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200 papers
Early-Onset Retinal Dystrophy in Alpha-Mannosidosis: A Case Report.
Almhmoudi F, Bamusa A, Alrashid A … +2 more , Khalid A Alomari B, Alselami GI
Case Rep Ophthalmol · 2026 · PMID 42282242 · Full text
INTRODUCTION: Alpha-mannosidosis is a rare inherited lysosomal storage disorder characterized by immune deficiency, intellectual disability, hearing loss, and skeletal and facial dysmorphism. It results from biallelic pa...
INTRODUCTION: Alpha-mannosidosis is a rare inherited lysosomal storage disorder characterized by immune deficiency, intellectual disability, hearing loss, and skeletal and facial dysmorphism. It results from biallelic pathogenic variants in on chromosome 19. Ophthalmic manifestations previously described in alpha-mannosidosis include corneal opacities, lenticular changes, wheel-like cataracts, and strabismus. Although a few reports have documented retinal dystrophy in affected individuals, these cases have typically occurred later in life, between the fourth and sixth decades. CASE PRESENTATION: We report a 17-year-old female with genetically confirmed alpha-mannosidosis who presented with decreased visual function. Ophthalmic evaluation revealed bilateral optic nerve atrophy, peripapillary hyperpigmentation, salt-and-pepper retinopathy, and optic coherence tomography evidence of photoreceptor disruption. Fundus imaging demonstrated tilted discs and generalized pallor. These features are consistent with early-onset retinal dystrophy. CONCLUSION: This case represents one of the youngest reported patients with alpha-mannosidosis and retinal dystrophy. Our findings underscore the importance of routine ophthalmologic surveillance, including optical coherence tomography, ERG, and dilated fundus examination, to facilitate early detection, guide family counseling, and optimize visual outcomes.
Query-Driven Retinal Layer Segmentation in OCT Using Cross-Attentive Feature Learning.
Sobahi N, Özçelik STA, Atila O … +2 more , Sengur A, Akpınar MH
Diagnostics (Basel) · 2026 May · PMID 42279565 · Full text
: Retinal layer segmentation in optical coherence tomography (OCT) is essential for the diagnosis and monitoring of retinal diseases such as age-related macular degeneration (AMD) and diabetic macular edema (DME). Althou...
: Retinal layer segmentation in optical coherence tomography (OCT) is essential for the diagnosis and monitoring of retinal diseases such as age-related macular degeneration (AMD) and diabetic macular edema (DME). Although deep learning methods have achieved strong performance, most rely on dense pixel-wise predictions and often struggle to preserve anatomical consistency, particularly in regions with low contrast or structural deformation. This study aims to address these limitations by introducing a query-based segmentation framework that explicitly models retinal layer structure. : In this paper, we propose the RetiQueryNet architecture that employs encoding of retinal layers in the form of query embeddings with the use of cross attention to interact with pixel level features encoded by a transformer based encoder. The architecture integrates multi-scale features through a compact query-driven decoder with modest additional computational overhead. Normalization and resizing of OCT images preceded their usage as inputs, while the layer labels were converted to multi-class segmentation maps. In the training process, we used loss function with combination of cross entropy loss and Dice loss. Our model performance was compared with multiple state-of-the-art models such as U-Net, DeepLabV3, FPN, MANet and SegFormer, while performance metrics were Dice, IoU and mean surface distance (MSD). : RetiQueryNet was able to attain a mean Dice score of 0.934 ± 0.0046 and outperformed all baseline models on the main performance measures. Improvements were particularly evident in challenging retinal layers such as IBRPE and OBRPE, where boundary ambiguity is high. It should be noted that RetiQueryNet had a relatively lower MSD value, meaning that the predicted boundaries were more accurate. Furthermore, visual observations suggest that the approach generated smooth and coherent segmentations. : The findings demonstrate that query-based modeling offers a viable approach to pixel-wise segmentation. In particular, by making use of structural priors in the form of learnable queries, RetiQueryNet improves not only segmentation accuracy but also anatomical consistency. Query-based modeling appears to be an exciting area for retinal image segmentation that could potentially be applied to other applications in medical image segmentation.
Volumetric Imaging of Ex Vivo Oral Mucosa Specimens with Multi-Scale Wide Field-of-View Optical Coherence Tomography/Microscopy in Near-Infrared-II Window.
Chueh CB, Cheng SJ, Ko HH … +3 more , Tu MC, Chen TH, Lee HC
Diagnostics (Basel) · 2026 May · PMID 42279549 · Full text
Intraoperative margin assessments of oral squamous cell carcinoma (SCC) are fundamentally limited by sampling errors and freezing artifacts inherent to standard frozen section analysis. We developed a mobile, multi-scale...
