OPTICAL COHERENCE TOMOGRAPHY
Sun
200 papers
Noninvasive Diagnosis Revealed a Strong Therapeutic Response and Skin Barrier Changes in Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains.
Chen K, Wu JZ, Hu YY … +6 more , Jiang Q, Xia YX, Chen J, Chen L, Chen LQ, Li DS
Skin Res Technol · 2026 Jun · PMID 42298918 · Full text
BACKGROUND: Noninvasive skin imaging, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), has been extensively used to collect objective clinical data and assess the morphological and ul...
BACKGROUND: Noninvasive skin imaging, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), has been extensively used to collect objective clinical data and assess the morphological and ultrastructural change of tissue. However, the application of these noninvasive diagnosis techniques for the therapeutic evaluation of hemoporfin-mediated photodynamic therapy (HMME-PDT) in port-wine stains (PWS) has rarely been reported. OBJECTIVES: To explore the clinical efficacy of HMME-PDT for PWS, and assess the application of RCM and OCT in objective assessment of the efficacy of HMME-PDT. METHODS: Clinical images, RCM findings, and OCT scans were used to evaluate the treatment efficacy. The vascular diameter and density under RCM findings, the vascular density, and depth of OCT scans were used for objective therapeutic evaluation. Skin surface roughness and barrier functions were used to analyze the skin barrier changes. RESULTS: After PDT treatment, the clinical pictures showed excellent improvements, and the RCM findings revealed significantly decreased vascular diameter (100.0 ±2.450 vs. 59.61± 4.021, p<0.05) and density (16.79 ± 0.6568 vs. 10.91 ± 0.8052) in treated areas. Moreover, the OCT scans further confirmed the decrease in vascular density and depth, and the skin surface roughness of Ra (arithmetic mean), Rz (the average depth of roughness), Rq (the mean square roughness) and the skin barrier function of transepidermal water loss (TEWL), stratum corneum hydration (SCH), and potential of hydrogen (pH) of these treated areas all were significantly changed (p < 0.05). CONCLUSIONS: HMME-PDT is an effective and safe treatment option for PWS patients, and noninvasive diagnosis combined with clinical images are excellent techniques for objectively evaluating efficacy of HMME-PDT.
Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention in multivessel coronary artery disease: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials.
Mohamed AA, Elhefnawy AM, Shehata AS … +6 more , Khalid S, Mostafa A, Ali A, Ibrahim B, Saeed TZ, Dibas M
BMC Cardiovasc Disord · 2026 Jun · PMID 42298423 · Full text
BACKGROUND: Percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease is associated with increased anatomical complexity and adverse cardiovascular outcomes. Conventional angiography p...
BACKGROUND: Percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease is associated with increased anatomical complexity and adverse cardiovascular outcomes. Conventional angiography provides limited assessment of vessel structure and plaque characteristics, whereas intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may improve procedural guidance. However, the clinical impact of imaging-guided PCI in this population remains uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing intravascular imaging-guided versus angiography-guided PCI in patients with multivessel coronary artery disease regarding major adverse cardiovascular events (MACE). Major databases were searched through December 2025. Outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models. Trial sequential analysis (TSA) and an exploratory network meta-analysis (NMA) were performed. RESULTS: Five randomized trials, including 3,023 patients, were analyzed. Imaging-guided PCI was associated with a significant reduction in MACE compared with angiography-guided PCI (RR 0.58, 95% CI 0.46 to 0.74; p < 0.0001; I = 9.8%). In subgroup analyses by imaging modality, IVUS-guided PCI was associated with a reduction in MACE (RR 0.53, 95% CI 0.39 to 0.73; p < 0.0001; I = 0%), as was OCT-guided PCI (RR 0.49, 95% CI 0.28 to 0.87; p = 0.014; I = 24.3%). TSA provided supportive evidence for a beneficial effect of imaging-guided PCI. NMA suggested that both IVUS and OCT were associated with improved outcomes compared with angiography, with no significant difference between the two imaging modalities. CONCLUSION: Intravascular imaging-guided PCI is associated with a reduction in MACE in patients with multivessel coronary artery disease. These findings support the clinical value of intravascular imaging in this population, with similar effects observed across imaging modalities.
Optical coherence tomography angiography in systemic sclerosis: from a microvascular signal to clinical utility.
Yamaguchi S, Yamamoto S, Saito R … +1 more , Ito H
Eur J Intern Med · 2026 Jun · PMID 42297694 · Publisher ↗
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Long-term prognostic impact of optical coherence tomography detected plaque rupture in nonculprit coronary segments.
Biccirè FG, Arbustini E, Ozaki Y … +16 more , Fabbiocchi F, Limbruno U, Gatto L, Romagnoli E, Kakizaki R, Preti G, Turturo M, Di Vito L, Cesaro A, Calabrò P, Alfonso F, Farcomeni A, Antuna P, Papafaklis MI, Räber L, Prati F
Atherosclerosis · 2026 Jun · PMID 42297530 · Publisher ↗
BACKGROUND AND AIMS: Atherosclerotic plaque rupture is largely acknowledged as the main mechanism of acute coronary syndrome. However, the prognostic significance of plaque rupture detected in nonculprit coronary sites r...
