British Journal of Ophthalmology

Khodeiry, Mohamed M; Lauter, Alison J; Sayed, Mohamed S; Han, Ying; Lee, Richard K

doi: 10.1136/bjophthalmol-2021-319757pmid: 34848391

AimsTo report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).MethodsA retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.ResultsIOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (p<0.001). The preoperative number of glaucoma medications dropped from 3.3±1.1 at baseline to 2.0±1.5 at the last postoperative visit (p<0.001). The cumulative probabilities of success at 12 and 24 months were 71.7% and 64.2 %, respectively. Mean logarithm of the minimum angle of resolution VA was relatively unchanged from 2.27±0.63 to 2.25±0.66 at the last follow-up visit (p=0.618). The most common observed complications were decrease in baseline VA (13.2%) and anterior chamber inflammation (9.4%).ConclusionsSlow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.

Wong, Wendy Meihua; Sun, Wu; Vyas, Chinmayi; Fong, Angie Hon Chi; Chee, Caroline K; Su, Xin Yi; Teo, Kelvin YC; Cheung, Chui Ming Gemmy

doi: 10.1136/bjo-2022-322457pmid: 36810152

AimTo describe the clinical characteristics in a cohort of patients with the pachychoroid phenotype and to evaluate the association of ocular and systemic factors with type of complications observed.MethodsWe report baseline findings from a prospective observational study which recruited subjects with subfoveal choroidal thickness (SFCT) of ≥300 µm on spectral-domain optical coherence tomography (OCT). Multimodal imaging was used to classify eyes as uncomplicated pachychoroid (UP) or pachychoroid disease with pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC) or pachychoroid neovasculopathy (PNV) subtypes.ResultsAmong 181 eyes of 109 participants (mean age 60.6 years, 33 (30.3%) female, 95 (7.2%) Chinese), 38 eyes (21.0%) had UP. Of 143 eyes (79.0%) with pachychoroid disease, 82 (45.3%), 41 (22.7%) and 20 (11.0%) had PPE, CSC and PNV, respectively. Addition of autofluorescence and OCT angiography to structural OCT led to reclassification of 31 eyes to a more severe category. Systemic and ocular factors evaluated, including SFCT, were not associated with disease severity. Comparison of PPE, CSC and PNV eyes showed no significant difference in OCT features of retinal pigment epithelial (RPE) dysfunction, but disruption of the ellipsoid zone (PPE 30.5% vs CSC 70.7% vs PNV 60%, p<0.001) and thinning of inner nuclear/inner plexiform layers (PPE 7.3% vs CSC 36.6% vs PNV 35%, p<0.001) were more frequent in CSC and PNV eyes.ConclusionsThese cross-sectional associations suggest pachychoroid disease manifestations may reflect progressive decompensation from the choroid to the RPE then retinal layers. Planned follow-up of this cohort will be beneficial in clarifying the natural history of the pachychoroid phenotype.

Li, Yong; Foo, Li-Lian; Wong, Chee Wai; Li, Jonathan; Hoang, Quan V; Schmetterer, Leopold; Ting, Daniel S W; Ang, Marcus

doi: 10.1136/bjophthalmol-2021-320926pmid: 35288438

Pathologic myopia is a severe form of myopia that can lead to permanent visual impairment. The recent global increase in the prevalence of myopia has been projected to lead to a higher incidence of pathologic myopia in the future. Thus, imaging myopic eyes to detect early pathological changes, or predict myopia progression to allow for early intervention, has become a key priority. Recent advances in optical coherence tomography (OCT) have contributed to the new grading system for myopic maculopathy and myopic traction maculopathy, which may improve phenotyping and thus, clinical management. Widefield fundus and OCT imaging has improved the detection of posterior staphyloma. Non-invasive OCT angiography has enabled depth-resolved imaging for myopic choroidal neovascularisation. Artificial intelligence (AI) has shown great performance in detecting pathologic myopia and the identification of myopia-associated complications. These advances in imaging with adjunctive AI analysis may lead to improvements in monitoring disease progression or guiding treatments. In this review, we provide an update on the classification of pathologic myopia, how imaging has improved clinical evaluation and management of myopia-associated complications, and the recent development of AI algorithms to aid the detection and classification of pathologic myopia.