Intraoperative margin assessments of oral squamous cell carcinoma (SCC) are fundamentally limited by sampling errors and freezing artifacts inherent to standard frozen section analysis. We developed a mobile, multi-scale, wide field-of-view (FOV) swept-source optical coherence tomography/microscopy (SS-OCT/OCM) system operating in the Near-Infrared-II (NIR-II) window (1.68 μm) to provide a rapid, non-destructive, volumetric evaluation of excised oral mucosal tissues. To correlate optical images with histopathology, we engineered a custom 3D-printed tissue cassette that physically mitigates macroscopic shrinkage during scanning and subsequent tissue fixation. A three-axis motorized assembly extends the effective imaging FOV without compromising resolution, while a custom 3D multi-resolution pyramid stitching algorithm synthesizes wide-FOV mosaics. The customized cassette enabled precise, one-to-one spatial correlation between optical volumes and histopathology sections. Crucially, a 3 × 3 mosaic scan acquired with a 10× objective balanced imaging resolution and acquisition time, providing sufficient structural clarity to visualize basement membrane loss-a hallmark of SCC invasion. This 1.68 μm, fully automatic, multiscale SS-OCT/OCM platform demonstrates the feasibility of serving as a rapid, three-dimensional imaging tool for potential future use as an adjunct to conventional frozen sections.
Fine Tuning RETFound with Clinically Guided Foveal ROI for Automated DRIL Classification in Diabetic Macular Edema OCT.
Chakrapani PK, Kumar P, Bhandary SV … +3 more , Maiya G, Shenoy S, Fernandes S
Diagnostics (Basel) · 2026 May · PMID 42279522 · Full text
: Disorganization of retinal inner layers (DRIL) is an important and supportive biomarker in optical coherence tomography (OCT) imaging for diagnosing the extent of diabetic macular edema (DME) in patients and anticipati...
: Disorganization of retinal inner layers (DRIL) is an important and supportive biomarker in optical coherence tomography (OCT) imaging for diagnosing the extent of diabetic macular edema (DME) in patients and anticipating visual outcomes. But the manual DRIL identification is subject to interobserver bias and requires a lot of time and effort from the experts. This research presents a novel, computerized, and clinically guided approach for the classification of DRIL that leverages the central 1 mm foveal region extracted through the annotations provided by the expert ophthalmologists and investigates the effectiveness of a transformer and Masked Auto Encoder (MAE) based foundation model (RETFound) as the primary approach. : We fine-tuned and validated the RETFound model, utilizing accurate foveal center coordinates provided by the experienced ophthalmologists. Our approach emphasizes the macular region that is significant diagnostically, where DME biomarkers manifest more predominantly. To guarantee robust evaluation, the dataset was divided into 85% training and 15% held-out test sets. We performed 5-fold cross-validation exclusively on the training dataset with baseline, conservative, and moderate fine-tuning strategies, and the final model was evaluated on the independent, unseen test set. Convolutional neural network (CNN)-based transfer learning (TL) models (MobileNetV2, EfficientNetB0, InceptionV3, DenseNet121, and DenseNet169) were also assessed for comparative evaluation. : The RETFound model yielded the best outcomes under the conservative fine-tuning strategy, achieving a mean test accuracy (AC) of 0.9339 ± 0.0036 and an area under the curve (AUC) of 0.9660 ± 0.0028 on the independent held-out test set across the five fold-trained models. The moderate and baseline evaluations achieved comparatively lower outcomes, highlighting the effectiveness of the conservative approach. The RETFound model consistently outperformed CNN models, exhibiting stability and superior generalization for DRIL classification. We performed statistical validation using the Wilcoxon signed-rank test and 95% confidence intervals to confirm the robustness of the proposed method, and an ablation analysis showed that the fovea-centered region of interest (ROI) guidance consistently improved results when compared with whole OCT analysis. : This research demonstrates that the deep-learning (DL) methods assisted by expert clinical knowledge with an anatomically aligned ROI could provide remarkable results in DRIL detection applications. This work attempts to establish an anatomically relevant framework for computerized DRIL identification that focuses on the highly crucial macular region, possibly helping in faster intervention and improved diagnosis in the management of DME.
Advanced Preoperative Imaging in Macula-Off Rhegmatogenous Retinal Detachment: Emerging Diagnostic and Prognostic Insights for Clinical Management.
Motta L, Mastropasqua R, Cillis M … +7 more , Craighero G, Sereni N, De Santis C, Quarta A, Gelso A, Lo Giudice G, Iovino C
Diagnostics (Basel) · 2026 May · PMID 42279448 · Full text
Retinal detachment (RD) is a potentially sight-threatening condition that requires timely diagnosis and appropriate surgical management. In macula-off rhegmatogenous retinal detachment (RRD), visual recovery after succes...
Retinal detachment (RD) is a potentially sight-threatening condition that requires timely diagnosis and appropriate surgical management. In macula-off rhegmatogenous retinal detachment (RRD), visual recovery after successful reattachment remains highly variable, highlighting the need for reliable preoperative prognostic markers. This study focuses on the contribution of advanced retinal imaging to the preoperative assessment of macula-off RRD, summarizing current evidence on imaging-derived biomarkers associated with disease severity and postoperative functional outcome. In this narrative review, we analyze studies employing spectral-domain and swept-source optical coherence tomography (SD-OCT and SS-OCT), OCT angiography (OCT-A), and adaptive optics OCT (AO-OCT) to characterize microstructural and microvascular retinal alterations. Emerging approaches, including ultra-widefield OCT (UWF-OCT) and artificial intelligence-based image analysis, are also discussed for their potential role in refining diagnosis, supporting surgical planning, and improving prognostic stratification. While several imaging parameters appear promising, their prognostic value is not yet fully realized. Further prospective studies are required to validate clinically meaningful imaging biomarkers and to integrate advanced imaging into routine preoperative decision-making for macula-off RRD.
