Associations between Serial Intravitreal Injections and Dry Eye

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Associations between Serial Intravitreal Injections and Dry Eye

Created
Tags CGMHOPHCornea
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology Volume 130, Number 5, May 2023

中文摘要

本研究旨在探討anti-VEGF 治療neovascular AMD患者的連續IVI注射 對眼表和meibomian glands的影響。研究結果表明，相較於對側未注射眼，IVI治療tear break up time，角膜染色，Schirmer test osmolarity, meibomian gland expressibility and quality等數據均未有顯著差異，但可以減少MG流失，增加淚液體積，並減少炎症跡象。因此，這種治療方案可能對眼表有益影響。建議進一步研究IVI對眼表和MG的影響。

]English Abstract

The study aimed to investigate the effects of serial intravitreal injections on the ocular surface and meibomian glands in patients treated with anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Ninety patients were included in the study, and there were no differences between treated and fellow eyes regarding various dry eye parameters. The study found that the repeated application of povidone-iodine could have antibacterial properties that can protect against ocular surface damage associated with dry eye disease. Contrary to expectations, the study revealed healthier values of various dry eye parameters including reduced MG loss, increased tear volume (tear meniscus height), and reduced signs of inflammation (bulbar redness) in eyes treated with IVI compared with the fellow untreated eyes. However, further investigations with prospective studies are warranted to support these findings and explore the mechanisms involved.

Fast Progressors in Glaucoma Prevalence Based on Global and Central Visual Field Loss

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Fast Progressors in Glaucoma Prevalence Based on Global and Central Visual Field Loss

Created
Tags Glaucoma
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology Volume 130, Number 5, May 2023

中文摘要

這篇研究的目的是評估青光眼患者在視野測試中fast global and central field progression的患病率。研究人員收集了在澳大利亞、加州和紐約進行常規護理的青光眼患者的測試結果，發現約1/8的眼睛在global MD 值（< -1.0 dB/年）方面呈現快速進展(fast progression)，近1/3的眼睛在中央方面呈現 (-0.5 dB/年) 的衰退。研究發現突顯了評估中央視野損失進展的臨床重要性，並強調需要新的治療方法來預防快速進展的視功能障礙。

English Abstract

This study aimed to determine the prevalence of fast global and central visual field progression in individuals with glaucoma receiving routine care. The study included patients from a private ophthalmology clinic in Melbourne and participants who were examined as part of two prospective, longitudinal, observational studies of visual function and structural changes in glaucoma. All individuals had a diagnosis of glaucoma and had performed five or more reliable 24-2 VF tests over a 1- to 5-year period. The study found that approximately 1 in 8 eyes with glaucoma receiving routine care showed fast progression based on global MD values (< -1.0 dB/year), and nearly 1 in 3 eyes showed a < -0.5 dB/year decline centrally. These findings highlight the clinical importance of assessing progressive central VF loss and reinforce the need for new therapies to prevent functional disability in a notable proportion of individuals who continue to exhibit fast progression.

Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity

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Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity

Created
Tags Retina
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology 2023;130:373-378 ª 2022 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmolog

中文摘要

此研究比較了治療早產兒視網膜病變的兩種靜脈內注射藥物，Bevacizumab和Ranibizumab，並探討不同劑量或類型的抗血管內皮生長因子(VEGF)是否與再次治療有關。研究收集了661名患者873只眼睛的數據。主要分析的樣本包括307名患者的567只眼睛，其中沒有再次治療和再次治療兩組在出生體重、胎齡、首次注射年齡、ROP階段或受影響的時鐘小時數等方面沒有差異。然而，再次治療組中，有較大比例的ROP較為激進aggressive(34%對18%)，並且有更大比例的第一區ROP(49對34%)。與此同時，Bevacizumab的較低劑量與較高的再次治療率相關。研究結果還發現，Ranibizumab的使用與較高的再次治療率相關，而Bevacizumab的較低劑量與再次治療相關。

English Abstract

This study compares the retreatments between Bevacizumab and Ranibizumab intravitreal injections in treating Retinopathy of Prematurity (ROP), examining if specific dosages or types of anti-vascular endothelial growth factors (VEGF) are associated with retreatment. Data from 873 eyes of 661 patients were collected. The primary analysis included 567 eyes of 307 patients, where no significant difference was found between the no retreatment and retreatment groups in terms of birthweight, gestational age, age at first injection, ROP stages, or number of involved clock hours. However, the retreatment group had a larger percentage of aggressive ROP (34% vs 18%) and a greater percentage of zone 1 ROP (49% vs 34%). Concurrently, lower doses of Bevacizumab were associated with higher retreatment rates. The results also found that the use of Ranibizumab was associated with a higher rate of retreatment, whereas the rate of retreatment was not associated with a specific dose of ranibizumab. In a multicenter study of ROP patients initially treated with anti-VEGF therapy, ranibizumab and
lower-dose bevacizumab use were associated with an increased rate of retreatment when compared with higher dose bevacizumab.