BACKGROUND AND AIMS: Atherosclerotic plaque rupture is largely acknowledged as the main mechanism of acute coronary syndrome. However, the prognostic significance of plaque rupture detected in nonculprit coronary sites remains largely unknown. METHODS: We investigated the long-term clinical outcomes of nonculprit plaque rupture detected by optical coherence tomography in the prospective CLIMA study. The primary composite endpoint was cardiac death or target-segment myocardial infarction (TS-MI) through 5-year follow-up. RESULTS: Among 1003 patients (age 64.8y; 24.6% women), nonculprit plaque rupture was observed in 7.3% of patients. Three-vessel disease, total plaque length, thin-cap fibroatheroma and large lipid arc were independently associated with nonculprit plaque rupture. The presence of nonculprit plaque rupture was associated with the primary endpoint at univariable (HR 2.09, 95%CI 1.07-4.08, p = 0.030) but not clinical (adjusted HR 1.70, 95%CI 0.83-3.48, p = 0.145) and morphological (adjusted HR 1.63, 95%CI 0.83-3.21, p = 0.156) multivariable analysis. The individual rates of cardiac death (HR 1.64, 95%CI 0.70-3.85, p = 0.252) and TS-MI (HR 2.87, 95%CI 0.97-8.47, p = 0.057) did not significantly differ between patients with vs without nonculprit plaque rupture. At the Kaplan-meier analysis, the presence of nonculprit plaque rupture was significantly associated with the primary endpoint only in presence of a thin-cap fibroatheroma (TCFA). The presence of nonculprit plaque rupture did not improve the predictive accuracy of any TCFA in multiple prediction models. CONCLUSIONS: Nonculprit plaque rupture was associated with cardiac events at univariable but not multivariable analysis. Identification of nonculprit PR did not improve the predictive value of established high-risk morphological features such as TCFA; however, future ad hoc studies are needed to further clarify its potential independent clinical relevance. CLINICAL TRIAL REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02883088.
Aqueous Humour Outflow Assessment Using Imaging-Based Techniques in Angle-Based Minimally Invasive Glaucoma Surgery (MIGS): A Systematic Review.
Ang BCH, Jin E, Yeo S … +3 more , Strohmaeir CA, Dada T, Huang AS
Clin Exp Ophthalmol · 2026 Jun · PMID 42297373 · Publisher ↗
BACKGROUND: The adoption of angle-based minimally invasive glaucoma surgery (MIGS) procedures has accelerated in recent years; however, inherent limitations remain. Imaging-based techniques across the pre-, intra- and po...
BACKGROUND: The adoption of angle-based minimally invasive glaucoma surgery (MIGS) procedures has accelerated in recent years; however, inherent limitations remain. Imaging-based techniques across the pre-, intra- and post-operative stages of surgery may facilitate patient selection and improve surgical outcomes. This systematic review explores the application of imaging-based techniques to visualise aqueous humour outflow (AHO) in angle-based MIGS. METHODS: A literature search was performed on PubMed, EMBASE and Cochrane Library from inception to 16 February 2025. Cohort, cross-sectional and observational studies reporting the use of imaging-based techniques to visualise AHO in angle-based MIGS were included in this review. RESULTS: An initial 393 studies were identified, with 21 studies included in final analysis. Imaging techniques reported in literature included various methods to directly observe episcleral veins, haemoglobin venous imaging (HVI), fluorescein and indocyanine green (ICG) aqueous angiography, channelogram and anterior segment optical coherence tomography angiography (AS-OCTA). Visualisation of AHO pre- and intra-operatively may predict surgical outcomes, aiding in patient selection and surgical prognostication. Intra-operative imaging may facilitate targeted placement of MIGS in areas of initially angiographically low or high areas of AHO. AHO assessment pre-, intra- and post-operatively may allow comparative analysis of surgical success and efficacy across various angle-based MIGS. CONCLUSIONS: Imaging-based techniques visualising AHO have significant potential to improve surgical outcomes of angle-based MIGS.
Analysis of Vessel Density and Foveal Avascular Zone in Proliferative Diabetic Retinopathy based on Internal Carotid Artery Stenosis Grade Using OCTA.
Lee CY, Yeom MI, Park JM … +1 more , Kim NG
Korean J Ophthalmol · 2026 Jun · PMID 42297365 · Publisher ↗
PURPOSE: This study investigates the relationship between retinal changes in proliferative diabetic retinopathy (PDR) patients and the severity of internal carotid artery (ICA) stenosis, using optical coherence tomograph...
PURPOSE: This study investigates the relationship between retinal changes in proliferative diabetic retinopathy (PDR) patients and the severity of internal carotid artery (ICA) stenosis, using optical coherence tomography angiography (OCTA). The goal is to explore potential correlations between ICA stenosis and specific retinal parameters, aiding in risk factor identification. METHODS: A retrospective analysis was conducted on 73 PDR patients (146 eyes), assessing carotid artery stenosis (CAS) severity via neck CT angiography and carotid doppler ultrasonography. Patients were divided into two groups based on ICA stenosis: normal to mild (Group I) and moderate or above (Group II). Retinal parameters, including the foveal avascular zone (FAZ) area and vessel density in both superficial and deep capillary plexuses, were analyzed using OCTA and Image J software. Statistical adjustments were made for age differences between the groups, and appropriate statistical methods were employed to account for the non-independence of eyes within the same patient and small sample size in Group II. RESULTS: The average age was 64.84±9.4 years. Group II patients were on average about 5 years older than Group I, and this age difference was significant. After adjusting for age, significant differences remained between the groups in macular vessel density of the superficial plexus and FAZ area, with Group II showing decreased vessel density and increased FAZ area in severe ICA stenosis cases. However, deep capillary plexus vessel density showed no significant variation. CONCLUSIONS: OCTA demonstrates that increased ICA stenosis in PDR patients correlates with decreased macular vessel density and expanded FAZ area, underscoring the need for carotid assessments. Early microvascular changes detectable by OCTA, even at mild NPDR stages, may indicate disease progression, positioning OCTA as a crucial non-invasive monitoring tool.
Performance of Deep Learning in Classifying Age-Related Macular Degeneration From Images: Systematic Review and Meta-Analysis.
Zhu Y, Niu Y, Sun S … +3 more , Liu W, Dou Y, Guo Y
J Med Internet Res · 2026 Jun · PMID 42296531 · Full text
BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of irreversible blindness worldwide. Retinal imaging and deep learning (DL) may support scalable screening, but deployment requires evidence on pooled...
BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of irreversible blindness worldwide. Retinal imaging and deep learning (DL) may support scalable screening, but deployment requires evidence on pooled performance. This is important because missed neovascular disease may delay treatment, whereas excessive false positives may overload referral pathways. OBJECTIVE: This study aimed to compare the diagnostic performance of DL algorithms with ophthalmologists for detecting AMD and differentiating wet AMD (wAMD) from dry AMD (dAMD) and to identify factors that influence DL performance. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched through October 5, 2025, and updated on April 19, 2026. Eligible studies applied DL to classify AMD from normal retinas or wAMD from dAMD using retinal images. Two reviewers (MHT and XL) independently extracted data and assessed risk of bias using the Prediction model Risk Of Bias Assessment Tool for Artificial Intelligence (PROBAST+AI) tool. Pooled sensitivity, specificity, accuracy, and area under the curve were estimated using bivariate random-effects models. Clinician comparisons were stratified by experience (junior vs senior). Small-study effects were assessed via Deeks' funnel plot asymmetry test. Evidence certainty was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251243276). RESULTS: Overall, 28 studies were included, comprising 77,485 samples for AMD detection and 28,705 samples for wAMD versus dAMD classification. For AMD detection, DL achieved a pooled sensitivity of 0.98 (95% CI 0.96-0.99; prediction interval [PI] 0.95-0.99), specificity of 0.98 (95% CI 0.95-0.99; PI 0.95-0.99), accuracy of 0.97 (95% CI 0.96-0.99), and area under the curve of 1.00 (95% CI 0.99-1.00). For wAMD versus dAMD, DL showed sensitivity of 0.95 (95% CI 0.91-0.97; PI 0.89-0.97), specificity of 0.95 (95% CI 0.93-0.97; PI 0.92-0.97), accuracy of 0.95 (95% CI 0.92-0.97), and area under the curve of 0.99 (95% CI 0.97-0.99). DL showed higher sensitivity than senior ophthalmologists for AMD (0.98 vs 0.75; P<.001) and higher specificity and accuracy than junior ophthalmologists for wAMD classification. Optical coherence tomography-based models performed more consistently than color fundus photography or multimodal models. Evidence certainty was moderate. CONCLUSIONS: Compared with ophthalmologists, DL algorithms demonstrated superior and more balanced diagnostic performance in the available head-to-head evidence, potentially providing a consistent decision-support baseline that mitigates human threshold-dependent trade-offs. However, high heterogeneity, wide PIs, predominantly retrospective designs, and possible performance inflation from internal validation mean that these relative performance findings remain preliminary rather than deployment ready. DL should be viewed as a triage adjunct requiring local calibration, not an autonomous diagnostic replacement. Prospective, multicenter, patient-level external validation with prespecified human comparison arms is required.
E2E-OCT: end-to-end joint learning model using optical coherence tomography images for vocal cord leukoplakia diagnosis.
Ban Y, Zhang Y, Li X … +3 more , Hong W, Yue S, Chen X
Opt Lett · 2026 Jun · PMID 42295933 · Publisher ↗
In our previous study, a home-built handheld OCT system was used to collect OCT images in vocal cord leukoplakia. First, 383 valid OCT images were collected from 12 patients with leukoplakia (including low-risk, high-ris...
In our previous study, a home-built handheld OCT system was used to collect OCT images in vocal cord leukoplakia. First, 383 valid OCT images were collected from 12 patients with leukoplakia (including low-risk, high-risk, and malignant types). The best overall accuracy and recall were 92.59% and 93.25% for low-risk, high-risk, and malignant classification, by random forest (RF) model using 5-fold validation. However, low-risk dysplasia with a sensitivity of 87.72% could not meet clinical requirements. Here, we proposed an end-to-end joint learning model using optical coherence tomography (E2E-OCT) images for vocal cord leukoplakia diagnosis. The overall accuracy and recall improved by 5.58% and 4.87%, and especially the sensitivity for low-risk dysplasia improved from 87.72% to 97.48%. Notably, under leave-one-patient-out (LOPO) cross-validation, the model also maintained 96.64% sensitivity for low-risk dysplasia. The ablation experiments and explanation experiments demonstrated the robustness of our model.
Community Optometrist-Led Monitoring of Quiescent Neovascular Age-Related Macular Degeneration: The FENETRE Randomized Clinical Trial.
Sharma A, Jaber A, Pal B … +22 more , Lawrenson JG, Harper RA, Tufail A, Learoyd AE, Robinson E, Douiri A, Burman R, Kernohan A, Vougioukalou S, Read S, Csontos J, Jones A, Mahmood S, McKibbin M, Peacock JL, Gale R, Patel PJ, Keane PA, Hamilton R, Vale L, Bunce C, Balaskas K
JAMA Netw Open · 2026 Jun · PMID 42295759 · Full text
IMPORTANCE: Hospital-based ophthalmology faces increasing demand for long-term monitoring of neovascular age-related macular degeneration (nAMD). Safe redistribution of routine monitoring to community clinicians is relev...