Impact of Axial Length on Visual Outcomes and OCT Findings in Epiretinal Membrane: A Retrospective Study.
Sueno R, Kubota N, Mori Y … +5 more , Miyata K, Nakano Y, Goto H, Kunishige T, Okamoto F
J Clin Med · 2026 Jun · PMID 42279221 · Full text
Axial elongation may influence the structural characteristics and surgical prognosis of epiretinal membrane (ERM), but its impact across different axial length (AL) categories remains unclear. We retrospectively analyze...
Axial elongation may influence the structural characteristics and surgical prognosis of epiretinal membrane (ERM), but its impact across different axial length (AL) categories remains unclear. We retrospectively analyzed 557 eyes from 515 patients with ERM who underwent vitrectomy and were followed for at least 6 months. Eyes were stratified by AL into normal to mild myopia (NM; <26 mm), high myopia (HM; ≥26 to <28 mm), and extreme high myopia (EHM; ≥28 mm). Clinical variables included age, AL, and pre- and postoperative best-corrected visual acuity (BCVA). OCT parameters assessed included inner and outer retinal cystoid lesions, epiretinal proliferation (EP), and ellipsoid zone (EZ) disruption. Postoperative BCVA significantly improved in the NM and HM groups ( < 0.001) but not in the EHM group ( = 0.091). Although preoperative BCVA was comparable among groups, postoperative BCVA was significantly better in the HM group (-0.02 ± 0.17 logMAR) compared with the NM (0.03 ± 0.20 logMAR) and EHM (0.21 ± 0.43 logMAR) groups ( < 0.05). Outer retinal cystoid lesions were significantly more frequent in the EHM group ( < 0.05), whereas the prevalence of EZ disruption, inner retinal cystoid lesions, and EP did not differ significantly among groups. Eyes with ERM and extreme high myopia exhibited limited postoperative visual improvement and a higher prevalence of outer retinal cystoid lesions, suggesting that axial elongation may adversely affect surgical prognosis.
Diagnostic Performance of Artificial Intelligence Corrected OCT Measurements in Highly Myopic Eyes with Glaucoma.
Robles Amor P, Antón López A, Duch Tuesta S … +8 more , Moreno Montañés J, Muñoz Negrete FJ, Rodríguez Uña I, Morales Fernández L, Sáenz Francés F, García Feijoó J, Martínez de la Casa JM, On Behalf Of GlaucoAI-Spain
J Clin Med · 2026 Jun · PMID 42279183 · Full text
This study aimed to evaluate the diagnostic performance of peripapillary retinal nerve fiber layer (RNFL) thickness measurements corrected by artificial intelligence (AI) compared to original uncorrected values for glauc...
This study aimed to evaluate the diagnostic performance of peripapillary retinal nerve fiber layer (RNFL) thickness measurements corrected by artificial intelligence (AI) compared to original uncorrected values for glaucoma detection in highly myopic patients. This cross-sectional diagnostic accuracy study included 57 eyes from highly myopic patients (31 with glaucoma, 26 without glaucoma). Peripapillary RNFL parameters were obtained using Spectralis optical coherence tomography (OCT). A deep learning algorithm (MGU-Net) was employed to automatically segment retinal layers and compensate for scan tilt in elongated eyes, producing AI-corrected measurements. RNFL thickness values were extracted for six sectoral parameters (ST, SN, N, IN, T, IT) and global. Diagnostic performance was assessed using area under the ROC curve (AUC) and compared between corrected and uncorrected values. Multivariable logistic regression models were also developed using stepwise selection. AI-corrected values were significantly lower than original measurements in all sectors ( < 0.001), with mean differences ranging from 15 to 35 µm. In glaucomatous eyes, significant thinning was observed in the global ( = 0.049) and inferior nasal (IN) sector ( = 0.037) among corrected values. The highest AUCs were found in IN (0.69), IT (0.67), and global (0.66) for corrected values, and in IT (0.63), T (0.59), and global (0.63) for uncorrected data. A model combining ST, T, and IT AI-corrected values achieved an AUC of 0.79. AI-corrected RNFL thickness measurements improve consistency and enhance diagnostic performance in highly myopic glaucoma patients. Correction algorithms may reduce false positives and help reveal glaucomatous damage otherwise obscured by myopic anatomical changes.
Deep Optic Nerve Head Structural Alterations in Adults with Cystic Fibrosis.
Liberski S, Skulimowski B, Waśniewski F … +4 more , Kałużna A, Petrovski G, Cofta S, Kocięcki J
J Clin Med · 2026 Jun · PMID 42279171 · Full text
Cystic fibrosis (CF) is a systemic genetic disorder characterized by chronic inflammation, hypoxia, and metabolic imbalance that may affect neural and microvascular structures. While previous studies have evaluated super...