Validation of Rates of Mean Deviation Change as Clinically Relevant End Points for Glaucoma Progression

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Validation of Rates of Mean Deviation Change as Clinically Relevant End Points for Glaucoma Progression

Created
Tags Glaucoma
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology Volume 130, Number 5, May 2023

中文摘要

本研究使用兩種方法評估病情進展： Guided Progression Analysis (GPA) 和美國食品和藥物管理局(FDA)建議的終點(endpoint)。標準自動視野檢測(SAP)仍然是監測青光眼功能變化的首選方法，青光眼是全球導致不可逆失明的主要原因。視野評估在臨床護理中的角色除了用於評估新的治療方法以減緩或停止青光眼進展外。本研究中，患者必須在基線訪視時被診斷為原發性開角型青光眼。眼睛被納入的條件是他們在基線訪視時有連續（2次）的視野檢測結果異常。研究結果顯示，SAP平均偏差(MD)變化的斜率可以作為臨床試驗中新的青光眼治療方法的合適終點。總體而言，這些分析顯示，用Ordinary Least Squares得到的斜率也能預測未來的進展事件，並進一步支持我們的結論。

English Abstract

This study assessed disease progression using two methods: Guided Progression Analysis (GPA) and an endpoint suggested by the United States Food and Drug Administration (FDA). Standard Automated Perimetry (SAP) remains the preferred method for monitoring functional changes in glaucoma, a leading cause of irreversible blindness globally. Visual field assessment, besides its role in clinical care, can serve as an endpoint for evaluating new treatments aimed at slowing or halting glaucoma progression. In this study, patients were required to have a diagnosis of primary open-angle glaucoma at the baseline visit. The conditions for inclusion of eyes were that they had consecutive (2) abnormal visual field test results at the baseline visit. The study results show that slopes of change in SAP Mean Deviation (MD) could serve as suitable endpoints in clinical trials investigating potential new therapies in glaucoma. Overall, these analyses demonstrate that slopes obtained with Ordinary Least Squares (OLS) were also predictive of future progression events, providing further support to our conclusions.

NOV03 for Dry Eye Disease Associated with Meibomian Gland Dysfunction

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NOV03 for Dry Eye Disease Associated with Meibomian Gland Dysfunction

Created
Tags CGMHOPHCornea
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology Volume 130, Number 5, May 2023

中文摘要

本研究旨在評估NOV03（perfluorohexyloctane,全氟己氧基辛烷）眼用滴劑在患者中的療效和安全性。NOV03是一種新型的、不含防腐劑、由全氟己氧基辛烷（一種無水的半氟烷）組成的眼用滴劑，目前正在美國食品藥品監督管理局進行審查，作為治療與Dry eye disease associated with meibomian gland dysfunction的局部藥物。本研究為一個階段3、多中心、隨機、雙盲、0.6% hypotonic saline對照試驗，共納入359名符合條件的患者，經過8週治療後，在total corneal fluoreicin staining (tCFS)和VAS dryness評分（0-100視覺類比標度）方面，NOV03組的改善優於鹽水對照組，且在安全性方面未發現明顯差異。NOV03可能通過形成長效抗蒸發屏障來預防水分蒸發，從而改善DED相關症狀。

English Abstract

The article discusses the efficacy and safety of a novel treatment for dry eye disease associated with meibomian gland dysfunction. The treatment, called NOV03, is a nonaqueous, preservative-free, ophthalmic drop consisting of perfluorohexyloctane. The study found that NOV03 significantly improved both signs and symptoms of dry eye disease compared to a hypotonic saline control group. The results suggest that NOV03 may be a highly effective treatment for dry eye disease associated with meibomian gland dysfunction. The article also provides information on the causes of dry eye disease and the traditional therapies used to treat it.

Invited commentary: A Vision for Addressing Social Needs and Social Determinants of Health

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Invited commentary: A Vision for Addressing Social Needs and Social Determinants of Health

Created
Tags CGMHOPH
Journal JAMA Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Published Online: April 6, 2023.
doi:10.1001/jamaophthalmol.2023.0924

中文摘要

所討論的文章描述了社會健康決定因素（social determinants of health, SDOH）對青少年和成人視力損失之間的聯繫。研究結果顯示，不良的社會風險因素與視力惡化有關，這並不令人意外，因為SDOH影響幾乎所有的健康結果。然而，問題是如何利用這些信息來改善人口健康。作者建議，醫療保健系統和臨床醫生應擴大社會需求篩查，並與其他部門合作，幫助患者獲取所需的資源。他們還強調需要進行持續監測和政策倡導，以改善眼科服務的訪問和實施預防和訪問政策來解決不平等問題。最後，作者區分了社會風險因素和社會需求以及在開發干預措施時對SDOH的更廣泛概念，並呼籲解決不良SDOH的基礎因素，作為對患者健康最有力的影響因素之一。

