To Örebro University

PURPOSE: To study ocular fundus morphology and its relation to growth in adolescents born moderate-to-late preterm (MLP) and full term.

METHODS: This prospective and population-based cohort study included 50 MLP adolescents (26 girls, mean age 16.5 years) and 50 full-term controls (30 girls, mean age 16.7 years). Optical coherence tomography measurements were studied in relation to gestational age, auxological data, insulin-like growth factor-I (IGF-I) and IGF-binding protein 3 (IGFBP-3).

RESULTS: The MLP group showed an increased central macular retinal thickness (MRT) compared with controls in right eye (RE) (249.7 ± 21.0 vs. 239.9 ± 16.4 μm, p = 0.019). Moreover, the MLP group showed a thinner total peripapillary retinal nerve fibre layer (ppRNFL) thickness in RE (104.3 ± 8.5 vs. 109.1 ± 8.3, p = 0.0011). Nasal ppRNFL thickness was thinner in both RE (79.4 ± 13.2 vs. 85.0 ± 10.8, p = 0.0012) and left eye (LE) (77.0 ± 13.8 vs. 81.7 ± 13.4, p = 0.025) compared with controls. A weak association between total ppRNFL thickness and IGF-I levels was found (RE, r = 0.28, p = 0.032; LE, r = 0.27, p = 0.048), as well as between central MRT and a ratio between IGF-I and IGFBP-3 levels (RE, r = 0.30, p = 0.022). Additionally, there was a correlation between optic cup/disc area ratio and birth weight (RE: r = -0.44, p = 0.0006; LE: r = -0.30, p = 0.026).

CONCLUSION: The present study suggests that growth and MLP birth may impact ocular fundus morphology. The MLP adolescents were shown to have thinner ppRNFL thickness and greater MRT, compared with full-term controls. Furthermore, a weak association between these structures and growth factors was found. In addition, the current study proposes that birth weight may impact optic disc parameters.

AIM: This qualitative study explored the lived experiences of the patients with microphthalmia and anophthalmia and their parents, focusing on the healthcare, school settings and daily life challenges to improve patient management.

METHODS: In-depth interviews were conducted in Stockholm, Sweden, from October 2022 to June 2023. Participants were recruited through the St Erik Eye Hospital database (2008-2022), and the data was analysed using reflexive thematic analysis.

RESULTS: The study included 15 patients (9 female and 6 male), with a median age of 21 years (range 15-31), and 1 parent per patient. Five key themes were identified from the parental interviews and three from the patient interviews. Both groups emphasised the need for improvements in healthcare, including better physician continuity, emotional support, information provision and prosthesis functionality. Families of those with severe bilateral visual impairment highlighted the need for additional school and daily life support. While some parents had future concerns, most patients viewed their condition as a natural part of life.

CONCLUSION: Patients and parents shared insights on the psychosocial impact and suggested improvements in the healthcare and school settings, providing valuable guidance for enhancing care and management for this patient group.

PURPOSE: To compare inflammatory response, visual acuity, and complications of two intraocular lenses (IOLs) in patients with and without uveitis. SETTING: Tertiary referral centre at Sahlgrenska University Hospital/Mölndal, Sweden.

DESIGN: Prospective randomised controlled trial.

PATIENTS AND METHODS: Patients with and without uveitis eligible for cataract surgery were randomised to receive a hydrophobic or a hydrophilic square-edged intraocular lens (IOL). Patients undergoing bilateral surgery received a hydrophobic IOL in one eye and a hydrophilic in the other. Visual acuity, flare, and central foveal thickness were used as outcome measures.

RESULTS: In total, 34 (61%) patients (52 eyes) with uveitis and 22 (39%) non-uveitic patients (38 eyes) were included in the study. Comparable corrected distance visual acuity (CDVA) was seen, regardless of IOL material. Flare, six months postoperatively, for those undergoing bilateral surgery, showed no significant difference between eyes receiving a hydrophilic IOL or a hydrophobic IOL; mean difference was -3.2 (SD ± 20.7) ph/ms between eyes with uveitis (p = 0.53) and -0.6 SD ± 7.5 ph/ms between eyes without uveitis (p = 0.77). No significant difference in cystoid macular edema (CME) was seen for uveitic patients receiving a hydrophobic IOL (n = 2; 8.0%) and those receiving a hydrophilic IOL (n = 6; 22.2%; p = 0.25).

CONCLUSION: No significant differences in postoperative inflammatory reaction or rate of CME were seen regardless of using a hydrophobic or a hydrophilic IOL. In general, an improvement in CDVA was seen after cataract surgery with both types of IOLs. Thus, the present study did not support either of the IOL materials as advantageous in patients with uveitis.

PURPOSE: To assess and compare the characteristics, therapy interventions, occurrence of uveitis and ocular complications in children with juvenile idiopathic arthritis (JIA) screened and examined for uveitis in Gothenburg, Sweden, over 20 years. Biological immunomodulatory treatment was increasingly used during the second half of the over 20 years.

METHODS: Data were retrospectively collected from children with JIA examined for uveitis at the Queen Silvia Children's Hospital between 2012 and 2021. These data were compared with those from a previously published study of children (the first cohort) screened between 2002 and 2011 in the same setting.

RESULTS: The first 10-year cohort (2002-2011) included 299 children, while the second cohort (2012-2021) included 253 children. The median age at JIA diagnosis was 5 years (range: 1-15 years) in both cohorts (p = 0.72), and girls were overrepresented in both groups, 68.9% and 72.7%, respectively (p = 0.32). Oligoarthritis was less frequent in the first cohort than in the second, 57.5% versus 73.9% (p < 0.001). The presence of anti-nuclear antibodies (ANAs) was similar between the cohorts, 57.6% versus 57.9% (p = 0.95). Uveitis occurred less frequently in the first cohort, 10.7% versus 17.0% in the second (p = 0.032). However, uveitis children had (not significantly) more ocular complications in the first cohort, 46.9% versus 34.9% in the second (p = 0.34) and complications were more often affecting both eyes, 73.3% versus 40.0% (p = 0.14). Systemic treatments, particularly biological immunomodulatory therapies, were less commonly used in the first cohort, 24.4% versus 42.7% in the second cohort (p < 0.001).