Cystic fibrosis (CF) is a systemic genetic disorder characterized by chronic inflammation, hypoxia, and metabolic imbalance that may affect neural and microvascular structures. While previous studies have evaluated superficial optic nerve head (ONH) parameters in CF, deep ONH structures, particularly the lamina cribrosa (LC), remain insufficiently explored. This study aimed to assess both superficial and deep ONH morphology in adults with CF using swept-source optical coherence tomography (SS-OCT). This observational case-control study included 34 CF individuals and 34 age- and sex-matched healthy controls. CF patients were examined at baseline and after 12-18 months of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy. All participants underwent comprehensive ophthalmic examination and SS-OCT imaging. Assessed parameters included peripapillary retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT), and lamina cribrosa depth (LCD). Between-group comparisons were performed using ANCOVA adjusted for axial length (AL) and IOP. After adjustment for AL and IOP, total RNFL thickness did not differ significantly between the CF group and controls (F(1,92) = 0.363, = 0.548). However, CF patients demonstrated significantly reduced central LCT (170.2 µm [95% CI 162.2-178.2] vs. 214.6 µm [95% CI 208.6-220.7]; F(1,91) = 72.205, < 0.001) without markedly altered LCD (425.5 µm [95% CI 390.4-454.2] vs. 354.7 µm [95% CI 329.6-379.8]; F(1,94) = 10.090, = 0.099) compared with controls. Intraocular pressure was also higher in CF patients (17.50 mmHg [95% CI 16.60-18.41] vs. 15.87 mmHg [95% CI 15.19-16.55]; F(1,83) = 7.660, = 0.007). Longitudinally, total RNFL thickness decreased from 106.5 µm (IQR 15.25) to 102.0 µm (IQR 15.5) following therapy (z = 3.488, < 0.001), while LCT ( = 0.364) and LCD ( = 0.660) remained stable. CF is associated with significant alterations in deep ONH structures, characterized by thinner LC, independent of ocular biometry. In contrast, superficial RNFL differences appear to be largely influenced by AL. LC parameters, particularly LCT, may represent potential structural markers of systemic involvement in CF, pending further validation.
Advanced Multimodal Imaging in Granulomatous Uveitis: From Differential Diagnosis to Treatment Monitoring and Surgical Integration.
Capobianco M, Bandello F, Miserocchi E … +1 more , Rissotto F
J Clin Med · 2026 May · PMID 42279083 · Full text
: Granulomatous uveitis comprises a clinically heterogeneous group of inflammatory disorders, including ocular sarcoidosis, Vogt-Koyanagi-Harada disease, sympathetic ophthalmia, tuberculosis-associated uveitis, and syphi...
: Granulomatous uveitis comprises a clinically heterogeneous group of inflammatory disorders, including ocular sarcoidosis, Vogt-Koyanagi-Harada disease, sympathetic ophthalmia, tuberculosis-associated uveitis, and syphilitic uveitis. Because these entities may share overlapping posterior segment findings, clinical examination alone is often insufficient for differential diagnosis, particularly when choroidal, retinal, or retinal vascular involvement predominates. : This review provides a clinically oriented overview of multimodal imaging in granulomatous uveitis, including optical coherence tomography (OCT), enhanced-depth imaging OCT, swept-source OCT, OCT angiography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and ultrawidefield imaging. : Emphasis is placed on imaging patterns that help localize the predominant anatomic compartment of inflammation, distinguish major etiologies, identify diagnostic pitfalls, and assess disease activity over time. By integrating current evidence with representative multimodal imaging findings, we propose an anatomic and decision-oriented framework for interpreting granulomatous posterior segment inflammation. : Particular attention is given to the distinction between active inflammation and irreversible structural damage, as this distinction may influence treatment escalation or tapering, timing of elective surgery, local corticosteroid therapy, and the need for diagnostic sampling in infectious or masquerade-like presentations.
Masked Corneal Opacity in Bullous Keratopathy: The Impact of Epithelial Pathology on Surgical Decision-Making-A Case Report.
Luboń W, Drzyzga Ł, Rokicki W … +1 more , Wyględowska-Promieńska D
J Clin Med · 2026 May · PMID 42278920 · Full text
Bullous keratopathy may lead to severe corneal opacity and impaired visualization of anterior segment structures, complicating surgical qualification for endothelial keratoplasty (EK). We report the case of a 67-year-old...
Bullous keratopathy may lead to severe corneal opacity and impaired visualization of anterior segment structures, complicating surgical qualification for endothelial keratoplasty (EK). We report the case of a 67-year-old male with pseudophakic bullous keratopathy and Fuchs endothelial dystrophy presenting with clinically complete corneal opacity and visual acuity limited to hand motion. Slit-lamp examination and anterior segment optical coherence tomography demonstrated marked epithelial remodeling with a dense plaque-like surface lesion obscuring deeper corneal structures. A staged intraoperative approach was undertaken. Following mechanical epithelial debridement, partial restoration of corneal transparency allowed for an intraoperative reassessment of stromal clarity and subsequent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Histopathological examination demonstrated reactive epithelial thickening with associated subepithelial fibrosis consistent with chronic bullous keratopathy. Postoperatively, corneal transparency was restored and best-corrected visual acuity improved to 0.7 Snellen (0.15 logMAR), remaining stable during follow-up without graft-related complications or recurrent epithelial abnormalities. This case highlights the importance of considering epithelial contributions to apparent corneal opacity in advanced bullous keratopathy and suggests that staged intraoperative reassessment may support individualized surgical decision-making in selected patients with inconclusive preoperative evaluation.
