Diana Chabané Schmidt

Purpose: To compare retinal vessel oxygen saturations and diameters before, 1 and 3 months after trabeculectomy. Methods: Retinal oxygen saturations and vessel diameters were obtained using retinal oximetry. The effect of the postoperative intraocular pressure (IOP) decrease on the arteriovenous difference (AV‐difference) was evaluated, adjusting for mean defect (MD). The impact of trabeculectomy on AV‐difference was compared between lowest (Q1) and highest (Q4) MD quartiles. Paired t ‐test, linear regression and Welch's t ‐test were applied. Results: Of 72 enrolled participants, 64 eyes of 64 participants were included. Arteriolar oxygen saturations were unchanged (97.4 ± 4.9% preoperatively, 98.1 ± 6.0% 1 month [ p = 0.053], 98.2 ± 6.8% 3 months postoperatively [ p = 0.154]). Venular saturations were also unchanged (62.0 ± 9.5% preoperatively, 61.7 ± 8.0% 1 month [ p = 0.505], 61.3 ± 10.6% 3 months postoperatively [ p = 0.685]). No significant difference in AV‐difference occurred. Arteriolar diameters were unchanged 1 month postoperatively (109.7 μm ± 16.2 vs. 110.9 μm ± 19.3 [ p = 0.80]) but decreased to 106.0 μm ± 15.7 3 months postoperatively ( p = 0.012). Venular diameters increased 1 month postoperatively (152.8 μm ± 21.3 vs. 147.7 μm ± 20.0 [ p = 0.034]) but not 3 months postoperatively (148.6 μm ± 24.8; p = 0.893). No association between postoperative IOP decrease and postoperative MD‐adjusted AV‐difference was found ( p = 0.380). No significant change in AV‐difference between Q1 and Q4 ( p = 0.18) was found. Conclusion: Retinal oxygen saturations remained stable, whereas vessel diameter changes occurred after trabeculectomy, probably reflecting alterations in IOP and perfusion pressure.

To determine the effectiveness of various interventions in reducing myopia progression in children. Literature databases were searched on December 2, 2023: PubMed, Embase, the Cochrane Central, Web of Science Core Collection, BIOSIS Previews, Current Contents Connect, Data Citation Index, Derwent Innovations Index, KCI‐Korean Journal Database, Preprint Citation Index, ProQuest™ Dissertations and Theses Citation Index and SciELO Citation Index. PRISMA guidelines and the Cochrane Handbook recommendations were followed. All unique interventions were analyzed individually in order to generate clinically applicable results. The main outcome was axial length progression. Secondary outcomes were incident corneal infiltrates, photophobia, development of an allergic response towards the intervention, visual acuity at near and distance and drop‐out from allocated intervention/control. We identified 74 RCTs involving 12 154 participants aged 6–18 years. Network meta‐analysis compared axial length after 1 year between 45 interventions and placebo or single‐vision spectacles. The most effective interventions reported in weighted mean difference and 95% confidence interval were low‐level red‐light (−0.33 mm (−0.40, −0.25)), ortho‐K with 5 mm treatment zone (−0.32 mm (−0.41, −0.24)), ortho‐K with aspheric base curve (−0.29 mm (−0.37, −0.22)), atropine 1.0% (−0.28 mm (−0.30, −0.26)), combined atropine 0.01% and ortho‐K (−0.24 mm (−0.37, −0.11)), spectacles with highly aspherical lenslets (−0.23 mm (−0.26, −0.19)), ortho‐K with increased compression factor (−0.23 mm (−0.28, −0.17), atropine 0.05% (−0.21 mm (−0.30, −0.13)) and defocus incorporated multiple segments spectacles (−0.21 mm (−0.27, −0.15)). Photophobia and reduced near‐visual acuity were reported for atropine, and lower adherence to treatment was found for atropine at 1.0%. There was no significant association between any interventions and corneal infiltrates or allergic reactions. Over 70% of the studies were conducted in Asian populations. This systematic review and network meta‐analysis highlights the efficacy of various interventions, including orthokeratology lenses, atropine, highly aspherical lenslets and defocus incorporated multiple segments spectacles in slowing axial elongation in children. Low‐level red‐light therapy also slowed axial length progression, but further research is needed to assess the potential side effects. Future studies should include diverse populations and standardized methodologies to enhance the applicability and comparability of results.

