• 文章类型: Journal Article
    背景:影响眼睛后段的非感染性葡萄膜炎(NIU-PS)是一种炎症性疾病,如果不充分治疗,可能会严重损害视力。氟轻松-丙酮持续释放-0.2µg/天玻璃体内(FAc)植入物可用于预防复发性NIU-PS的复发。这里的目的是为临床医生提供一些基于共识的建议,用于使用0.2µg/天FAc植入物的NIU-PS患者的临床管理。
    方法:一个欧洲临床专家组同意就NIU-PS患者使用FAc植入物的不同问题制定一份共识报告。
    结果:临床专家小组针对NIU-PS的临床表现(单侧/双侧);NIU-PS的全身受累和晶状体状态提供了具体建议。开发了治疗算法;一个是指在临床实践中对NIU-PS患者的管理,另一个是建立使用FAc植入物的最佳临床方案,作为单一疗法和辅助疗法。此外,临床专家小组提供了有关在临床中使用FAc植入物的建议.临床专家小组还考虑了FAc植入物的安全性及其在日常实践中的可能影响。
    结论:随着使用FAc植入物获得更多临床经验,有必要更新指导临床患者管理的临床建议.当前的共识文件解决了与不同类型的NIU-PS病因不同的患者使用FAc植入物相关的问题,并进行了标准化方法,以帮助专家获得更好的临床结果。
    BACKGROUND: Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants.
    METHODS: A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS.
    RESULTS: The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice.
    CONCLUSIONS: As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes.
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  • 文章类型: Journal Article
    计算模型可以通过考虑机械失衡或事先测试不同的手术技术等因素来帮助临床医生计划手术。在文献中发现了不同级别的建模复杂性,目前尚不清楚在有限元(FE)角膜模型中应该包括哪些方面来获得准确的结果。这项工作提出了一种方法,以缩小建模特征的最低要求,以报告诸如PRK的屈光干预的临床数据。
    介绍了创建屈光手术FE模型的管道:它测试了不同的几何形状,边界条件,加载,以及光机械模拟输出上的网格大小。角膜组织的力学模型解释了人角膜中胶原纤维的分布。针对不同模型分析了机械和光学结果。最后,该方法学应用于5种患者特异性模型,以确保准确性.
    为了模拟术后角膜光力学,我们的结果表明,最精确的结果是通过具有100µm网格大小的患者特定模型获得的,边缘处的滑动边界条件,和眼内压强制为分布式负荷。
    已经开发了一种用于激光手术模拟的方法,该方法能够再现激光介入的光学目标,同时还分析机械结果。
    屈光干预建模缺乏标准化导致不同的模拟策略,很难将它们与其他出版物进行比较。这项工作建立了进行屈光介入的光机械模拟时要遵循的标准化指南。
    UNASSIGNED: Computational models can help clinicians plan surgeries by accounting for factors such as mechanical imbalances or testing different surgical techniques beforehand. Different levels of modeling complexity are found in the literature, and it is still not clear what aspects should be included to obtain accurate results in finite-element (FE) corneal models. This work presents a methodology to narrow down minimal requirements of modeling features to report clinical data for a refractive intervention such as PRK.
    UNASSIGNED: A pipeline to create FE models of a refractive surgery is presented: It tests different geometries, boundary conditions, loading, and mesh size on the optomechanical simulation output. The mechanical model for the corneal tissue accounts for the collagen fiber distribution in human corneas. Both mechanical and optical outcome are analyzed for the different models. Finally, the methodology is applied to five patient-specific models to ensure accuracy.
    UNASSIGNED: To simulate the postsurgical corneal optomechanics, our results suggest that the most precise outcome is obtained with patient-specific models with a 100 µm mesh size, sliding boundary condition at the limbus, and intraocular pressure enforced as a distributed load.
    UNASSIGNED: A methodology for laser surgery simulation has been developed that is able to reproduce the optical target of the laser intervention while also analyzing the mechanical outcome.