Functional and Structural Outcomes of Photobiomodulation Therapy in Dry Age-Related Macular Degeneration: A Single-Center Experience.
Ipek SC, Durmaz Engin C, Karatas E … +2 more , Yildirim C, Grzybowski A
J Clin Med · 2026 May · PMID 42278869 · Full text
To evaluate the anatomical and functional efficacy of photobiomodulation (PBM) therapy in patients with dry age-related macular degeneration (AMD) and to investigate structural predictors of visual response. This retros...
To evaluate the anatomical and functional efficacy of photobiomodulation (PBM) therapy in patients with dry age-related macular degeneration (AMD) and to investigate structural predictors of visual response. This retrospective study included 47 eyes of 30 patients with dry AMD treated with PBM. Best-corrected visual acuity (BCVA) was recorded as Early Treatment Diabetic Retinopathy Study (ETDRS) letter score, and visual change (ΔBCVA) was calculated. Spectral-domain optical coherence tomography parameters-central retinal thickness (CRT), central macular volume (ETDRS 9-subfield central zone), and photoreceptor layer integrity (external limiting membrane [ELM], ellipsoid zone [EZ], and interdigitation zone [IZ])-were assessed pre- and post-treatment. Age-Related Eye Disease Study (AREDS) stage was graded per eye. Because both eyes from some patients were included, generalized estimating equation (GEE) models with patient-level clustering were used to account for inter-eye correlation. Effect estimates were reported as unstandardized coefficients with 95% confidence intervals. Visual acuity improved following PBM therapy, with mean ETDRS letter scores increasing from 75.0 ± 14.1 to 78.0 ± 12.1 letters. In the GEE model accounting for patient-level clustering, the estimated mean gain was 2.97 ETDRS letters (95% CI: 1.15 to 4.79; = 0.001). Mean CRT showed no significant change following PBM therapy (210.32 ± 48.61 µm vs. 211.23 ± 50.27 µm; GEE estimate: +0.91 µm; 95% CI: -5.52 to 7.35; = 0.780). Central macular volume likewise remained stable (0.1913 ± 0.030 vs. 0.1919 ± 0.033 mm; GEE estimate: +0.0006 mm; 95% CI: -0.0054 to 0.0067; = 0.836). Photoreceptor layer integrity demonstrated limited structural change, with no significant time effect for EZ or IZ integrity in binary GEE models and no observed pre-post change in ELM integrity. In multivariable GEE analysis, baseline BCVA ( < 0.001), ELM integrity ( < 0.001) and central macular volume ( = 0.041) were associated with change in ETDRS letter score, whereas AREDS category, EZ integrity, and IZ integrity were not. PBM therapy demonstrated limited short-term anatomical change but variable functional outcomes in dry AMD. Baseline BCVA emerged as the primary determinant of visual response, suggesting that treatment benefit may be influenced predominantly by pre-treatment functional reserve.
Reliability of Macular Ganglion Cell-Inner Plexiform Layer Thickness Measurements Across Scan Protocols in Spectral-Domain Optical Coherence Tomography.
Krajnc N, Bertich M, Föttinger F … +5 more , Macher S, Schwarz FK, Stapf C, Pemp B, Bsteh G
J Clin Med · 2026 May · PMID 42278861 · Full text
: We aimed to assess whether modified OCT acquisition parameters improve GCIPL measurement reliability. : Participants with multiple sclerosis (PwMS) and age- and sex-matched healthy controls (HC) underwent OCT (Spectral...
: We aimed to assess whether modified OCT acquisition parameters improve GCIPL measurement reliability. : Participants with multiple sclerosis (PwMS) and age- and sex-matched healthy controls (HC) underwent OCT (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) at baseline and after two and four weeks. At each visit, five macular scan protocols were acquired: standard (49 lines, high-speed [HS], automated real-time tracking [ART]: 9), high-ART (49 lines, HS, ART: 50), high-lines (97 lines, HS, ART: 9), high-resolution (49 lines, high-resolution [HR], ART: 9), and maximum (97 lines, HR, ART: 50). Reliability was assessed using intraclass correlation coefficients (ICC). Absolute test-retest reproducibility was quantified using the mean absolute difference (MAD). : Thirty-eight eyes from nine PwMS (mean age 34.1 ± 8.0 years, 44.4% female) and ten HC (31.7 ± 11.1 years, 50.0% female) were included. At baseline, mean GCIPL thickness ranged from 70.8 µm to 71.5 µm across protocols, demonstrating excellent inter-protocol agreement (ICC 0.99; 95% confidence interval [CI]: 0.98-0.99; < 0.001) and only marginally higher values with increased ART. Test-retest reliability was excellent for all protocols, demonstrating marginally lower absolute measurement variability of high-ART and high-lines protocols (MAD 0.26-0.27; 95% CI: 0.21-0.32), while temporal agreement remained excellent and comparable across acquisition settings. Mean acquisition time ranged from 10.6 ± 1.6 s for the standard protocol to 231.9 ± 36.4 s for the maximum protocol. : All OCT acquisition protocols demonstrated excellent inter-protocol and test-retest reliability for GCIPL measurements. The high-lines protocol provides the most favourable balance between measurement reliability and acquisition time, supporting its potential utility for longitudinal GCIPL monitoring.
