Surv Ophthalmol [JOURNAL]
Sun
200 papers
Schlaegel lines: History, etiology, multimodal imaging, and differential diagnosis of curvilinear streaks in chorioretinal disorders.
Forte P, Feo A, Forte G … +16 more , Bianco L, Boscia G, Levin MMF, Antropoli A, Scandale P, Cattaneo J, Quarta A, Ferro Desideri L, Eandi CM, Parravano M, Marchese A, Chan HH, Popovic MM, Miserocchi E, Sarraf D, Tsui E
Surv Ophthalmol · 2026 May · PMID 42103031 · Publisher ↗
Schlaegel lines (SL) represent distinctive curvilinear patterns of chorioretinal atrophy that have emerged as a distinctive, yet non-pathognomonic, funduscopic sign across diverse ocular disorders. First described as rel...
Schlaegel lines (SL) represent distinctive curvilinear patterns of chorioretinal atrophy that have emerged as a distinctive, yet non-pathognomonic, funduscopic sign across diverse ocular disorders. First described as related to presumed ocular histoplasmosis syndrome in the early 1980s in Histoplasma-endemic regions, these peripheral fundus lesions have since been documented across numerous other etiologies. The majority of SL arise in the context of inflammatory chorioretinal disorders, with idiopathic multifocal choroiditis and punctate inner choroiditis constituting the most frequent underlying causes. SL can also occur in a subset of inherited retinal diseases, where they may represent a secondary acquired sign of outer retinal damage. SL demonstrate a predilection for young to middle-aged myopic women. On fundus examination, SL appear as linear atrophic spots or streaks with variable pigmentation. Optical coherence tomography demonstrates retinal pigment epithelium-Bruch membrane-choriocapillaris complex disruption or, when SL are detected during the active inflammatory phase, hump-like hyperreflective RPE elevations. The differential diagnosis of SL requires recognition of the characteristic multimodal imaging patterns to distinguish them from mimicking conditions, such as Verhoeff lines and West Nile chorioretinitis. A comprehensive understanding of the diverse etiologies of SL is essential for accurate diagnosis and appropriate clinical management.
The role of adjunctive aqueous suppressants for anti-vascular endothelial growth factor therapy: A systematic review.
Sadek K, Yu P, Al-Burak SA … +8 more , Osman R, Tao BK, Al-Ani A, Ghaseminejad F, Khan H, Arjmand P, Hutnik C, Navajas EV
Surv Ophthalmol · 2026 May · PMID 42103030 · Publisher ↗
Our goal is to determine whether adjunctive aqueous suppressants (topical β-blockers, carbonic anhydrase inhibitors, or oral acetazolamide) enhance outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy...
Our goal is to determine whether adjunctive aqueous suppressants (topical β-blockers, carbonic anhydrase inhibitors, or oral acetazolamide) enhance outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME), retinal vein occlusion (RVO), and neovascular age-related macular degeneration (nAMD), focusing on retinal thickness, visual acuity, injection burden, intraocular pressure (IOP), and safety. DME, RVO, and nAMD are leading causes of vision loss treated with repeated intravitreal injections, yet many eyes show persistent fluid. Aqueous suppressants are inexpensive and widely available, with potential to prolong intravitreal drug residence and improve outcomes, but their clinical value remains uncertain. Following a registered protocol, we searched 4 databases (January, 2000 toMay, 2025) for randomized and comparative studies evaluating adjunct aqueous suppressants with anti-VEGF therapy. Primary outcome was change in retinal thickness; secondary outcomes included visual acuity, injection burden, IOP, and adverse events. Risk of bias was assessed and findings synthesized narratively. Twelve studies (7 randomized trials; 495 eyes) met inclusion criteria. In DME, 3 of 4 trials showed greater thickness reduction with adjunctive dorzolamide (±timolol), although visual gains were inconsistent. In RVO, 1 trial suggested transient anatomical benefit, whereas oral acetazolamide showed no added effect. In nAMD, adjunctive dorzolamide-timolol reduced residual fluid in refractory cases without visual or treatment-sparing benefit. Topical therapy produced modest IOP reductions without serious adverse events. Adjunct aqueous suppressants may provide limited short-term anatomical benefit, particularly in DME and refractory nAMD, but consistent functional or durability effects are not found in this study. Larger, longer-term randomized studies are needed.