    UNASSIGNED: The lack of standardization in modeling refractive interventions leads to different simulation strategies, making difficult to compare them against other publications. This work establishes the standardization guidelines to be followed when performing optomechanical simulations of refractive interventions.
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  • 文章类型: Journal Article
    在台湾临床实践中,就使用皮质类固醇(CS)治疗非感染性葡萄膜炎达成共识。这需要检查不同的管理方法,它们的优点和缺点,并根据现行证据和卫生政策考虑替代疗法。
    10位眼科医生和1位风湿病专家于2022年12月11日召开会议,审查和讨论有关该主题的文献。探索的数据库是中央Cochrane图书馆,EMBASE,Medline,pubmed,和WebofScience使用相关关键字。搜索时间从1996年1月到2023年6月。在给出了文献综述的初步结果后,公开投票决定了最后声明,如果获得70%以上的协议,一份声明将被接受。然后,在确定最终版本之前,在重要会议上提出了这一共识,以供进一步讨论。
    审议中出现了一个流程图和九项声明。他们解决了CS在葡萄膜炎管理中的重要性,使用局部CS的指南,眼周或玻璃体内和全身治疗的适应症,以及局部和全身CS的逐渐减少和停药方法。
    虽然CS是非感染性葡萄膜炎治疗的基石,他们的管理需要仔细考虑,取决于临床情况和葡萄膜炎的具体类型。本文产生的共识为台湾从业者提供了指导,考虑到当地卫生政策和有关该主题的最新研究。它强调了战略缩表的重要性,替代疗法的潜力,以及以患者为中心的护理的重要性。
    UNASSIGNED: To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies.
    UNASSIGNED: Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established.
    UNASSIGNED: A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS.
    UNASSIGNED: While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.
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  • 文章类型: Journal Article
    尽管在地理萎缩(GA)的详细成像方面具有广泛的可用性和共识,光谱域光学相干断层扫描(SD-OCT)可能受益于GA诊断中的自动定量OCT分析,监测,并报告其具有里程碑意义的临床试验。
    分析pegcetacoplan与一致GASD-OCT终点之间的关联。
    这是对来自2项平行3期研究的1258名参与者中的936名的11614个SD-OCT卷的事后分析,比较玻璃体腔内APL-2治疗与假注射治疗继发于年龄相关性黄斑变性(OAKS)的地理萎缩(GA)患者的疗效和安全性的研究,以及比较玻璃体腔内APL-2治疗的疗效和安全性的研究。OAKS和DERBY是24个月,多中心,随机化,双面蒙面,2018年8月至2020年7月,在眼底自发荧光成像上对总面积为2.5至17.5mm2的GA成人进行了假对照研究(如果多焦点,至少1个病灶≥1.25mm2)。这项分析是在2023年9月至12月进行的。
    研究参与者接受了pegcetacoplan,每0.1毫升玻璃体内注射15毫克,每月或每隔一个月,或假注射每月或每隔一个月。
    主要终点是3个治疗组中每个治疗组中的视网膜色素上皮面积和外部视网膜萎缩相对于基线的最小二乘均值变化(pegcetacoplan每月,pegcetacoplan每隔一个月,并在24个月时合并假[每月假和每隔一个月假])。通过早期治疗糖尿病视网膜病变研究(ETDRS)感兴趣区域(即,中央凹,侧腹,和中心凹)。
    在936名参与者中,平均(SD)年龄为78.5(7.22)岁,570名参与者(60.9%)为女性。Pegcetacoplan,但不是假治疗,在长达24个月的时间内,与GA的SD-OCT生物标志物的生长速率降低相关。在3至24个月的每个时间点均可检测到视网膜色素上皮和外部视网膜萎缩面积相对于基线的最小二乘均值(SE)变化(最小二乘均值与合并的假手术在24个月,pegcetacoplan每月:-0.86mm2;95%CI,-1.15至-0.57;P<.001;pegcetacoplan每隔一个月:-0.69;95%CI-39,P<这种关联在更频繁的给药(pegcetacoplan每月与pegcetacoplan每隔一个月在第24个月:-0.17mm2;95%CI,-0.43至0.08;P=.17)。在每月的pegcetacoplan和每隔一个月的pegcetacoplan中,在半凹和中央凹区域都观察到了更强的关联。
    这些发现为pegcetacoplan对GA发展的潜在影响提供了更多的见解,包括对视网膜色素上皮和光感受器的潜在影响。
    ClinicalTrials.gov标识符:NCT03525600和NCT03525613。
    UNASSIGNED: Despite widespread availability and consensus on its advantages for detailed imaging of geographic atrophy (GA), spectral-domain optical coherence tomography (SD-OCT) might benefit from automated quantitative OCT analyses in GA diagnosis, monitoring, and reporting of its landmark clinical trials.