Coronary Artery Calcification: From Molecular Mechanisms to Interventional Strategies.
Zivkovic S, Misevic V, Krupnikovic K … +7 more , Obradovic A, Timcic S, Mandic A, Juricic S, Rakocevic J, Bojic M, Dobric M
Int J Mol Sci · 2026 Jun · PMID 42278635 · Full text
Coronary artery calcification (CAC) represents a clear sign of advanced atherosclerosis and a strong indicator of coronary artery disease burden and cardiovascular risk. Beyond its established prognostic value, CAC signi...
Coronary artery calcification (CAC) represents a clear sign of advanced atherosclerosis and a strong indicator of coronary artery disease burden and cardiovascular risk. Beyond its established prognostic value, CAC significantly influences plaque biology, lesion morphology, and the technical complexity of percutaneous coronary intervention (PCI). This review summarizes current knowledge on the mechanisms of vascular calcification, its clinical determinants, diagnostic assessment, and therapeutic implications. Vascular calcification is now understood as an active, regulated process involving osteogenic transdifferentiation of vascular smooth muscle cells, inflammatory signaling pathways, extracellular vesicle release, and disturbances in mineral metabolism. Distinct calcification phenotypes exert different effects on plaque stability: micro- and spotty calcifications are frequently linked to plaque vulnerability, whereas dense, sheet-like calcification is more typical of stable fibrocalcific lesions. The prevalence of CAC increases with age and differs between sexes, while cardiometabolic risk factors, chronic kidney disease, systemic inflammation, and genetic predisposition further contribute to its development. Noninvasive computed tomography remains the cornerstone for CAC detection and quantification, enabling reliable cardiovascular risk stratification. Intravascular imaging techniques, particularly intravascular ultrasound and optical coherence tomography, provide detailed characterization of calcified plaque morphology and support optimal procedural planning. In patients with heavily calcified lesions, intravascular imaging-guided lesion preparation and stent optimization represent the most effective strategy for improving PCI outcomes.
Preoperative pterygium extension rate predicts postoperative corneal optical recovery after pterygium excision.
Miyakoshi A, Toyoda N, Katayama H … +1 more , Hayashi A
BMC Ophthalmol · 2026 Jun · PMID 42277726 · Full text
BACKGROUND: Pterygium progression induces corneal optical distortion, and delayed surgery may limit postoperative recovery of corneal optics. However, quantitative criteria indicating the latest acceptable timing of surg...
BACKGROUND: Pterygium progression induces corneal optical distortion, and delayed surgery may limit postoperative recovery of corneal optics. However, quantitative criteria indicating the latest acceptable timing of surgery remain unclear. This study aimed to determine extension-rate thresholds predicting postoperative normalization of corneal asymmetry and higher-order irregularity (HOI). METHODS: This retrospective observational study included 134 eyes with primary pterygium that underwent surgical excision. The pterygium extension rate was calculated from slit-lamp photographs as the ratio of the apex-to-limbus distance to the horizontal corneal diameter. Corneal asymmetry and HOI within the central 3-mm zone were measured preoperatively and 1 month postoperatively using swept-source anterior segment optical coherence tomography. Receiver operating characteristic (ROC) analyses were used to determine cutoff values predicting postoperative normalization. RESULTS: The pterygium extension rate correlated significantly with preoperative corneal asymmetry (r = 0.5899, p < 0.001) and HOI (r = 0.5462, p < 0.001). ROC analysis showed good predictive ability for postoperative corneal asymmetry (AUC 0.80; cutoff 0.359; sensitivity 58.0%, specificity 89.3%) and moderate predictive ability for HOI (AUC 0.74; cutoff 0.292; sensitivity 72.3%, specificity 64.7%). Postoperative normalization occurred in 62.7% of eyes for asymmetry and 38.1% for HOI. CONCLUSIONS: The pterygium extension rate is a simple clinical metric that predicts postoperative optical recovery. These extension-rate thresholds may help support clinical estimation of how long pterygium surgery may be deferred while maintaining the possibility of postoperative optical recovery.
Language-assisted multimodal convolutional transformer pipeline for retinal lesions segmentation.
Khan W, Alsaffar M, Abrar MF … +1 more , Hassan T
Sci Rep · 2026 Jun · PMID 42277160 · Full text
Retinal lesion segmentation is one of the critical tasks to analyze retinal diseases. Many researchers have proposed deep-learning models to extract lesions from the retinal scans. However, these models often rely on ima...
Retinal lesion segmentation is one of the critical tasks to analyze retinal diseases. Many researchers have proposed deep-learning models to extract lesions from the retinal scans. However, these models often rely on image features that might not be clinically meaningful for identifying the retinal lesions. Additionally, these models need pixel-level ground truths, which are challenging to procure in the real world. To overcome these issues, we present a novel language-assisted multimodal convolutional transformer pipeline that aligns image features with the text features, where the text features are extracted from the prompts that contain clinically meaningful information about the retinal lesions, and the image features are generated from the retinal scans. This alignment between image and text features is established with one-time training using the proposed loss function. Afterward, the proposed network can robustly extract retinal lesions across different datasets at the inference stage. Moreover, since the proposed network infers learning from the text prompts, it does not require additional training rounds using pixel-level ground truth annotations to adapt to new datasets like the state-of-the-art methods. The proposed network is thoroughly tested on six public datasets, and it outperforms the state-of-the-art by achieving up to 7.77% improvements in terms of intersection-over-union.