The clinical and genetic profiles, management, and treatment outcomes of familial exudative vitreoretinopathy.
Tao LR, Zhang WF, Chen YN … +3 more , Wang ZC, Zhao XY, Liu SZ
Surv Ophthalmol · 2026 May · PMID 42097232 · Publisher ↗
Our meta-analysis of 99 studies (463 patients) clarifies key controversies in familial exudative vitreoretinopathy. We found that nearly half of patients are asymptomatic at diagnosis, underscoring the need for early scr...
Our meta-analysis of 99 studies (463 patients) clarifies key controversies in familial exudative vitreoretinopathy. We found that nearly half of patients are asymptomatic at diagnosis, underscoring the need for early screening in at-risk individuals. Pathogenic mutations (most commonly in FZD4, LRP5, NDP) were identified in 43% of cases. Critically, treatment analysis suggests that combination therapy (laser + anti-vascular endothelial growth factor) was associated with a reduced incidence of retinal detachment in early-stage disease, and vitrectomy was associated with improved anatomical outcomes in advanced stages. These findings provide evidence for genotype-aware, stage-based management.
Dynamic regulation mechanisms of macrophages and advances in targeted therapy for corneal injury repair.
Li Y, Tao Y, Wu J … +8 more , He Y, Li J, Li Y, Wu L, Xiong F, Liao H, Xu Q, Wang A
Surv Ophthalmol · 2026 May · PMID 42086093 · Publisher ↗
Corneal injury is a major cause of visual impairment worldwide and involves a tightly regulated cascade of inflammation, tissue repair, and remodeling. This process typically progresses from an early inflammatory phase t...
Corneal injury is a major cause of visual impairment worldwide and involves a tightly regulated cascade of inflammation, tissue repair, and remodeling. This process typically progresses from an early inflammatory phase to proliferative repair and ultimately to stromal remodeling, with potential outcomes including corneal neovascularization and fibrosis that compromise transparency and vision. Accumulating evidence highlights macrophages as central regulators across these stages. In the early phase, pro-inflammatory (M1-like) macrophages mediate pathogen clearance and immune activation through cytokines such as IL-1β and TNF-α. During the reparative phase, a transition toward anti-inflammatory (M2-like) phenotypes facilitates epithelial regeneration, extracellular matrix remodeling, and resolution of inflammation. Dysregulation of this dynamic balance, however, contributes to chronic inflammation, pathological angiogenesis driven by hypoxia-inducible factor-vascular endothelial growth factor signaling, and TGF-β-mediated fibrotic remodeling. We summarize current understanding of macrophage-associated signaling networks in corneal injury, including pathways governing inflammation, angiogenesis, and fibrosis, and highlights emerging macrophage-targeted therapeutic strategies such as cytokine modulation, nanocarrier-based delivery, and gene editing approaches. Despite promising preclinical results, challenges including macrophage heterogeneity, temporal specificity, and translational safety remain. A deeper mechanistic understanding may enable the development of more precise immunomodulatory therapies to improve corneal repair and visual outcomes.
Multi-omics panorama of glaucoma: Pathogenesis, biomarkers, and novel therapeutic strategies.
Gao J, Liu M, Liu X … +5 more , Zhang M, Qu W, Wang W, Cao P, Mo Y
Surv Ophthalmol · 2026 May · PMID 42082055 · Publisher ↗
Glaucoma is a group of irreversible, blinding eye diseases characterized by progressive loss of retinal ganglion cells, leading to gradual visual field defects that severely impact patients' quality of life. Its complex...