English Abstract

The article being discussed describes the association between vision loss and social determinants of health (SDOH) in adolescents and adults. The findings suggest that adverse social risk factors are associated with worse vision, which is not surprising as SDOH affects almost all health outcomes. However, the question is how to use this information to improve population health. The authors suggest that health care systems and clinicians should expand social needs screening and collaborate with other sectors to help patients access the resources they need. They also emphasize the need for ongoing surveillance and policy advocacy to improve access to ophthalmology services and implement prevention and access policies to address disparities. Finally, the authors distinguish between social risk factors and social needs from the broader conceptualization of SDOH in developing interventions, and they call for addressing the underpinnings of adverse SDOH as among the most powerful influences on the health of patients.

Genome-Wide Association Study of AgeRelated Macular Degeneration Reveals 2 New Loci Implying Shared Genetic Components with Central Serous Chorioretinopathy

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Genome-Wide Association Study of AgeRelated Macular Degeneration Reveals 2 New Loci Implying Shared Genetic Components with Central Serous Chorioretinopathy

Created
Tags Retina
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology 2023;130:361-372 2022 by the American Academy of Ophthalmology

中文摘要

這篇論文描述了在日本人中進行的年齡相關性黃斑部退化（AMD）的基因組關聯研究。通過對兩個獨立的genome-wide association studies (GWAS)進行meta-analysis，確定了6個與AMD顯著相關的基因座(loci)，發現了兩個新的基因座（(rs4147157 near WBP1L and rs76228488 near GATA5)與AMD的關聯。此外，通過基因相關性分析，作者們發現了AMD與戒煙有關的多基因結構，意味著AMD和中心性漿液性脈络膜病（central serous chorioretinopathy）可能具有共享的遺傳。作者們的研究提供了有關AMD基因組學和各種流行病學風險因素之間相互作用的更深入的理解。

English Abstract

The study investigated the genetic architecture of age-related macular degeneration (AMD) in a Japanese population through a meta-analysis of two independent genome-wide association studies (GWASs), identifying six loci significantly associated with AMD. The study also found two new loci that were associated with AMD, indicating shared genetic components with central serous chorioretinopathy. Additionally, the study conducted a genetic correlation analysis that implicated a polygenic architecture shared between AMD and smoking cessation. The findings imply that some AMD heritability can be explained by genetic components that affect Japanese lifestyles.

Mendelian Randomization Implicates Bidirectional Association between Myopia and Primary Open-Angle Glaucoma or Intraocular Pressure

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Mendelian Randomization Implicates Bidirectional Association between Myopia and Primary Open-Angle Glaucoma or Intraocular Pressure

Created
Tags CGMHOPHGlaucoma
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Ophthalmology 2023;130:394-403

中文摘要

本研究旨在利用Mendelian randomization (MR)分析解決外部混淆因素，確定近視、青光眼和相關特徵之間的遺傳因果關係。研究發現，眼壓對於refractive spherical equivalent 和原發性開角型青光眼 (POAG) 的影響最顯著（Sobel test，0.13; 95%信賴區間，0.09-0.17; P = 1.37 x10-8）。研究指出，近視和POAG之間存在著強烈的雙向遺傳因果關係，而眼壓是其主要中介因素。因此，本研究提出儘管臨床上在近視眼要做青光眼的診斷有些困難，但降低眼壓治療青光眼對近視眼可能有益。

English Abstract

The article discusses the use of Mendelian randomization (MR) analysis to investigate the causal relationship between myopia, primary open-angle glaucoma (POAG), and glaucoma-related traits, to overcome external confounders. The study used existing data from genome-wide association studies in White and Asian populations, and evaluated multiple statistical methods to address potential issues with assumptions and pleiotropy. The study found a bidirectional genetic causal link between myopia and POAG, primarily mediated by intraocular pressure (IOP). The findings suggest that IOP-lowering treatment for glaucoma may be beneficial in myopic eyes, despite challenges in diagnosis.