Zhang, Shaohua; Chen, Jiahui; Yang, Fan; Xu, Binxin; Tang, Yating; Lu, Yi

doi: 10.1136/bjophthalmol-2021-319991pmid: 35086805

PurposeTo estimate the prevalence rates of cataract and cataract surgery in suburban Shanghai, China.MethodsThis population-based, cross-sectional study was carried out in Pujiang Town, Shanghai, China, using a random cluster sampling strategy. A total of 5846 participants (11,657 eyes) aged ≥65 years were enrolled. Detailed eye examinations included presenting visual acuity (VA), best-corrected VA, non-contact tonometry, measurement of ocular parameters using IOLMaster 700, slit-lamp assessment of lens opacities using the Lens Opacities Classification System III and dilated fundus evaluation.ResultsCataract was present in 57.0% of participants (53.8% of eyes). Cortical, nuclear and posterior subcapsular cataract (PSC) were found in 41.3%, 41.0% and 12.6% of participants. Among participants with any cataract, VA was <20/40 in 32.5%. According to Global Burden of Disease Study visual impairment (VI) criteria, 52.5% of participants with PSC had VI, 4.9% were considered blind (VA <20/400) and 31.9% had moderate VI (VA ≥20/400 to <20/63). This rate was significantly greater than that in participants with cortical (32.0%) or nuclear (38.0%) cataract (P<0.05). Cataract surgery was performed in 8.1% of eyes (men, 3.1%; women, 5.0%) or 10.9% of participants (men, 4.2%; women, 6.7%).ConclusionsThe Pujiang Cataract Cohort Study has revealed the prevalence rates of cataract and cataract surgery among elderly individuals in suburban Shanghai, China. Although the frequency of cataract surgery has increased in China in recent decades, the high prevalence of cataract-related VI among older people suggests further attention to primary eyecare and medical awareness is necessary.

Mohanty, Amrita; Behera, Himansu Sekhar; Barik, Manas Ranjan; Kaur, Amanjot; Sharma, Savitri; Das, Sujata; Fernandes, Merle; Panda, Sailendra; Sahu, Srikant K

doi: 10.1136/bjophthalmol-2021-319784pmid: 34937694

Najjar, Raymond P; Rukmini, A V; Finkelstein, Maxwell T; Nusinovici, Simon; Mani, Baskaran; Nongpiur, Monisha Esther; Perera, Shamira; Husain, Rahat; Aung, Tin; Milea, Dan

doi: 10.1136/bjophthalmol-2021-319938pmid: 34853018

Background/aimsEarly detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.MethodsIn this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF).ResultsPupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT.ConclusionHCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.

Larkin, Frank

doi: 10.1136/bjo-2023-323673pmid: N/A

Ducloux, Alexandre; Marillet, Simon; Ingrand, Pierre; Bullimore, Mark A; Bourne, Rupert R A; Leveziel, Nicolas

doi: 10.1136/bjophthalmol-2021-319568pmid: 34937695

BackgroundThe prevalence of myopia is increasing worldwide. The purpose of this study was to evaluate the progression of myopia in teenagers and adults in France.MethodsThis nationwide prospective study followed 630 487 myopic adults and teenagers (mean age 43.4 years±18.2, 59.8% of women) between January 2013 and January 2019. Myopia and high myopia were defined as a spherical equivalent less than or equal to –0.50 and –6.00 diopters (D), respectively. Demographic data were collected at first visit and refractive characteristics were collected at each visit. Analysis of short-term progression (first 12 to 26 months postbaseline) was modelled using analysis of variance (ANOVA). Progression of myopia was stratified according to age, gender and spherical equivalent at first visit.ResultsHigher proportions of progressors were observed in the youngest age groups: 14–15 (18.2 %) and 16–17 years old (13.9 %). In multivariate analysis, after adjustment for over age, spherical equivalent and gender, the mean short-term progression decreased from –0.36 D in the 14–15 years age group to –0.13 D in the 28–29 years age group. Young age and higher myopia at baseline together were strongly associated with the risk of developing high myopia, the 5-year cumulative risk being 76% for youngest teenager with higher myopia status at baseline.ConclusionIn this large cohort of myopic teenagers and adults, myopia progression was reported in 18.2% and 13.9% of the 14–15 and 16–17 age groups, respectively. The risk to develop high myopia was higher for younger individuals with higher myopia at baseline examination.

Lin, Fengbin; Qiu, Zhen; Li, Fei; Chen, Yu; Peng, Yuying; Chen, Meiling; Song, Yunhe; Xiong, Jian; Cheng, Weijing; Liu, Yuhong; Tan, Mingkui; Zhang, Xiulan; Weinreb, Robert

doi:

Belkin, Avner; Chaban, Yuri Valere; Waldner, Derek; Samet, Saba; Ahmed, Iqbal Ike K; Gooi, Patrick; Schlenker, Matthew B

doi: 10.1136/bjophthalmol-2021-320270pmid: 34930723

BackgroundTo assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).MethodsA retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.ResultsMean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.ConclusionGATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.