IMPORTANCE: Hospital-based ophthalmology faces increasing demand for long-term monitoring of neovascular age-related macular degeneration (nAMD). Safe redistribution of routine monitoring to community clinicians is relevant to integrated community (primary)-secondary care models. OBJECTIVE: To examine whether community optometrist-led monitoring of nAMD is noninferior to hospital-based monitoring for detecting disease activity requiring treatment. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, noninferiority randomized clinical trial was conducted from October 8, 2019, to January 31, 2024, at secondary centers (17 hospitals) and primary centers (60 community optometry practices) with 12-month follow-up. Statisticians were masked to patient grouping. Adults 55 years or older with quiescent AMD in at least 1 eye (and quiescent or nonneovascular disease in the other) were recruited at participating hospitals. Data analysis was performed from October 2024 to March 2025. INTERVENTIONS: Participants were randomized 1:1 to monitoring sessions once every 2 months in hospitals (control) or community practices (intervention). Trained and accredited optometrists performed optical coherence tomography imaging, clinical examination, patient management, and online reporting at each visit. MAIN OUTCOMES AND MEASURES: The primary outcome (participant level) was a binary indicator of whether a false-negative clinical management decision occurred at any visit within 12 months (missed quiescent nAMD reactivation or new fellow-eye nAMD, adjudicated by a central reading-center reference standard). The noninferiority margin was a 10-percentage point absolute risk difference. Secondary outcomes were false-positive clinical management decisions, attendance adherence, visual acuity change, harms, loss to follow-up, suspicious classifications, and confirmation visit outcomes. RESULTS: Of 704 randomized participants, 635 (90.2%) completed at least 1 follow-up visit, including 287 at community practices (mean [SD] age, 80.6 [8.1] years; 236 [67.4%] female) and 348 at hospitals (mean [SD] age, 80.1 [8.5] years; 203 [57.3%] female). False-negative clinical management decisions occurred in 11 of 287 community participants (3.8%) vs 27 of 348 hospital participants (7.8%) (risk difference, -3.9 percentage points; 95% CI, -7.4 to -0.3 percentage points; P = .04; adjusted odds ratio, 0.51; 95% CI, 0.24-1.07; P = .08), meeting noninferiority. False-positive clinical management decisions occurred in 24 of 287 community participants (8.4%) vs 12 of 348 hospital participants (3.5%) (risk difference, 4.9 percentage points; 95% CI, 0.9-9.0 percentage points). Findings were consistent across per-protocol, cluster-adjusted, and relative risk sensitivity analyses. No adverse event-related withdrawals occurred. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, community optometrist-led monitoring of quiescent nAMD was noninferior to hospital monitoring for detecting disease activity requiring treatment. These results provide evidence for its use in integrated clinical care models. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03893474.
An AI-Based OCT System to Detect Diabetic Macular Edema: A Prospective Validation and Noninferiority Randomized Clinical Trial.
Zhang S, Ran A, Zhou J … +46 more , Ling A, Sham K, Zhang Y, Tang Z, Nguyen TX, Yang D, Lam N, Yuen HKL, Chan VTT, Ho M, Chan JYY, Lam TCH, Yim CCL, Chow CWY, Cheung SSL, Lam MCW, Lai ACH, Wong CYK, Yu AHY, Hui VWK, Mak ACY, Li SL, Chan NCY, Yip WWK, Young AL, Ozaki R, Loo KM, Luk AOY, Chan JCN, Chan P, Luk MMH, Lai LKP, Wong DHT, Shiu J, Wang X, Heng PA, Lin H, Sivaprasad S, Wong TY, Li KKW, Chan CKM, Pang CP, Tham CC, Lai TYY, Szeto SKH, Cheung CY
JAMA · 2026 Jun · PMID 42295755 · Full text
IMPORTANCE: Screening for diabetic retinopathy using fundus photographs is the global standard of care but results in high false-positive referrals to evaluate diabetic macular edema (DME), placing a substantial burden o...
IMPORTANCE: Screening for diabetic retinopathy using fundus photographs is the global standard of care but results in high false-positive referrals to evaluate diabetic macular edema (DME), placing a substantial burden on specialist eye clinics. Integrating an AI-based optical coherence tomography (AI-OCT) system into screening pathways may reduce potentially unnecessary referrals. OBJECTIVE: To evaluate the diagnostic and referral performance of an AI-OCT system for DME detection within a diabetic retinopathy screening pathway in clinical settings. DESIGN, SETTING, AND PARTICIPANTS: Stepwise evaluation conducted in Hong Kong Special Administrative Region: a prospective silent-mode validation (February 2020 to July 2023) recruiting 603 patients with diabetes at a tertiary hospital triage unit, followed by a multicenter noninferiority RCT (September 2023 to April 2025), with follow-up completed in May 2025, recruiting 276 patients with suspected DME referred from a territory-wide diabetic retinopathy screening program. INTERVENTIONS: RCT participants were randomized to intervention (referral for DME evaluation based on both fundus photograph-based screening reports and AI-OCT reports [n = 137]) or control (automatic referral based solely on fundus photograph-based screening reports [n = 139]) groups. The AI-OCT system incorporated image-quality assessment, DME detection, and uncertainty flagging. Study outcomes focused on referral rates under the 2 pathways; for ethical reasons, all participants ultimately underwent specialist evaluation. MAIN OUTCOMES AND MEASURES: The primary outcome was false-positive DME referral rate, with a prespecified noninferiority margin of 20%. The secondary outcomes included sensitivity and specificity for DME detection and DME referral. RESULTS: In prospective silent-mode validation (mean age, 64.7 [SD, 9.4] years; 56.2% male), 86 of 1200 scans (7.2%) were identified as ungradable and 49 of 1114 gradable scans (4.4%) were classified as uncertain. The system achieved 98.8% (95% CI, 94.5%-100.0%) sensitivity and 90.7% (95% CI, 88.7%-92.4%) specificity for DME detection. In the RCT (mean age, 63.9 [SD, 10.9] years; 54.7% male), DME prevalence was similar in the intervention and control groups (30.9% vs 29.9%). The false-positive DME referral rate was 24.1% (95% CI, 14.6%-37.0%) and 69.1% (95% CI, 61.0%-76.1%), respectively (absolute difference, -45% [95% CI, -58.2% to -31.9%; P < .001 for noninferiority]; upper bound of the CI below the prespecified noninferiority margin of 20%). Sensitivity for DME referral was 100.0% (95% CI, 100.0%-100.0%) in both groups. Specificity for DME referral was 86.5% (95% CI, 79.3%-92.9%) in the intervention group and 0.0% (95% CI, 0.0%-0.0%) in the control group. No cases of DME occurred among nonreferred participants in the intervention group. CONCLUSIONS AND RELEVANCE: Compared with standard practice, incorporation of the AI-OCT system as a secondary screening tool was noninferior with respect to false-positive referral rates and was associated with a substantial reduction in potentially unnecessary DME referrals without compromising sensitivity. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2300075087.