CONCLUSION: Over 20 years, we observed a higher occurrence of uveitis in children with JIA in the second 10-year cohort. However, despite being statistically insignificant, we found fewer ocular complications, and less frequent in both eyes. This may indicate a beneficial effect of the increased use of biological immunomodulatory therapy.

PURPOSE: To evaluate visual, anatomical and safety outcomes of aflibercept 8 mg in previously treated patients with neovascular age-related macular degeneration (nAMD).

METHODS: This retrospective study included nAMD patients switched to aflibercept 8 mg from prior anti-VEGF therapies at Sahlgrenska University Hospital between February 2024 and February 2025. Data on best-corrected visual acuity (BCVA), central retinal thickness (CRT), pigment epithelial detachment (PED) height, fluid status, treatment intervals, time to fluid recurrence and adverse events were collected.

RESULTS: 181 eyes (167 patients; mean age 80.4 ± 8.5 years; 67.7% female) were included, with a median follow-up of 12.9 weeks (range 4.1-48.1). A total of 415 injections were administered (mean 2.1 ± 1.5 per eye). BCVA remained stable (baseline 0.46 ± 0.31 logMAR; post-treatment 0.47 ± 0.37 logMAR; p = 0.18). CRT decreased significantly (-19.5 ± 47.2 μm; p < 0.001), as did PED height (-37.4 ± 68.4 μm; p < 0.001). Intraretinal fluid prevalence decreased from 34.3% to 19.3% (p < 0.001) and subretinal fluid from 53.0% to 33.7% (p < 0.001). The median maximal dry interval achieved was nine weeks, and analysis of interval extension showed a statistically significant mean increase of 1.27 ± 4.24 weeks overall (p = 0.0009), particularly in eyes dry at baseline. The median time to fluid recurrence among those with reactivation was ten weeks. Higher baseline CRT predicted greater CRT reduction (-44.1 μm per 100 μm increase; p < 0.001) but shorter dry intervals. Safety was favourable, with one case (0.6% per eye; 0.2% per injection) of mild anterior uveitis and no cases of intraocular pressure elevation.

CONCLUSIONS: Switching to aflibercept 8 mg led to stable vision, significant anatomical improvements, extended treatment intervals and a favourable short-term safety profile. Longer follow-up is warranted.

PURPOSE: To present a case of atypically located plasmacytoma recurrence with bilateral involvement of the optic nerves.

OBSERVATIONS: A 73-year-old man with diabetes, essential hypertension, and primary hypercholesterolemia presented to our clinic with subjective visual loss in his left eye. The patient had a previous history of solitary extramedullary plasmacytoma in the spinal cord, which was treated with resection surgery at the thoracic T6-T12 levels and curative radiotherapy two years prior. The ophthalmological examination indicated best-corrected visual acuity of 20/50 (0.4 logMAR) in both the right eye (OD) and left eye (OS). Intraocular pressure was normal and fundus examination of the eyes showed edema in the left optic nerve, but no other findings. Magnetic resonance imaging of the brain and orbits showed enhancement in both optic nerves, as in other parts of the central nervous system (CNS).

CONCLUSIONS AND IMPORTANCE: Plasmacytoma represents a rare form of plasma cell neoplasm. When the condition progresses and affects different sites within the CNS, it is essential to re-evaluate and exclude progression to multiple myeloma and/or other plasma cell neoplasms. Individuals diagnosed with plasmacytoma who complain of visual disturbances should undergo ophthalmologic evaluation.

PURPOSE: To evaluate the incidence and risk factors for secondary ocular hypertension (SOHT) following intravitreal dexamethasone implants (Ozurdex®) in patients with diabetic macular oedema (DME) and macular oedema secondary to retinal vein occlusion (RVO) in a Swedish cohort.

METHODS: This retrospective study included 309 eyes from 249 patients treated with Ozurdex® at Sahlgrenska University Hospital, Mölndal, Sweden, from 1 January 2016 to 31 December 2023. Electronic medical records were reviewed for data including patient demographics, number of injections, incidence of and treatment modalities for SOHT and rate of Ozurdex® discontinuation.

RESULTS: Of the 309 eyes, 217 (70.2%) were in the DME group and 92 (29.8%) in the RVO group. Overall, 117 eyes (37.9%) developed SOHT (intraocular pressure (IOP) ≥25 mmHg or a rise of ≥10 mmHg from baseline); this included 77 of 217 DME eyes (35.5%) and 40 of 92 RVO eyes (43.5%). Men were more than twice as likely as women to develop SOHT (adjusted odds ratio [aOR]: 2.53, p < 0.001). Each unit increase in baseline IOP was associated with an 8% increase in the odds of SOHT (aOR: 1.08 p = 0.025). Of all eyes, 30.5% received IOP-lowering treatment, primarily prostaglandins. None required invasive surgery.

CONCLUSION: Our finding that 30.5% of eyes received IOP-lowering treatment confirms that SOHT is a prevalent complication following intravitreal dexamethasone implants. Male gender and higher baseline IOP were key indicators for developing SOHT after Ozurdex® treatment, emphasizing the need for vigilant monitoring. Most cases were managed with IOP-lowering eye drops, indicating that while common, SOHT is typically manageable without invasive interventions.