Incidence of Retinal Detachment, Macular Edema, and Ocular Hypertension after Neodymium:Yttrium-Aluminum-Garnet Capsulotomy

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Incidence of Retinal Detachment, Macular Edema, and Ocular Hypertension after Neodymium:Yttrium-Aluminum-Garnet Capsulotomy

Created
Tags CGMHOPH
Journal Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

Place-Journal-info-here

中文摘要

本文報導了一個觀察性群體研究，旨在估計針對白內障手術後後囊膜混濁（PCO）治療常見程序中使用的Nd:YAG-capsulotomy後不良事件（AEs）的發生率和風險因素。該研究使用法國全國代表樣本的數據，對於在2014年至2017年間進行Nd:YAG-caps的患者進行了為期12個月的後續追蹤。三個研究AEs為眼壓增高（ocular hypertension, OHT）、黃斑水腫（ME）和視網膜剝離（RD）。在白內障手術後1年內進行Nd:YAG-caps的患者比晚期進行Nd:YAG-caps的患者更容易發生AEs，尤其是ME。在白內障手術後1至2年進行Nd:YAG-caps的患者比晚期進行Nd:YAG-caps的患者更容易發生OHT。糖尿病人更容易發生OHT及ME. 糖尿病和在白內障手術後早期進行Nd:YAG-caps是AE發生的主要驅動因素。該研究強調了Nd:YAG-caps後初始期間密切的眼科追的重要性，以評估是否需要適當的治療。

English Abstract

The article reports on an observational cohort study that aimed to estimate the incidence and risk factors associated with adverse events (AEs) after neodymium:yttrium-aluminum-garnet posterior capsulotomy (Nd:YAG-caps), which is a common procedure for the treatment of posterior capsule opacification (PCO) after cataract surgery. The study used data from the French national representative sample and followed up patients who underwent Nd:YAG-caps between 2014 and 2017 for 12 months post-procedure. The three AEs of interest were ocular hypertension (OHT), macular edema (ME), and retinal detachment (RD). The 3-month and 12-month overall AE rates ( >1 AE of interest) were 8.6% and 13.3%, respectively. Among patients with > 1 AE of interest, 68.4% of AEs occurred within 3 months post-Nd:YAG-caps. Three-month rates were = 5% for OHT and ME. Retinal detachment remained 0.5% over follow-up. Cox model showed that patients who underwent Nd:YAG-caps performed within 1 year after cataract surgery had a higher risk of AEs than those with later Nd:YAG-caps, notably ME. Patients with Nd:YAG-caps performed between 1 and 2 years after cataract surgery were more at risk of OHT than patients with later Nd:YAG-caps. Diabetic patients were more at risk of OHT and ME. Diabetes and an early Nd:YAG-caps after cataract surgery were among the main drivers for AE occurrence. The study emphasizes the importance of a close ophthalmological follow-up during the initial period after Nd:YAG-caps to evaluate if appropriate treatment is required.

Blurred Vision After a Kidney Transplant

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Blurred Vision After a Kidney Transplant

Created
Tags Retina
Journal JAMA Ophthalmology
Status 審查完成
校稿者 蕭靜熹 醫師

JAMA Ophthalmology Published online April 6, 2023

中文摘要

這篇文章報導了一名三十幾歲的腎移植病人，在罹患巨細胞病毒（CMV）網膜炎並於視網膜發現多個 cotton wool spots後，接受多種治療而未獲改善，最後轉而使用 multivirus-specific cytotoxic T-lymphocyte (CTL, 多病毒特異性細胞毒性T細胞治療）。CTL是一種免疫療法，透過接受來自供者的T細胞以提供病毒特異性免疫反應以清除感染。此病例接受了Posoleucel，一種多病毒特異性T細胞療法，治療後眼睛和CMV指標的情況都有明顯改善。然而，病人在治療後八週回診時出現視力下降和視網膜水腫的症狀。最終，病人因移植後淋巴增生性疾病的併發症而轉入安寧療護，並未能進一步驗證視力下降的原因。此研究表明，CTL是一種有前途的新型療法，需要進一步的研究，特別是在前瞻性試驗中評估其在CMV網膜炎治療中的作用。

English Abstract

This article discusses a case study of a patient who experienced blurred vision after receiving a kidney transplant. The patient had a medical history of deceased donor kidney transplant, cytomegalovirus (CMV) colitis, and CMV viremia with documented resistance to foscarnet and ganciclovir. Clinical examination revealed multiple cotton wool spots along the arcades and periphery, and granular, hypopigmented retinal lesions without hemorrhage in the macula and temporal periphery in both eyes. Despite the patient’s documented UL97 and UL54 mutations, a series of five biweekly intravitreal injections of foscarnet and ganciclovir were performed, given their vision-threatening lesions, but retinal pathology failed to improve. The patient eventually refused additional intravitreal therapy because of pain and transiently decreased vision after each injection. The patient then received multivirus-specific cytotoxic T-lymphocyte (CTL) therapy, with dramatic improvement in both retinal findings and CMV titers one month after the first infusion. Unfortunately, before any additional testing could occur, the patient rapidly declined from complications of posttransplant lymphoproliferative disorder and transitioned to hospice. CTL therapy is a promising novel therapy that requires further investigation, ideally with prospective trials, to evaluate its role in the treatment of CMV retinitis.