Serous Maculopathy due to Aspecific Choroidopathy (SMACH): a case report with differential diagnosis based on multimodal imaging analysis.
Ren X, Yu X, Huang S … +3 more , Qi X, Wang S, Sun Y
Doc Ophthalmol · 2026 Jun · PMID 42295499 · Publisher ↗
BACKGROUND: Serous Maculopathy Due to Aspecific Choroidopathy (SMACH) is a rare chorioretinal disease characterized by polymorphic, non-pigmented choroidal lesions, with or without subretinal fluid (SRF). Its clinical ma...
BACKGROUND: Serous Maculopathy Due to Aspecific Choroidopathy (SMACH) is a rare chorioretinal disease characterized by polymorphic, non-pigmented choroidal lesions, with or without subretinal fluid (SRF). Its clinical manifestations overlap with common conditions such as central serous chorioretinopathy (CSC) and age-related macular degeneration (AMD), leading to a high risk of misdiagnosis, particularly in elderly patients. Multimodal imaging, including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein fundus angiography (FFA), and indocyanine green angiography (ICGA), is critical for accurate diagnosis. CASE PRESENTATION: A 76-year-old Asian female presented with a 6-month history of blurred vision in her left eye. Ophthalmic examination revealed multiple yellowish-white subretinal lesions with mild elevation in the posterior pole of the left eye. OCT and OCTA demonstrated hyperreflective fibrinous exudates between the retinal pigment epithelium (RPE) and Bruch's membrane, choroidal thickening, and outer retinal damage. Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) provided complementary findings consistent with choroidal dysfunction and blood-retinal barrier disruption. Systemic evaluations, including laboratory tests for rheumatological immune indicators, tuberculin test, syphilis serology, and imaging examinations, excluded other systemic diseases. Based on these multimodal imaging findings and exclusion of alternative diagnoses, the patient was diagnosed with SMACH. CONCLUSIONS: This case report describes a typical presentation of SMACH in an elderly patient, emphasizing that multimodal imaging, as demonstrated in this case, can help identify characteristic features of SMACH (choroidal thickening, hyperreflective exudates), though its diagnostic reliability in larger populations requires further validation.The exclusion of systemic diseases and differentiation from similar chorioretinal disorders (e.g., CSC, AMD) are crucial for accurate diagnosis.This case adds to the existing limited data on SMACH in elderly populations and further supports the role of multimodal imaging in improving diagnostic accuracy to reduce misdiagnosis.
Peripheral Degenerative Retinoschisis: Imaging Evidence for Two Distinct Structural Configurations.
Spaide RF
Retina · 2026 Jun · PMID 42295052 · Publisher ↗
PURPOSE: To characterize vitreoretinal architecture in peripheral degenerative retinoschisis using high-resolution swept-source optical coherence tomography and to distinguish two morphologically and potentially mechanis...
PURPOSE: To characterize vitreoretinal architecture in peripheral degenerative retinoschisis using high-resolution swept-source optical coherence tomography and to distinguish two morphologically and potentially mechanistically distinct forms of retinoschisis. METHODS: This retrospective imaging study evaluated eyes with peripheral degenerative retinoschisis using swept-source optical coherence tomography with extended dynamic-range processing and volume rendering. Retinoschisis was categorized as columnar retinoschisis, with residual intraretinal tissue columns, or bullous retinoschisis, with a large intraretinal cavity. Anatomical features were assessed descriptively and interpreted in the context of retinal physiology. RESULTS: Nineteen eyes of eleven patients were analyzed. All eyes demonstrated regions of columnar retinoschisis, and thirteen eyes also showed bullous retinoschisis. Vitreoschisis was identified only in eyes with bullous retinoschisis. Imaging commonly showed adherent cortical vitreous overlying schitic regions, with adjacent vitreous liquefaction, a configuration inconsistent with sustained traction as the sole explanation for the schisis cavity. Columnar retinoschisis was associated with limited separation between retinal layers and was typically contiguous with bullous schisis, which showed substantially greater intraretinal cavity height. CONCLUSIONS: These findings support the distinction between columnar and bullous retinoschisis as separate morphologic entities. While vitreous traction may contribute to initiation of retinoschisis, progression to bullous schisis may involve additional mechanisms. Loss of Müller cell columns may remove both a structural element that limits expansion of the schisis cavity and a pathway for intraretinal fluid regulation through the deep capillary plexus, allowing metabolic water production to contribute to cavity enlargement in the absence of sustained mechanical forces.
Secondary Myxomatous Corneal Degeneration: Two Cases With Histopathologic Diagnosis and a Systematic Review Supporting Conservative Management.
Dhillon J, Abdelghaffar M, Sriranganathan A … +2 more , Farmer J, Al-Kaabi A
Cornea · 2026 Jun · PMID 42294845 · Publisher ↗
PURPOSE: Myxomatous corneal degeneration is a rare, often misdiagnosed lesion miming other corneal pathologies. We report 2 cases of secondary corneal myxomatous degeneration, along with systematic review of literature h...