Glaucoma is a group of irreversible, blinding eye diseases characterized by progressive loss of retinal ganglion cells, leading to gradual visual field defects that severely impact patients' quality of life. Its complex pathophysiological mechanisms remain incompletely understood, limiting the development of early diagnostic and effective therapeutic strategies. Advances in omics technologies have provided new insights into elucidating the pathophysiology of glaucoma. We summarize specific alterations in genomics, transcriptomics, proteomics, metabolomics, epigenomics, and microbiomics associated with glaucoma. We emphasize the systematic analysis of disease mechanisms, identification of clinically applicable biomarkers, and discovery of novel therapeutic targets through the integration of these data. This approach paves new pathways for glaucoma subtype diagnosis and personalized treatment, while also outlining future research directions and challenges.
Quantitative imaging for assessing uveitis activity: A comprehensive review.
Nabavi A, Zarei M, Shome A … +4 more , Rupenthal ID, Caspi RR, Davis J, Yousefi S
Surv Ophthalmol · 2026 May · PMID 42082054 · Publisher ↗
Assessment of uveitis activity is critical for guiding treatment and monitoring outcomes. Conventional measures, however, are largely subjective and heterogeneous. Advances in ocular imaging have increasingly enabled a s...
Assessment of uveitis activity is critical for guiding treatment and monitoring outcomes. Conventional measures, however, are largely subjective and heterogeneous. Advances in ocular imaging have increasingly enabled a shift from qualitative clinical grading to quantitative approaches. In the anterior chamber and vitreous, optical coherence tomography (OCT)-based signatures offer repeatable and potentially reproducible surrogates for inflammatory cell count and haze quantification. Similarly, quantitative fundus fluorescein angiography offers leakage and non-perfusion measures beyond traditional semi-quantitative scores, while OCT angiography (OCTA) provides noninvasive assessment of retinal vascular density. At the retinal tissue level, OCT signatures have been expanded beyond central subfield thickness to include perivascular mapping and ultrastructural parameters such as ellipsoid zone integrity and disorganization of the retinal inner layers. Choroidal biomarkers, including thickness, vascularity index, and OCTA-derived flow parameters, have improved understanding of choroidal involvement in specific uveitic entities and show promise as potential endpoints. Peripapillary OCT and OCTA extend activity assessment to the optic nerve, introducing additional structural and microvascular metrics. Composite indices, including clinician-derived scales, imaging-based scores, and end-to-end artificial intelligence-based grading systems, have also been recently proposed. Across these modalities, methods have evolved from manual to semi-automated and now fully automated pipelines; however, clinical translation requires rigorous validation, including assessment of construct validity, responsiveness to change, and reproducibility across devices. We summarize current strategies for quantifying uveitis activity, their applications, limitations, and future directions toward standardized, objective endpoints.
Optical coherence tomography biomarkers in patients with diabetic macular edema treated with dexamethasone implants.
Cicinelli MV, Frizziero L, Sarao V … +5 more , Cennamo G, Marsico S, Di Fino S, Gallinaro V, Borrelli E
Surv Ophthalmol · 2026 May · PMID 42070754 · Publisher ↗
Beyond conventional optical coherence tomography (OCT)-based morphological classifications of diabetic macular edema (DME), an expanding range of OCT-derived biomarkers has been identified that reflect distinct pathophys...
Beyond conventional optical coherence tomography (OCT)-based morphological classifications of diabetic macular edema (DME), an expanding range of OCT-derived biomarkers has been identified that reflect distinct pathophysiological mechanisms and may carry diagnostic, prognostic, and therapeutic relevance. We summarize current evidence on potential OCT biomarkers in DME, with a particular focus on their role in patients treated with intravitreal dexamethasone implants. We conducted a structured literature search using PubMed to identify relevant clinical and imaging studies. OCT biomarkers are discussed according to their principal clinical utility: diagnostic, such as central retinal thickness and central subfield thickness; prognostic, including hyperreflective retinal foci, disorganization of the retinal inner layers, and disruption of the ellipsoid zone and external limiting membrane; and therapeutic markers, encompassing subretinal fluid, intraretinal fluid, intracystic hyperreflective material, and vitreomacular interface abnormalities. The concurrent presence and longitudinal evolution of these OCT biomarkers may assist in patient stratification, prediction of treatment response, and personalization of therapeutic strategies with dexamethasone implants. Nevertheless, robust prospective and comparative studies are required to validate their predictive value across heterogeneous DME populations. In parallel, artificial intelligence and machine-learning approaches are expected to further refine OCT-based phenotyping and outcome prediction.