To investigate levels of specific plasma-biomarkers related to neurodegeneration and inflammation in patients with different chronic degenerative retinal diseases, using an ultrasensitive technology called ‘single molecule array’ (SiMoA). Also, to investigate if biomarkers were measurable in the patient’s blood, dependent on age and medical comorbidities, and useful for stratifying the diseases. This exploratory, cross-sectional study recruited 151 adults at the Department of Ophthalmology, Rigshospitalet, Denmark (period 2019 to 2020). Clinical data came from the electronic medical-record system. The study population consisted of 131 patients: 32 with diabetic retinopathy (DR; 51 diabetes, DM), 27 with glaucoma, 53 with inherited retinal degeneration (IRD and 20 healthy controls (HC). Medical comorbidities included organ failure, other active eye diseases, and comorbidities. Three biomarkers, neurofilament-light-chain (NFL), glial-fibrillary-acidic-protein (GFAP), and CXC-motif chemokine ligand 13 (CXCL13), were measured with SiMoA technology. The age-adjusted values were reported as fold differences (FD) with 95% confidence intervals (CI). Increased NFL levels were found in DR patients compared to HCs (FD 1.81 95%CI 1.43, 2.28, p < 0.001, adj-p < 0.001). Similarly increased NFL levels were reported in advanced DR (PDR, DME), compared to both DM (FD 2.52 (95%CI: 1.71; 3.72, p < 0.001, adj-p < 0.001, and FD 2.04 (95%CI: 1.33; 3.12, p < 0.001, adj-p < 0.001), respectively) and HCs (FD 2.35 (95%CI: 1.67; 3.30, p < 0.001, adj-p < 0.001), and FD 1.89 (95%CI: 1.28; 2.79, p < 0.001, adj-p < 0.001) respectively). Independent of comorbidities, decreased NFL-levels were seen in IRD compared to DR (FD 0.49 (95% CI 0.39; 0.61, p < 0.001; adj-p < 0.001), ±comorbidities). Decreased GFAP levels were seen in DM patients compared to HCs (FD 0.69; 95%CI 0.55, 0.87, p = 0.002, adj-p = 0.02), but contrary to an increasing trend in advanced DR compared to DM (-comorbidities). These results imply that these biomarker-tests are useful for detecting and monitoring development of retinopathy in the circulations of diabetes patients. Plasma-biomarkers may be useful to stratify between retinal disease types. Prospective studies are underway to explore this hypothesis in depth.

Purpose: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic–pituitary–adrenal axis suppression. We wish to compare glaucoma outcomes following high‐dose and low‐dose glucocorticoid treatment after paediatric cataract surgery.Methods: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low‐dose or high‐dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High‐dose treatment included 0.5–1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6–8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low‐dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.Results: Overall, 267 children (388 eyes) were included in the study. Ninety‐five children (133 eyes) had received high‐dose treatment and had a median follow‐up time of 89 months (IQR: 57.2–107.4), while 173 children (255 eyes) had received the low‐dose treatment and had a median follow‐up time of 40.5 months (IQR: 22.9–60.4). Survival curves showed a lower risk of glaucoma in the low‐dose group for children with axial lengths ≥18 mm.Conclusion: Low‐dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High‐dose glucocorticoid should be limited in children undergoing cataract surgery.