    UNASSIGNED: To analyze the association between pegcetacoplan and consensus GA SD-OCT end points.
    UNASSIGNED: This was a post hoc analysis of 11 614 SD-OCT volumes from 936 of the 1258 participants in 2 parallel phase 3 studies, the Study to Compare the Efficacy and Safety of Intravitreal APL-2 Therapy With Sham Injections in Patients With Geographic Atrophy (GA) Secondary to Age-Related Macular Degeneration (OAKS) and Study to Compare the Efficacy and Safety of Intravitreal APL-2 Therapy With Sham Injections in Patients With Geographic Atrophy (GA) Secondary to Age-Related Macular Degeneration (DERBY). OAKS and DERBY were 24-month, multicenter, randomized, double-masked, sham-controlled studies conducted from August 2018 to July 2020 among adults with GA with total area 2.5 to 17.5 mm2 on fundus autofluorescence imaging (if multifocal, at least 1 lesion ≥1.25 mm2). This analysis was conducted from September to December 2023.
    UNASSIGNED: Study participants received pegcetacoplan, 15 mg per 0.1-mL intravitreal injection, monthly or every other month, or sham injection monthly or every other month.
    UNASSIGNED: The primary end point was the least squares mean change from baseline in area of retinal pigment epithelium and outer retinal atrophy in each of the 3 treatment arms (pegcetacoplan monthly, pegcetacoplan every other month, and pooled sham [sham monthly and sham every other month]) at 24 months. Feature-specific area analysis was conducted by Early Treatment Diabetic Retinopathy Study (ETDRS) regions of interest (ie, foveal, parafoveal, and perifoveal).
    UNASSIGNED: Among 936 participants, the mean (SD) age was 78.5 (7.22) years, and 570 participants (60.9%) were female. Pegcetacoplan, but not sham treatment, was associated with reduced growth rates of SD-OCT biomarkers for GA for up to 24 months. Reductions vs sham in least squares mean (SE) change from baseline of retinal pigment epithelium and outer retinal atrophy area were detectable at every time point from 3 through 24 months (least squares mean difference vs pooled sham at month 24, pegcetacoplan monthly: -0.86 mm2; 95% CI, -1.15 to -0.57; P < .001; pegcetacoplan every other month: -0.69 mm2; 95% CI, -0.98 to -0.39; P < .001). This association was more pronounced with more frequent dosing (pegcetacoplan monthly vs pegcetacoplan every other month at month 24: -0.17 mm2; 95% CI, -0.43 to 0.08; P = .17). Stronger associations were observed in the parafoveal and perifoveal regions for both pegcetacoplan monthly and pegcetacoplan every other month.
    UNASSIGNED: These findings offer additional insight into the potential effects of pegcetacoplan on the development of GA, including potential effects on the retinal pigment epithelium and photoreceptors.
    UNASSIGNED: ClinicalTrials.gov Identifiers: NCT03525600 and NCT03525613.