Efficacy, tolerability, and threshold effect of atropine eye drops for myopia control: A systematic review and dose-response meta-analysis.
Zhang XJ, Liu M, Yu M … +12 more , Ho ECF, Wong RTC, Zaabaar E, Chen W, Huang H, Guo PY, Sun J, Lam AK, Cheng CY, Yam JC, Shih KC, Leung CKS
Surv Ophthalmol · 2026 May · PMID 42070753 · Publisher ↗
Atropine is an emerging therapy for myopia, yet the optimal concentration for prescription remains uncertain. We searched PubMed, Embase, Web of Science, Cochrane Library, World Health Organization International Clinical...
Atropine is an emerging therapy for myopia, yet the optimal concentration for prescription remains uncertain. We searched PubMed, Embase, Web of Science, Cochrane Library, World Health Organization International Clinical Trials, and ClinicalTrials.gov registry platforms. We included the randomized clinical trials (RCTs) that compared any dose of atropine against a placebo in myopic children. Among 3566 studies assessed, we identified 33 eligible RCTs involving 6301 children aged 4-18 years, with 10 different concentrations and a mean follow-up time of 19.5 ± 12.3 months. A nonlinear relationship was observed between atropine dosage and treatment efficacy (P < 0.001). Compared to placebo groups, the mean differences in reducing annual spherical equivalent refraction progression for atropine concentrations of 0.01%, 0.02%, 0.03%, 0.04%, and 0.05% were 0.21 diopters (D) (95% CI, 0.13-0.28), 0.35 D (95% CI, 0.23-0.46), 0.42 D (95% CI, 0.28-0.56), 0.45 D (95% CI, 0.30-0.60), and 0.46 D (95% CI, 0.32-0.61) respectively For higher concentrations, the estimates were 0.49 D (95% CI, 0.34-0.63) for 0.1% and 0.99 D (95% CI, 0.66-1.31) for 1%, although these were based on fewer and smaller trials. Higher doses of atropine were associated with decreased amplitude of accommodation (P = 0.02), increased pupil diameters (P = 0.01) and a higher frequency of photophobia (P = 0.02). Our findings suggest that the increase in treatment efficacy with higher concentrations may plateau beyond a certain range, and that the current practice of increasing atropine concentrations for children who show inadequate responses to lower doses should be confined to a specific concentration range. This analysis is limited by the number, design heterogeneity, and sample sizes of available trials for higher concentrations, and by the frequent lack of pre-intervention refractive history in included studies. Therefore, estimates-particularly for doses exceeding 0.1%-should be interpreted with caution.
Omics in hereditary optic neuropathies: A systematic review of clinical studies with an integrated point of view.
Khanna RK, Cui X, Wong DCS … +9 more , Makam R, Ducloyer JB, Chao de la Barca JM, Bocca C, Vignal-Clermont C, Blasco H, Orssaud C, Reynier P, Yu-Wai-Man P
Surv Ophthalmol · 2026 Apr · PMID 42061574 · Publisher ↗
Hereditary optic neuropathies are characterized by bilateral visual loss due to the degeneration of retinal ganglion cells, resulting in optic nerve degeneration and atrophy. Although the genetic origin of the main isola...
