptal FFBs may be less likely to experience complications post-MRI compared to intraocular FFBs. Various factors affect the safety of MRIs, including FFB location, size, proximity to visually-significant structures, and MRI field strength.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessibility of Canadian ophthalmology department webpages for the visually impaired.","authors":"Mostafa S Bondok, Mohamed S Bondok, Rishika Selvakumar, Nina Ahuja, Edsel Ing","doi":"10.1016/j.jcjo.2025.02.018","DOIUrl":"10.1016/j.jcjo.2025.02.018","url":null,"abstract":"<p><strong>Objective: </strong>We reviewed Canadian university ophthalmology department webpages to determine the extent of web content accessibility for users with visual impairment and color vision deficiency.</p><p><strong>Methods: </strong>The Web Content Accessibility Guidelines 2.0 (WCAG 2.0) were used to assess the accessibility of all 15 Canadian ophthalmology website homepages using automated assessment and manual assessment strategies.</p><p><strong>Results: </strong>All department webpages had accessibility errors. The mean number of errors identified by each tool were: AChecker (13.3, SD = 9.4), ARC ToolKit (16.5, SD = 35.1), and WAVE (4.9, SD = 14). Forty-seven percent (7/15) of the websites had contrast errors, with the mean number of errors being 2.2 (SD = 3.9). Accessibility errors relevant to users with visual impairment or those that utilize screen readers included the absence of alternative text, explaining the content of images, hyperlinks without information regarding where the link navigates to, improper declaration of website language causing screen readers to read French text as if it were in English, and the duplication of the same element ID resulting in screen reader processing errors.</p><p><strong>Conclusions: </strong>The ophthalmology webpages of Canadian universities should be revised to better comply with the WCAG guidelines and enhance digital accessibility for users with visual impairment.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of systemic disease in patients undergoing cataract surgery at a hospital versus outpatient clinics.","authors":"Angel Gao, Davin Johnson","doi":"10.1016/j.jcjo.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jcjo.2025.03.002","url":null,"abstract":"<p><strong>Objective: </strong>To compare demographic and clinical characteristics of patients undergoing cataract surgery at a hospital versus a private outpatient clinic (POC) within a shared funding model in Ontario, Canada. Our tertiary academic hospital operates a unique funding arrangement, in which some hospital funds support cataract surgeries at a POC, enabling oversight of provincially funded surgeries at both sites.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>All patients who underwent cataract surgery in 2023 at both the hospital (Kingston Health Sciences Centre) and the affiliated POC were included.</p><p><strong>Methods: </strong>We compared demographic and clinical data, including age, gender, blood pressure, comorbidities (e.g., diabetes, hypertension), American Society of Anesthesiologists scores, and medication usage.</p><p><strong>Results: </strong>Patients included in this study numbered 3441 (1982 hospital patients and 1459 POC patients). Mean age was similar, although significantly more females underwent surgery at the POC (p = 0.004). Hospital patients had higher systolic blood pressure (p < 0.0001), higher rates of diabetes (1.5 odds ratio, 95% confidence interval [CI] 1.3-1.8; p < 0.0001), higher American Society of Anesthesiologist scores (0.3 mean difference, 95% CI 0.27-0.35; p < 0.0001), and higher smoking rates (p < 0.0001). The use of anticoagulation, antidiabetes, and prostate medications were significantly higher among hospital patients (p < 0.001), with greater use of antihypertensive medications (p = 0.018).</p><p><strong>Conclusions: </strong>Our data support concerns that healthier patients are more likely to undergo surgery at outpatient clinics. Factors, such as mandated restrictions on patient selection at POCs, surgeon preference, and referral patterns may contribute. As outpatient surgical care grows, documenting these differences is essential to ensure fair distribution of resources and equitable access to care.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing clinical variables indicative of uveal melanoma to determine how they affect decisions made by an artificial intelligence classifier.","authors":"Emily Laycock, Ezekiel Weis, Antoine Sylvestre-Bouchard, Rachel Curtis, Esmaeil Shakeri, Emad Mohammed, Behrouz Far, Trafford Crump","doi":"10.1016/j.jcjo.2025.02.012","DOIUrl":"10.1016/j.jcjo.2025.02.012","url":null,"abstract":"<p><strong>Objective: </strong>The \"black box\" nature of many artificial intelligence (AI) models has limited their adoption in real-world ophthalmologic practices. Our lab developed an AI model for detecting the presence of a choroidal melanocytic lesion (CML) in colour fundus images. The purpose of this article is to investigate whether there are known clinical features of CMLs that are associated with false-negative (FN) classifications from the model to aid in validation and increase its interpretability.</p><p><strong>Methods: </strong>A retrospective cohort study of CML patients was performed. A total of 388 fundus images from 194 patients with (n = 194) and without (n = 194) CMLs collected through routine clinical assessment were used to train an AI model. The model's classification (lesion present/lesion absent) of the images with CMLs, as well as CML characteristics, demographics, and risk factors for uveal melanoma (UM) were extracted. Logistic regression models were used to test for associations between the FN classifications and these characteristics.</p><p><strong>Results: </strong>The AI model returned 150 true-positive classifications and 44 FN classifications (23%) for CML eyes. Thinner lesions were more likely to be missed by the model (p = 0.026), resulting in a FN classification. The presence of imaging risk factors for UM was not shown to have any statistically significant relationships with a FN classification.</p><p><strong>Conclusions: </strong>The results from this study demonstrate that the FN classifications for CML fundus image classifications from our AI model are not associated with the presence of imaging risk factors for UM but are influenced by thinness of the lesion.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin A deficiency masquerading as cancer-associated retinopathy.","authors":"Naveen Karthik, Sumit Sharma","doi":"10.1016/j.jcjo.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jcjo.2025.03.005","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outer nuclear layer thickness as a biomarker for photoreceptor function in pachychoroid spectrum disorders.","authors":"Su Min Jo, Kyung Tae Kim, Eoi Jong Seo","doi":"10.1016/j.jcjo.2025.02.009","DOIUrl":"10.1016/j.jcjo.2025.02.009","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the outer nuclear layer (ONL) could serve as a quantitative biomarker for photoreceptor function in pachychoroid pigment epitheliopathy (PPE) and pachychoroid neovasculopathy (PNV). Additionally, to assess the impact of pachychoroid features, the presence of neovascularization, and a history of exudation on photoreceptor function.</p><p><strong>Methods: </strong>One hundred and one eyes with pachychoroid features and thirty-four normal control eyes were retrospectively analyzed. The study groups were categorized into PNV and PPE subgroups based on the presence of neovascularization detected on optical coherence tomography angiography. PNV eyes were further stratified based on a history of exudation. The average thicknesses of individual retinal layers and choroidal thickness were measured, along with best-corrected visual acuity (BCVA). The relationship between BCVA and each retinal/choroidal layer thickness was analyzed.</p><p><strong>Results: </strong>ONL thickness differed significantly among the 3 groups, with the thinnest in the PNV group and the thickest in the control group (p = 0.001), revealing a linear correlation to BCVA. The PPE group exhibited thicker ONL and better BCVA than the PNV group without a history of exudation (p < 0.001 and p = 0.015, respectively). In PNV eyes, those with a history of exudation had thinner ONL and worse BCVA compared to those without such a history (p = 0.003 and 0.008, respectively).</p><p><strong>Conclusions: </strong>ONL thickness serves as a quantitative biomarker of photoreceptor function in PNV and PPE. Photoreceptor function declines in eyes with pachychoroid features, the presence of neovascularization, and a history of exudation. The development of neovascularization or exudation in PNV or PPE should be treated promptly to salvage photoreceptors.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}