Alternative posology for brolucizumab: a 6-week loading regimen is as effective as a 4-week regimen for the treatment of nAMD.
Mulyukov Z, Olgac U, Kearns JD … +3 more , Liu C, Pigeolet E, Weissgerber G
BMJ Open Ophthalmol · 2026 Jun · PMID 42276734 · Full text
BACKGROUND: Extending the dosing interval with the anti-vascular endothelial growth factor (VEGF) brolucizumab in the loading phase may reduce treatment burden while maintaining functional and anatomical outcomes for pat...
BACKGROUND: Extending the dosing interval with the anti-vascular endothelial growth factor (VEGF) brolucizumab in the loading phase may reduce treatment burden while maintaining functional and anatomical outcomes for patients with neovascular age-related macular degeneration. METHODS: We integrated population pharmacokinetic/pharmacodynamic (PK/PD) and quantitative system pharmacology (QSP) modelling approaches to evaluate the effect of brolucizumab 6 mg on central subfield thickness (CSFT) and best-corrected visual acuity (BCVA) using an alternative reduced loading regimen (two or three administrations every 6 weeks (q6w)) followed by individualised every 12 weeks/every 8 weeks (q12w/q8w) maintenance. The simulation results were compared with the CSFT and BCVA outcomes in the phase 3 HAWK and HARRIER studies, in which patients received the approved loading regimen of 3 monthly doses. RESULTS: For both loading regimens, simulations of the QSP model showed almost complete VEGF inhibition during the loading phase and free VEGF recovery commenced 6‒7 weeks following the last loading dose, returning to baseline levels after 12‒13 weeks.The population PK/PD simulations showed that week 48 and week 36-48 mean BCVA and CSFT changes from baseline using the alternative loading regimen and individualised maintenance treatment were similar to HAWK and HARRIER study measures. Simulated disease activity assessments indicate that only 20% of patients needed third q6w loading dose before switching to q12w/q8w maintenance treatment. CONCLUSIONS: This integrated modelling approach predicted that reducing the loading regimen of brolucizumab 6 mg treatment to two or three doses every 6 weeks is expected to result in similar efficacy outcomes, resulting in regulatory approval of this alternative dosing regimen in several countries.
Bridging the gap: Integrating oxidative stress profiling with retinal imaging for precision management of diabetic retinopathy.
El-Sehrawy AAMA, Jaber B, Narbutaeva D … +5 more , Ismatov N, Eshqobilov O, Kzar LA, Panigrahi R, Bainsal N
Exp Eye Res · 2026 Jun · PMID 42276507 · Publisher ↗
Diabetic retinopathy (DR) remains a primary cause of vision impairment in working-age adults, driven by chronic hyperglycemia-induced oxidative stress that exacerbates retinal microvascular alterations, including pericyt...
Diabetic retinopathy (DR) remains a primary cause of vision impairment in working-age adults, driven by chronic hyperglycemia-induced oxidative stress that exacerbates retinal microvascular alterations, including pericyte loss, endothelial dysfunction, and capillary occlusion. This narrative review summarizes evidence suggesting that specific oxidative signatures may precede detectable microvascular alterations, suggesting a "metabolic-memory" imprint on retinal cellular homeostasis. This paradigm shift implicates oxidative stress biomarkers not merely as correlates of disease but as predictive tools for stratifying patients at risk of progression from non-proliferative to proliferative DR. This review examines current laboratory evidence on oxidative stress markers, such as malondialdehyde (MDA), 8-isoprostanes, superoxide dismutase (SOD), glutathione (GSH), and total antioxidant capacity (TAC), in relation to DR pathogenesis and progression. Drawing on epidemiological and clinical studies, we elucidate how elevated lipid peroxidation products (e.g., MDA and 8-isoprostanes) correlate with early microvascular changes and disease severity, while diminished antioxidant enzymes (e.g., SOD and GSH) reflect systemic redox imbalance, potentially serving as prognostic indicators of transitions from non-proliferative to proliferative DR. Innovatively, we propose an integrated biomarker panel combining these oxidative indices with advanced retinal imaging modalities, such as optical coherence tomography angiography, to enhance early detection sensitivity. Furthermore, emerging interventions targeting oxidative pathways, including carotenoid antioxidants like zeaxanthin and novel nanotechnology-based delivery systems for SOD mimetics, offer promising avenues for halting microvascular degeneration. By bridging laboratory assays with clinical translation, this review underscores the potential value of routine oxidative stress profiling in diabetic patients to support timely, biomarker-guided adjunctive interventions, ultimately mitigating DR-related morbidity and improving clinical risk stratification in ophthalmology.
Marginal Outer Retinal Ridge Following Rhegmatogenous Retinal Detachment Repair: A Novel Biomarker of Retinal Displacement.