Hereditary optic neuropathies are characterized by bilateral visual loss due to the degeneration of retinal ganglion cells, resulting in optic nerve degeneration and atrophy. Although the genetic origin of the main isolated and syndromic hereditary optic neuropathies has been characterized, the clinical phenotypes exhibit significant and poorly understood variability in both penetrance and expressivity. Additionally, the genetic and environmental factors that influence the onset of these optic neuropathies remain poorly understood, with limited biomarkers to predict disease progression or as readouts for therapeutic trials. Data-driven omics strategies allow deep phenotyping to improve our understanding of pathophysiological mechanisms and to search for new biomarkers and therapeutic targets. We explore whether the omics strategies applied to patients with hereditary optic neuropathies have provided such new insights. MEDLINE, Web of Science and EMBASE databases were screened for studies with terms relating to hereditary optic neuropathies, transcriptomics, epigenomics, proteomics, metabolomics and lipidomics in clinical studies exploring patients' samples. Out of 1244 references identified, 22 articles were included after double-masked data curation. These articles focused only on the 3 main forms of hereditary optic neuropathies, namely, OPA1-related dominant optic atrophy (n = 4), Leber hereditary optic neuropathy (n = 13), and Wolfram syndrome (n = 5). While the methodological designs and results of these studies were highly heterogeneous, they revealed molecular alterations that we have attempted to discuss at the integrated multi-omics level. This data integration highlighted several common pathophysiological mechanisms such as energetic impairment, endoplasmic reticulum stress, proteotoxic and oxidative stresses, lipid remodeling and altered amino acid and purine metabolisms, while suggesting potential new biomarkers and therapeutic targets. These findings underscore the potential of integrated multi-omics approaches to deepen our understanding of the phenotypic complexity of hereditary optic neuropathies and to support the development of innovative diagnostic and therapeutic strategies.
Current and future applications of intraocular bioadhesives in vitreoretinal surgery.
Mankal S, Saidkasimova S, Lim TH … +2 more , Steele TWJ, Ching J
Surv Ophthalmol · 2026 Apr · PMID 41935794 · Publisher ↗
Achieving retinal adhesion and tissue healing in rhegmatogenous retinal detachment repair has been explored using numerous methods since the foundational principles established by Jules Gonin. Current approaches rely on...
Achieving retinal adhesion and tissue healing in rhegmatogenous retinal detachment repair has been explored using numerous methods since the foundational principles established by Jules Gonin. Current approaches rely on delayed chorioretinal adhesion through thermal injury and inflammatory-mediated scarring. Intraocular bioadhesives (IOBs) offer an alternative strategy, providing efficient sealing of retinal breaks, and abrogating reliance on tamponade agents and their associated morbidities. Despite this, no IOBs are currently licensed for vitreoretinal surgery with limited clinical data to support biocompatibility and safety. We summarize the development and application of IOBs in vitreoretinal surgery, specifically cyanoacrylate, fibrin, polyethylene glycol, and transforming growth factor-beta. Biochemical properties, historical use, and performance are reviewed in context to retinal detachments, macular holes, optic disc maculopathy, and diabetic vitrectomy. We discuss trade-offs between tensile strength and biocompatibility, alongside surgical approaches. We also consider novel alternatives in early clinical studies (foldable capsular vitreous bodies and retinal tacks), and experimental studies (vitreous substitutes and thermofusion). Potential future applications of next-generation IOBs include intraocular drug delivery, treatment of open globe injuries, and sutureless repair of conjunctival and corneal defects. The current research gaps highlighted provide a foundation for addressing unmet needs in vitreoretinal surgery.
Quantitative fundus autofluorescence in age-related macular degeneration.
von der Emde L, Reiter GS, Mallwitz M … +5 more , Jauch AS, Wall K, Holz FG, Pollreisz A, Ach T
Surv Ophthalmol · 2026 Mar · PMID 41933659 · Publisher ↗
Fundus autofluorescence captures the fluorescence of the retina, specifically the retinal pigment epithelium (RPE). Within the RPE, fluorophores, including lipofuscin, melanolipofuscin, and melanosomes, fluoresce when ex...