Purpose: To investigate visual development and long‐term complications after cataract surgery in childhood.Methods: This cross‐sectional study included patients from a family with Marner's hereditary cataracts who had cataract surgery before 18 years of age. The study was conducted from 1 January 2022 until 31 December 2022. The patients contributed to their medical files and participated in an updated ophthalmologic examination.Results: We included 52 patients (101 eyes, 34 females). The median age at cataract surgery was 7 years (IQR: 5–10) and the age at examination was 40 years (IQR: 21–54). Primary and secondary intraocular lens implantation had been performed in 47.5% (25 patients, 48 eyes) and 16.8% (10 patients, 17 eyes). Visual acuity was ≤0.3 logMAR in 77% (78 eyes), and 6 dB) in 24% (24 eyes). Thirty‐five patients (67%) held a driver's licence, and three were not allowed to drive due to low visual function. All patients were employed.Conclusion: After cataract surgery in childhood, many patients achieve normal visual acuity, but mild visual field loss is common. Long‐term follow‐up is important due to the high risk of glaucoma.

Purpose: To examine the long‐term risk of glaucoma after cataract surgery in childhood. Methods: This study took place from January 2022 until December 2022 and included patients from a large family with hereditary childhood cataract who had cataract surgery before 18 years of age. Patients underwent an ophthalmologic examination to determine the presence of glaucoma or ocular hypertension (OHT). Patients who did not want to participate in the examination could contribute with a medical journal from their treating ophthalmologist. The risk of long‐term glaucoma was determined using survival analysis, and risk factors were assessed using a Cox proportional hazards regression model. Results: We included 68 patients (133 eyes) with a median age at cataract surgery of 7 years (IQR: 5–10). The median follow‐up time after cataract surgery to glaucoma/OHT or the latest ophthalmologic examination was 35 years (IQR: 15–48). Twelve patients (18 eyes) had glaucoma, and five patients (eight eyes) had OHT, resulting in 15 patients with glaucoma/OHT. The long‐term risk of glaucoma/OHT diagnosed in adulthood was 47.7% (CI: 21.8–70.9) at the age of 70 years of patients who were free of glaucoma before their 18th year. We could not confirm or dismiss an association between glaucoma/OHT and sex, age at surgery, number of ocular interventions before 18 years of age or glaucoma after cataract surgery in a first‐degree relative. Conclusion: Cataract surgery in childhood is associated with a high risk of late‐onset glaucoma. Regular lifelong follow‐up is important to ensure early diagnosis and prevent extensive vision loss.

Purpose: To examine the potential of different head-mounted displays in the rehabilitation of individuals with visual impairment. Methods: This prospective explorative study conducted between September 2019 and August 2020 included participants with Stargardt disease with moderate to severe visual impairment and a relatively preserved peripheral visual field. AceSight, eSight 3, IrisVision Live, and Jordy were tested. After instruction and training, participants chose two head-mounted displays for home use for two weeks per device. The Canadian Occupational Performance Measure was used for evaluation. Results: Twelve participants (aged 16– 53 years) tested all head-mounted displays in the clinic. Distance visual acuity and reading distance improved with all head-mounted displays and eSight and Irisvision improved near visual acuity. Six participants decided not to test the head-mounted display at home due to lack of time or energy, dizziness and discomfort, double vision and peripheral visual field limitation, or aesthetics. After home use, the participants reported improved visual function at a distance with IrisVision, AceSight, and e-Sight, whereas only AceSight improved vision during near tasks. IrisVision and eSight improved reading ability, and none of the devices improved vision during tasks involving computers. Five participants used the devices sparingly, and five avoided public use owing to aesthetics. Conclusion: We found an improvement in distance visual acuity and increased reading distance for all tested head-mounted displays. Additionally, IrisVision and eSight improved visual function at near and eSight also improved contrast vision at distance. Despite the possibility of improving vision, social stigma and device aesthetics kept the participants from using head-mounted displays in public and limited their use at home. Plain Language Summary: This study explored the potential of four different head-mounted displays for visual rehabilitation.Visual impairment not only affects daily activities but also limits participation in education, work, and social interactions.Patients with Stargardt disease tested the displays in a clinical setting and at home.We found that the head-mounted displays improved visual function. However, the patients did not wish to use the devices publicly due to social stigma and their aesthetics.The development of smaller and lighter devices that focus on aesthetics could increase usage.