Brosh K, Roditi E, Mordechai G … +2 more , Zadok D, Muni RH
Ophthalmol Retina · 2026 Jun · PMID 42276459 · Publisher ↗
PURPOSE: To describe a novel postoperative optical coherence tomography (OCT) finding following rhegmatogenous retinal detachment (RRD) repair and explore its relationship with retinal displacement. DESIGN: Retrospective...
PURPOSE: To describe a novel postoperative optical coherence tomography (OCT) finding following rhegmatogenous retinal detachment (RRD) repair and explore its relationship with retinal displacement. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Patients with primary RRD with partial macular involvement who underwent successful repair. METHODS: Patients after RRD repair who demonstrated a marginal outer retinal ridge (MORR) on postoperative OCT were included. MORR was defined as a linear outer retinal hyperreflective ridge adjacent and parallel to the RRD margin. MAIN OUTCOME MEASURES: Clinical characteristics, surgical variables, multimodal imaging findings, and evidence of retinal displacement were assessed. RESULTS: Twelve eyes were included. MORRs were predominantly located along the inferior RRD margin (11/12) and were detectable as early as postoperative day 1. In 4/12 eyes (33%), MORRs occurred in regions that were attached at presentation. MORRs resolved spontaneously within months in all cases. In two cases, MORR involved the fovea. Retinal displacement was more pronounced superior to a MORR, supporting retinal redundancy as the mechanism of formation. CONCLUSIONS: MORR represents a novel OCT biomarker of retinal displacement and reflects postoperative retinal redundancy. Recognition of MORR provides new insight into the biomechanics of retinal reattachment and may have implications for surgical technique, postoperative imaging, and functional outcomes.
Optic disc oedema in a patient with POEMS syndrome associated with Castleman's disease.
López Herrero F, Sánchez-Vicente JL, Gámez-Jiménez EM … +3 more , González-Jáuregui López B, Portillo-Martínez M, Guijarro-Ambel JV
Arch Soc Esp Oftalmol (Engl Ed) · 2026 Jun · PMID 42276248 · Publisher ↗
A case of POEMS syndrome associated with Castleman's disease is presented in a 36-year-old Caucasian patient, in whom papillary oedema was the neuro-ophthalmological manifestation. The patient presented with bilateral op...
A case of POEMS syndrome associated with Castleman's disease is presented in a 36-year-old Caucasian patient, in whom papillary oedema was the neuro-ophthalmological manifestation. The patient presented with bilateral optic disc oedema, which was confirmed by optical coherence tomography, showing thickening of the retinal nerve fibre layer. Fluorescein angiography demonstrated hyperfluorescence in the early phases with mild leakage in the late phases. Visual field testing using the central 24-2 threshold strategy revealed enlargement of the blind spot in both eyes, along with an inferior arcuate defect in the left eye. Papillary oedema represents the most common manifestation of POEMS syndrome, and its association with polyneuropathy and monoclonal proteins should prompt consideration of this diagnosis.
Effects of fingolimod therapy on choroidal vascularity index in patients with relapsing-remitting multiple sclerosis: A retrospective longitudinal study.
Dilek R, Cömert E, Köse H
Photodiagnosis Photodyn Ther · 2026 Jun · PMID 42276219 · Publisher ↗
PURPOSE: To evaluate the longitudinal effects of fingolimod therapy on choroidal vascular architecture, particularly the choroidal vascularity index (CVI), in patients with relapsing-remitting multiple sclerosis (RRMS)....
PURPOSE: To evaluate the longitudinal effects of fingolimod therapy on choroidal vascular architecture, particularly the choroidal vascularity index (CVI), in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: This retrospective study included 51 RRMS patients who initiated fingolimod therapy and were followed for a median of 24 months (range 12-36 months). 51 age- and sex-matched healthy individuals served as a cross-sectional reference group. Central macular thickness (CMT), retinal nerve fibre layer (RNFL) thickness, subfoveal choroidal thickness (SFCT), choroidal luminal area (LA), stromal area (SA), total choroidal area (TCA), and CVI were assessed at baseline and end of follow-up using spectral-domain OCT with enhanced depth imaging. Spearman correlation analysis was performed between treatment duration and the magnitude of change in CVI and SA. RESULTS: CMT, SFCT, RNFL, LA, and TCA remained stable throughout follow-up (all p > 0.05). SA decreased significantly (p = 0.007) and CVI increased significantly (0.6968 ± 0.0287 → 0.7082 ± 0.0321; mean paired difference +0.0114, 95% CI 0.0040-0.0188; p = 0.003). Follow-up CVI was significantly higher in patients than in healthy controls (p = 0.017). No patient developed macular oedema. A moderate positive correlation was found between treatment duration and ΔCVI (ρ = 0.38, p = 0.006).No correction for multiple comparisons was applied; all findings are exploratory. CONCLUSION: Fingolimod does not affect conventional OCT parameters in RRMS patients. A statistically significant increase in CVI accompanied by stromal reduction, correlating modestly with treatment duration, suggests a progressive change in choroidal vascular-stromal balance associated with treatment duration. These are exploratory findings; prospective studies with untreated RRMS comparators, longitudinal control data, and functional visual endpoints are required before drawing causal conclusions.
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