PURPOSE: Myxomatous corneal degeneration is a rare, often misdiagnosed lesion miming other corneal pathologies. We report 2 cases of secondary corneal myxomatous degeneration, along with systematic review of literature highlighting all reported cases of corneal myxomas. METHODS: Two cases were reported. A comprehensive search for corneal myxomatous degeneration in PubMed, Embase, Web of Science, and Scopus was conducted until December 2025. RESULTS: A 65-year-old man with history of bullous keratopathy presented with long-standing unilateral progressive corneal opacity and hand-motion vision. Anterior segment optical coherence tomography revealed a 600-μm thick subepithelial lesion. A 37-year-old male patient with suspected prior foreign body trauma also presented with a unilateral progressive conjunctival-corneal lesion and no light perception vision. Examination and anterior segment optical coherence tomography revealed a conjunctivalized fibrovascular growth with associated corneal surface irregularity. Both patients underwent superficial keratectomy with adjunctive mitomycin C, and no subsequent recurrence. Histopathological analysis demonstrated findings consistent with secondary myxomatous degeneration. The systematic review identified 20 studies of 35 patients. Most lesions were secondary to developmental anomalies, trauma, surgery, or corneal disease, whereas ∼23% were primary. Presentations commonly included decreased vision, high intraocular pressure, or progressive opacification, with lesions typically appearing as whitish or gelatinous elevations and managed through excision or keratoplasty. CONCLUSIONS: The current cases add to the spectrum of secondary corneal myxomatous degeneration, ranging from chronic degenerative to posttraumatic reactive process. Recognition of this entity is important as lesions can be successfully managed with superficial keratectomy and adjunctive mitomycin C rather than more invasive penetrating keratoplasty.
Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation.
Mochizuki J, Matsumura M, Suzuki M … +4 more , Misawa S, Matsumi H, Kawada K, Hata Y
Radiol Case Rep · 2026 Sep · PMID 42293499 · Full text
Calcified nodules are a form of coronary calcification associated with acute coronary syndrome and adverse outcomes after percutaneous coronary intervention. We report 2 cases in which noninvasive high-resolution coronar...
Calcified nodules are a form of coronary calcification associated with acute coronary syndrome and adverse outcomes after percutaneous coronary intervention. We report 2 cases in which noninvasive high-resolution coronary computed tomography (CT) suggested calcified nodules later corroborated by intravascular optical coherence tomography. In case 1, CT demonstrated a protruding calcified focus in the right coronary artery with lower attenuation than adjacent calcification. In case 2, CT showed a small nodular lesion in the proximal left circumflex artery with a similar attenuation pattern. In both cases, the CT findings prompted a calcium-modification strategy and directly informed procedural planning. High-resolution coronary CT may therefore enable noninvasive recognition of calcified nodules with direct implications for preprocedural strategy selection; however, further studies are needed.
Neuro-ophthalmic complications of tuberculosis and its treatment: a systematic review and meta-analysis.
Alessa AA, Awan AZ, Almutairi AB … +4 more , Ajabnoor IG, Jan MMM, Azzam AY, Badeeb N
Front Ophthalmol (Lausanne) · 2026 · PMID 42293031 · Full text
INTRODUCTION: Tuberculosis (TB) and its treatment have been associated with significant neuro-ophthalmic morbidity; however, the magnitude and determinants of these complications remain incompletely characterized. This s...
INTRODUCTION: Tuberculosis (TB) and its treatment have been associated with significant neuro-ophthalmic morbidity; however, the magnitude and determinants of these complications remain incompletely characterized. This systematic review and meta-analysis aimed to evaluate the incidence and risk factors of ethambutol optic neuropathy (EON), neuro-ophthalmic manifestations of tuberculous meningitis (TBM), and prognostic biomarkers for visual outcomes. METHODS: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar up to the 30th of September 2025. Studies reporting EON incidence, TBM neuro-ophthalmic complications, or subclinical neurotoxicity biomarkers were included. Random-effects meta-analysis with generalized linear mixed models was performed. RESULTS: Twenty-two studies (N = 260,430) were included. Pooled EON incidence was 1.54% (95% CI: 0.81-2.49%, I²=98.2%). Renal impairment (OR 3.73, 95% CI: 1.78-7.83) and hypertension (OR 2.37, 95% CI: 1.46-3.84) were significant risk factors. TBM neuro-ophthalmic manifestations included cranial nerve III palsy (17.4%), papilledema (12.5%), and optic atrophy (16.7%), with pediatric patients demonstrated significantly higher hydrocephalus rates (72.5% vs 13.0%, RR 5.56). Visual evoked potential (VEP) demonstrated better detection of subclinical changes over optical coherence tomography (OCT) (Hedges' g difference: 0.686, P-value = 0.001). Visual recovery occurred in 52.4% of clinical EON cases. Factors associated with improved recovery included younger age (MD= -3.8 years, P-value= 0.095) and earlier ethambutol discontinuation. CONCLUSIONS: TB-related neuro-ophthalmic complications represent significant morbidity with identifiable risk factors. Visual evoked potentials offer superior subclinical detection and early intervention improves visual outcomes. Screening protocols targeting high-risk populations are recommended. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251141453.
Visual and Neuro-Ophthalmic Manifestations of John Cunningham (JC) Virus-Related Natalizumab-Associated Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Systematic Review.
Jangirashvili T, Parthiv O, Shengelia L … +4 more , Tabeshadze Z, Kontchoshvili A, Waked CA, Tamer RM
Cureus · 2026 Jun · PMID 42292715 · Full text
Natalizumab (Tysabri®; Biogen, Cambridge, Massachusetts), a recombinant humanized monoclonal antibody targeting the α4-integrin subunit, is among the most efficacious approved therapies for relapsing-remitting multiple s...