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  • 文章类型: Journal Article
    这是对公开的互联网数据的横截面探索性分析,以检查对眼科患者教育社交媒体帖子的Web内容可访问性指南(WCAG)的合规性。WCAG确保残疾人(包括视力障碍)的Web内容可访问性。从10个眼科患者教育社交媒体页面和10个非眼科(心肺)页面中抽取总共100个社交媒体帖子作为对照组。三名独立的分级人员根据WebAIM的WCAG2清单评估了选定的帖子,隶属于犹他州立大学的非营利组织,在适应社交媒体帖子之后。已验证的辅助功能标准标签:\"0\"不符合任何标准,\"1\"或\"A\"满足最低可访问性要求,\"2\"或\"AA\"满足法律的可访问性要求,或\"3\"或\"AAA\"超过可访问性要求。没有足够的证据来检测眼科与非眼科职位之间的WCAG评分差异(p=0.80)。眼科社交媒体帖子的得分中有49%显示不符合任何WCAG。眼科岗位不符合标准的最常见原因是由于颜色和对比度问题(39%)。大多数眼科社交媒体帖子的WCAG得分较低,表明对WCAG的合规性较差。因为社交媒体是高度视觉化的,降低对WCAG的依从性可能会对低视力个体成功访问患者教育社交媒体内容造成障碍.
    This is a cross-sectional exploratory analysis of publicly available Internet data to examine compliance to web content accessibility guidelines (WCAG) on patient education social media posts in ophthalmology. WCAG ensures web content accessibility for those with disabilities (including visual impairment). A total of 100 social media posts were sampled from ten ophthalmology patient education social media pages and ten non-ophthalmology (cardiopulmonary) pages as the comparison group. Three independent graders evaluated the selected posts based on the WCAG 2 checklist by WebAIM, a non-profit affiliated with Utah State University, after its adaptation for social media posts. Validated accessibility standard labels: \"0\" for not meeting any standards, \"1\" or \"A\" for meeting bare minimum accessibility requirements, \"2\" or \"AA\" for meeting legal accessibility requirements, or \"3\" or \"AAA\" for exceeding accessibility requirements. There was not enough evidence to detect a difference in WCAG scores between ophthalmology and non-ophthalmology posts (p = 0.80). Forty-nine percent of scores for ophthalmology social media posts showed no compliance with any WCAG. The most common reasons that ophthalmology posts failed to meet criteria were due to color and contrast issues (39%). Most ophthalmology social media posts had low WCAG scores, indicating poor compliance to WCAG. Because social media is highly visual, reduced compliance to WCAG may create barriers for low vision individuals to successfully access patient education social media content.
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  • 文章类型: Journal Article
    视网膜母细胞瘤(RB)是儿童时期最常见的眼内恶性肿瘤。由于缺乏意识,RB的高级陈述在中低收入国家(LMICs)很常见,与摘除有关的社会禁忌,寻求其他保守治疗方案,和难以获得医疗保健。在过去的几十年里,在眼外RB(EORB)的管理方面取得了显著进步,改善了结局,并有助于将治疗相关毒性最小化.包括化疗在内的多模式方法的结合,手术,和放射治疗(RT)已显示出有希望的结果;然而,预后仍然较差,尤其是在LMIC中。在这篇文章中,作者讨论了ICMR关于EORB管理的共识指南,包括转移性RB。
    Retinoblastoma (RB) is the most common intraocular malignancy of childhood. Advanced stage presentation of RB is common in low middle-income countries (LMICs) due to lack of awareness, social taboos associated with enucleation, seeking alternative conservative treatment options, and poor accessibility to health care. Over the last few decades, there have been significant advancements in the management of extraocular RB (EORB) which have improved outcomes and helped in minimizing treatment-related toxicities. The incorporation of multimodality approaches including chemotherapy, surgery, and radiotherapy (RT) has shown promising results; however, prognosis remains poor especially in LMICs. In this article, authors have discussed the ICMR consensus guidelines on the management of EORB, including metastatic RB.
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