Purpose To examine the prevalence and risk factors for hypothalamus-pituitary-adrenal axis suppression (HPA axis suppression) in infants receiving glucocorticoid (GC) eye drops after ocular surgery. Methods This was a clinical observational cohort study. Children under the age of two receiving GC eye drops after cataract or glaucoma surgery between 1 January 2017 and 31 December 2021 were included at one centre. Medical history and results of the adrenocorticotropic hormone (ACTH) stimulation tests were obtained through patient charts. Results Forty-nine infants were included in the study. Ten out of 22 patients (45.5%) tested during treatment and two out of 27 patients (7.4%) tested after treatment cessation were diagnosed with HPA axis suppression. The duration of HPA axis suppression extended beyond 3 months in 8 out of 12 patients. Logistic regression showed that infants with HPA axis suppression had received a higher GC dose/body weight/day before the first ACTH test (p < 0.001). There was a 79% (95% CI:1.28;2.50) increase in the odds of having HPA axis suppression for a 0.01 mg GC increase/kg/day corresponding to an additional daily eye drop for an infant weighing 5 kg. There was an association between HPA axis suppression and number of days from surgery to test (p = 0.003), age at surgery (p = 0.035) and cumulated GC dose (p = 0.005). Three infants with HPA axis suppression had affected growth and one had Cushing-like features, but there were no cases of Addisonian crisis. Conclusion Infants are at risk of having hypothalamus-pituitary-adrenal axis suppression if they receive a high daily glucocorticoid dose per weight by topical ocular administration. Infants receiving glucocorticoids after ocular surgery should be monitored clinically or by ACTH testing.

Purpose . To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta‐analyses to compare visual acuity outcomes and complication rates. Methods . On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta‐analyses. Outcome measures were preoperative and postoperative best‐corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results . Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis‐associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1‐year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P = 0.027; 5‐year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P = 0.000036). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P = 0.000036) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P = 0.044). Conclusions . In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.

Purpose: To evaluate the efficacy of vitrectomy combined with hyaloido‐zonula‐iridectomy from an anterior or a posterior approach in patients with treatment‐resistant aqueous misdirection (chronic aqueous misdirection) by systematically reviewing existing literature in combination with presentation of a case series.Methods: A systematic literature review was performed in PubMed, EMBASE and Cochrane Library databases using search terms: malignant glaucoma, ciliary block, ciliolenticular block and aqueous misdirection. A consecutive series of three pseudophakic patients (5 eyes) diagnosed with chronic aqueous misdirection after cataract surgery is presented.Results: A literature search identified 31 articles describing treatment of chronic aqueous misdirection with vitrectomy and a hyaloido‐zonula‐iridectomy. Studies, where patients were treated with a complete vitrectomy from pars plana in combination with a hyaloido‐zonula‐iridectomy, reported low relapse rates. Studies describing a surgical approach with vitrectomy performed from the anterior chamber, followed by a hyaloido‐zonula‐iridectomy, also reported low relapse rates except for one reporting relapse in nearly half of the patients. In our case series, a complete vitrectomy combined with a hyaloido‐zonula‐iridectomy resolved the chronic aqueous misdirection in all five eyes after one procedure except one eye where the hyaloido‐zonula‐iridectomy was repeated due to an insufficient opening. Some of the eyes still needed antiglaucomatous treatment due to chronic angle closure.Conclusion: In treatment‐resistant malignant glaucoma, vitrectomy combined with a hyaloido‐zonula‐iridectomy should be considered performed to ensure communication between the anterior chamber and the vitreous cavity. If the condition has been unresolved for a long time, extensive synechiae of the angle may decrease the success rate due to chronic angle closure.