Natalizumab (Tysabri®; Biogen, Cambridge, Massachusetts), a recombinant humanized monoclonal antibody targeting the α4-integrin subunit, is among the most efficacious approved therapies for relapsing-remitting multiple sclerosis (RRMS). Its principal serious adverse effect is progressive multifocal leukoencephalopathy (PML), an opportunistic demyelinating encephalitis caused by reactivation of the John Cunningham (JC) polyomavirus (JCPyV). Despite the established clinical significance of this complication, its visual and neuro-ophthalmic dimensions have not been systematically synthesized. To provide a comprehensive, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of the spectrum, prevalence, anatomical substrates, and clinical significance of visual and neuro-ophthalmic manifestations in natalizumab-associated PML, and to synthesize available evidence on risk stratification, magnetic resonance imaging (MRI) correlates, immune reconstitution inflammatory syndrome (IRIS), and long-term functional outcomes. A systematic literature search was conducted across PubMed/MEDLINE, ScienceDirect, Google Scholar, and ResearchGate (January 2012 to April 2025) in accordance with PRISMA 2020 guidelines. Medical Subject Headings (MeSH) and structured free-text keyword strategies were applied. Eligibility criteria, data extraction, and quality appraisal were predefined. Thirty-five studies were included: 20 observational cohorts or case series, seven systematic reviews or meta-analyses, and eight narrative reviews with extractable data. To prevent double-counting, quantitative outcome data were extracted exclusively from primary observational studies; reviews contributed contextual synthesis only. Neuro-ophthalmic involvement was documented in 20-50% of natalizumab-associated PML patients across the included studies. Homonymous hemianopia was the most prevalent overt manifestation, arising from lytic demyelination of the optic radiations; occipital lobe involvement was recorded in 20% of cases in the largest dedicated MRI distribution dataset. Visual symptoms constituted the initial presentation in up to 25% of affected individuals. Subclinical visual field deficits were identified in 17.4% of post-PML survivors by formal perimetry in the absence of spontaneous visual complaint. Asymptomatic MRI-detected PML was associated with a modified Rankin scale score of two or below at follow-up in 64% of patients, compared with 34% among those diagnosed after symptom onset (p = 0.012). IRIS developed in 57-69% of patients following natalizumab withdrawal; neuropathological analysis confirmed a hyper-inflammatory response characterized by CD138-positive plasma cell density approximately 125 times that of standard multiple sclerosis plaques. Visual pathway compromise is a frequent and clinically underrecognized dimension of natalizumab-associated PML. Structured neuro-ophthalmic evaluation, encompassing formal perimetry, visual evoked potential recording, and optical coherence tomography, should be incorporated into surveillance protocols for high-risk patients. These tools provide functional evidence of visual pathway involvement during the diagnostic window when cerebrospinal fluid (CSF) JCPyV polymerase chain reaction (PCR) yields false-negative results owing to small lesion volumes. Prospective studies designed to evaluate visual pathway outcomes in this population are needed.
Scleral Transillumination-Guided Trocar Placement During Vitrectomy in Highly Myopic Eyes: A Case Report.
Takagi K, Ohtani H, Ida C … +2 more , Sugihara K, Tanito M
Cureus · 2026 Jun · PMID 42292714 · Full text
High myopia can make pars plana vitrectomy technically challenging because axial elongation may increase the distance between the conventional trocar insertion site and the posterior pole. Accordingly, more posterior tro...
High myopia can make pars plana vitrectomy technically challenging because axial elongation may increase the distance between the conventional trocar insertion site and the posterior pole. Accordingly, more posterior trocar placement has been proposed to improve access of vitreoretinal instruments to the retinal surface. We report two myopic eyes in which scleral transillumination was used intraoperatively to assess the posterior edge of the ciliary body and to guide trocar placement when needed. Case 1 underwent surgery for a macular hole, and Case 2 underwent surgery for macular hole retinal detachment. In both cases, involving the right eye, an intraocular light pipe was inserted through the superonasal trocar and directed toward the superotemporal sclera under reduced room and microscope illumination. The resulting transillumination boundary was marked externally. In Case 1, the trocar was placed at the conventional insertion site, and scleral transillumination was performed intraoperatively to assess the relationship between the transillumination boundary and the ciliary body. The boundary was located approximately 6 mm posterior to the corneal limbus, and intraoperative indentation confirmed that it corresponded to the posterior edge of the ciliary body. Postoperative anterior segment optical coherence tomography (AS-OCT) showed a ciliary body length of around 6.6 mm. In Case 2, scleral transillumination was used to guide trocar placement. The initial illumination border was observed approximately 6 mm posterior to the limbus and was used as a reference for trocar insertion. However, further peripheral observation revealed an additional posterior dark band approximately 9 mm from the limbus. External marking and indentation of this band corresponded to the posterior edge of the ciliary body, and postoperative AS-OCT showed a ciliary body length of around 9.9 mm. These preliminary observations from two highly myopic eyes suggest that scleral transillumination may be a useful intraoperative method for estimating the posterior edge of the ciliary body and guiding trocar placement. In Case 2, the initial transillumination boundary was located anterior to an additional peripheral dark band, which appeared to correspond more closely to the actual posterior edge of the ciliary body. Nevertheless, for practical vitrectomy, the anterior illumination boundary provided a sufficiently posterior and safe landmark for trocar placement. This technique should be considered selectively in highly myopic eyes with axial elongation rather than in eyes with normal or short axial length. Further studies are needed to determine the generalizability of these findings.
Managing Myopic Glaucoma-Beyond Structural Fragility and Diagnostic Challenges: Review Article.
Diniz CK, Meira MA, Gondim LA … +6 more , Dorairaj S, Lemos MB, Kanadani FN, Graciatelli CP, Paranhos A, Prata TS
J Curr Glaucoma Pract · 2026 · PMID 42292676 · Full text
AIMS AND BACKGROUND: Myopic glaucoma is a distinct subtype of glaucomatous optic neuropathy that is often underrecognized or misdiagnosed, particularly in younger patients whose intraocular pressures (IOP) fall within st...
AIMS AND BACKGROUND: Myopic glaucoma is a distinct subtype of glaucomatous optic neuropathy that is often underrecognized or misdiagnosed, particularly in younger patients whose intraocular pressures (IOP) fall within statistically normal ranges. High myopia presents complex structural, functional, and biomechanical challenges that hinder both early detection and effective disease management.This review summarizes current evidence on the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, providing a practical clinical framework for improved management. MATERIALS AND METHODS: This narrative review synthesizes current evidence from peer-reviewed clinical and basic science studies on myopic glaucoma. Drawing on a comprehensive literature search, it addresses the pathophysiology, clinical presentation, diagnostic limitations, and tailored therapeutic strategies for myopic glaucoma, with the aim of establishing a clinically relevant framework to inform optimized management. RESULTS: The global prevalence of myopia is increasing, with high myopia substantially elevating the risk of glaucoma, particularly among Asian populations. Structural alterations-including axial elongation, scleral thinning, lamina cribrosa deformation, and optic nerve head tilting-augment biomechanical vulnerability to glaucomatous damage, even when IOP remains within normal limits.Myopic glaucoma is often characterized by tilted optic discs, peripapillary atrophy, and early paracentral visual field defects, which may not be detected by standard perimetric methods. Diagnosis is complicated by the limitations of optical coherence tomography (OCT), including segmentation errors and the lack of normative databases specific to myopic eyes. Moreover, disease progression may occur even with low IOP, and distinguishing glaucomatous damage from myopia-induced structural changes remains a significant challenge. Recent advances, such as the identification of the crescent moon sign, implementation of 10-2 visual field testing, and use of biomechanically compensated tonometry, have improved diagnostic accuracy.Management requires lower IOP targets due to increased structural fragility, often necessitating combined medical therapy or early surgical intervention. However, surgery in young highly myopic patients carries a heightened risk of hypotony maculopathy.Emerging technologies, including artificial intelligence (AI)-based algorithms and widefield optical coherence tomography angiography (WF-OCTA), enhance diagnostic precision by addressing anatomical distortions and facilitating the early detection of glaucomatous changes. CONCLUSION AND CLINICAL SIGNIFICANCE: Early identification and tailored management of myopic glaucoma are crucial to mitigate vision loss in this high-risk population. Awareness of the unique challenges posed by high myopia, combined with emerging diagnostic and therapeutic approaches, can improve patient outcome and reduce the burden of undiagnosed disease. HOW TO CITE THIS ARTICLE: Diniz CK, Meira MA, Gondim LAVAS, Managing Myopic Glaucoma-Beyond Structural Fragility and Diagnostic Challenges: Review Article. J Curr Glaucoma Pract 2026;20(1):20-25.
Glaucoma and Systemic Neurodegenerative Diseases: The Brain-Eye Continuum.
Singh P, Karkhur S, Verma V … +2 more , Gupta S, Beri A
J Curr Glaucoma Pract · 2026 · PMID 42292675 · Full text
UNLABELLED: Glaucoma is a chronic, progressive optic neuropathy characterized by retinal ganglion cell (RGC) death and visual field loss. It is the leading cause of irreversible blindness globally, affecting more than 70...
UNLABELLED: Glaucoma is a chronic, progressive optic neuropathy characterized by retinal ganglion cell (RGC) death and visual field loss. It is the leading cause of irreversible blindness globally, affecting more than 70 million people, and its prevalence is expected to rise with aging populations. Traditionally, glaucoma was defined primarily as a disease of intraocular pressure (IOP) dysregulation, but recent decades have reframed it as a complex neurodegenerative disorder involving multiple systemic and local risk factors. In parallel, systemic neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS) pose immense healthcare and socioeconomic burdens. The concept of the "eye as a window to the brain" arises from the fact that the retina and optic nerve are direct extensions of the central nervous system (CNS). This has positioned the eye as a valuable site for studying neurodegenerative processes noninvasively, using advanced imaging modalities such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Glaucoma is a chronic neurodegenerative optic neuropathy, and the concept of the "eye as a window to the brain" highlights its overlap with systemic diseases such as AD, PD, and MS. HOW TO CITE THIS ARTICLE: Singh P, Karkhur S, Verma V, Glaucoma and Systemic Neurodegenerative Diseases: The Brain-Eye Continuum. J Curr Glaucoma Pract 2026;20(1):26-30.
Occult Retinal Abnormalities Detected by Routine Optical Coherence Tomography in Comprehensive Eye Examination: A Clinic Dataset.
Yau Z, Sum RWM, Lam AKC
Clin Optom (Auckl) · 2026 · PMID 42292552 · Full text
PURPOSE: Optical coherence tomography (OCT) is a widely utilized ophthalmic imaging technique commonly used in clinical practice. The axial resolution of modern commercial OCT devices is at the micron level, facilitating...
PURPOSE: Optical coherence tomography (OCT) is a widely utilized ophthalmic imaging technique commonly used in clinical practice. The axial resolution of modern commercial OCT devices is at the micron level, facilitating the detection of retinal problems that may be unable to be detected in conventional dilated fundus examination (DFE). We evaluated the efficacy of integrating OCT as a routine ophthalmic procedure for identifying occult retinal abnormalities using a university clinical dataset. METHODS: The University Optometry Clinic initiated routine OCT screening as part of comprehensive eye examinations at no additional cost in summer 2025. An ophthalmic assistant captured OCT images of patients aged 40 years or older under natural pupils before the optometrist consultation. A retrospective analysis was conducted based on these OCT images acquired with a concurrent review of electronic medical records. RESULTS: Overall, 1398 patients underwent routine OCT examinations in two months. Thirty-two patients were excluded because of bilateral suboptimal image quality attributed to undilated pupils. The three most common occult retinal abnormalities not identified by conventional DFE but revealed by OCT were partial posterior vitreous detachment (81 patients, 5.9%), epiretinal membrane, ERM (46 patients, 3.4%), and peripapillary intrachoroidal cavitation (43 patients, 3.1%). Other abnormalities identified by OCT included pigment epithelial detachment, thin retinal nerve fiber layer, focal choroidal excavation (FCE), and idiopathic central serous chorioretinopathy (ICSC). A more serious abnormality included lamellar holes. Patients with ERM (p < 0.001) and lamellar hole (p < 0.001) were older than those without. FCE (p = 0.003) and ICSC (p = 0.009) were more commonly occurred in male. CONCLUSION: Some occult retinal abnormalities were identified using OCT alone, but not discernible by conventional DFE. These mild abnormalities were unlikely to have serious consequence which may not affect clinical management. OCT examination might not be regarded as a necessary routine procedure.
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