Fundus autofluorescence captures the fluorescence of the retina, specifically the retinal pigment epithelium (RPE). Within the RPE, fluorophores, including lipofuscin, melanolipofuscin, and melanosomes, fluoresce when excited by light of varying wavelengths. Quantitative fundus autofluorescence (QAF), which has been implemented using blue excitation light, enables mapping and quantifying lipofuscin and melanolipofuscin fluorescence. This is achieved by using a reference bar to standardize measurements. The technical functionality of QAF relies on repeatability and high image quality. Multicenter studies, however, indicate variability. Age-related lens opacities also affect QAF, necessitating individualized correction formulas for accuracy. Accordingly, this review focuses on the development and application of QAF, addressing technical considerations and its relevance to structural and cellular changes in age-related macular degeneration (AMD), and highlighting how QAF can provide clinically meaningful information for AMD diagnosis and therapy monitoring. In AMD, numerous independent studies have found reduced autofluorescence at the posterior pole and as AMD progresses autofluorescence further decreases. Typical AMD lesions, such as subretinal drusenoid deposits, have been associated with significant QAF reduction. On a cellular level, granule aggregation and degranulation are identified as histological correlates. Subcellularly, technologies like serial block-face scanning electron and structured illumination microscopy have revealed a reduced lipofuscin volumetric density and RPE dysmorphia associated with AMD's reduced autofluorescence. New software tools enhance QAF's potential for detailed lesion analysis. Future advancements in QAF include integrating new excitation wavelengths and combining quantified emission spectra and fluorescence lifetimes to improve early detection of AMD-related changes. Despite challenges, QAF continues to evolve, promising better insights into retinal health and disease.
Artificial intelligence in retinal vein occlusion: Current applications, challenges, and future directions.
Torres-Costa S, Machado S, Barbosa G … +6 more , Carvalho E, Guerra A, Ramião N, Penas S, Parente M, Falcão M
Surv Ophthalmol · 2026 Mar · PMID 41921862 · Publisher ↗
Retinal vein occlusion (RVO) is a leading cause of visual impairment worldwide, underscoring the need for earlier detection, objective risk stratification and more personalized management. Recent advances in artificial i...
Retinal vein occlusion (RVO) is a leading cause of visual impairment worldwide, underscoring the need for earlier detection, objective risk stratification and more personalized management. Recent advances in artificial intelligence (AI), particularly deep learning, have enabled automated analysis of retinal imaging modalities routinely used in RVO, including color fundus photography, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography. We critically examine current AI applications in RVO, with a focus on disease detection, subtype classification, ischemia assessment, prognostic modeling and treatment-related decision support. Using a synthesis-oriented framework, we identify unifying methodological trends across studies and evaluate their clinical relevance and translational maturity. AI models demonstrate strong performance in experimental settings, particularly when leveraging lesion-centric representations and multimodal inputs, although most evidence remains limited to retrospective research environments. We further highlight key barriers to clinical adoption, including small and predominantly single-center datasets, limited external and prospective validation, inconsistent annotation and reporting standards. Ethical, regulatory and workflow integration challenges are also discussed. Finally, we outline future directions for RVO-specific AI development, emphasizing the need for multicenter validation, interpretability and clinically deployable tools that support, rather than replace, clinical decision-making.
Anti-vascular endothelial growth factor and choroidal thickness in retinal vein occlusion: A systematic review and meta-analysis.
Sadek K, Yu P, Butt FR … +9 more , Tao BK, Al-Ani A, Yeung S, Pereira A, Tang T, Arjmand P, Mishra A, Ing E, Yan P
Surv Ophthalmol · 2026 Mar · PMID 41912096 · Publisher ↗
Anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care for reetinsl vein occlusion (RVO)-related macular edema, yet its influence on subfoveal choroidal thickness (SFCT,) a potential adjuncti...
Anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care for reetinsl vein occlusion (RVO)-related macular edema, yet its influence on subfoveal choroidal thickness (SFCT,) a potential adjunctive biomarker of disease activity and treatment response, remains uncertain. We evaluated studies that quantify pooled changes in SFCT and best-corrected visual acuity (BCVA) following intravitreal anti-VEGF therapy in adults with RVO. Twenty-three studies (971 eyes) met inclusion criteria. Anti-VEGF therapy significantly reduced SFCT at 1 month (MD 10.25 µm; 95% CI 6.31-14.19), 3 months (25.94 µm; 15.57-36.32), 6 months (27.43 µm; 14.00-40.85), and 12 months (12.05 µm; 3.02-21.09). Branch RVO demonstrated early but transient thinning, while central RVO showed smaller yet more sustained changes. Bevacizumab yielded more consistent SFCT reduction than ranibizumab. BCVA improved across all time points, with the greatest gains (∼0.25 logMAR) within 6 months. Intravitreal anti-VEGF therapy induces moderate, early choroidal thinning and concurrent visual improvement in RVO. SFCT may represent an adjunct biomarker of response, warranting standardized prospective evaluation controlling for ocular biometry.
Laboratory tests of ocular toxocariasis: From pathological diagnosis to immunological diagnosis.
Xu Q, Zhu H, Gong C
Surv Ophthalmol · 2026 Mar · PMID 41887335 · Publisher ↗
Ocular toxocariasis (OT) is an inflammatory eye disorder caused by intraocular migration of Toxocara canis or Toxocara cati larvae, constituting a significant cause of visual impairment among children in developing count...
Ocular toxocariasis (OT) is an inflammatory eye disorder caused by intraocular migration of Toxocara canis or Toxocara cati larvae, constituting a significant cause of visual impairment among children in developing countries. Early and precise diagnosis is crucial for patients' optimal treatment and favorable prognosis. We elucidate 2 commonly employed laboratory diagnostic methods, including early pathological diagnosis and the currently predominant immunological diagnosis, and discuss the limitations inherent to each approach. Although pathological diagnosis is the gold standard for OT, the technical difficulty and inherent risks of ocular tissue biopsy limit its routine use in clinical practice. The first detection of anti-Toxocara IgG (T-IgG) in the vitreous and aqueous humor (AH) in 1979 established a basis for the immunological diagnosis of OT. ELISA is a commonly applied immunological detection method, with various commercial kits available targeting different antigens. Isolated serum anti-Toxocara IgG (T-IgG) testing cannot support an OT diagnosis, whereas intraocular T-IgG detection now constitutes the preferred laboratory diagnostic method. AH provides a reliable proxy when vitreous sampling is unfeasible. When T-IgG detection alone proves inconclusive, supplementary measurement of total IgE levels and eosinophil counts in intraocular fluids (IF) may enhance diagnostic accuracy. Furthermore, WB analysis and cytokine profiling of IF can serve as auxiliary diagnostic tools. Currently, Goldmann-Witmer coefficient (GWC) calculation is recommended for the definitive diagnosis of OT. Given the technical complexity and economic burden of total IgG assays, the feasibility of omitting GWC correction in patients with positive intraocular T-IgG and compatible ocular manifestations requires validation through large-scale multicenter studies. In aggregate, definitive parasite identification through ocular histopathology or imaging remains limited in OT clinical management, rendering immunological methods essential for diagnosis when direct parasitological evidence is absent.
Therapeutic potential of norrin/FZD4/β-catenin signaling in blood-retinal barrier protection.
Martyka A, Bolek B, Gospodarczyk N … +3 more , Czuj W, Wylęgała A, Wylęgała E
Surv Ophthalmol · 2026 Mar · PMID 41862006 · Publisher ↗
The therapeutic potential of the norrin protein, Frizzled-4 (FZD4) receptor, and the β-catenin signaling pathway is gaining increasing importance in ophthalmology due to their multifaceted effects on the function of the...
The therapeutic potential of the norrin protein, Frizzled-4 (FZD4) receptor, and the β-catenin signaling pathway is gaining increasing importance in ophthalmology due to their multifaceted effects on the function of the blood-retinal barrier (BRB). Disruption of BRB integrity represents a key mechanism underlying pathological vascular permeability and the progression of diabetic retinopathy and age-related macular degeneration. There remains an unmet need for the development of therapies specifically targeting the protection and regeneration of the BRB, as current treatment strategies primarily focus on symptom alleviation rather than addressing the underlying mechanisms of barrier breakdown. Interest in norrin signaling within the Wnt/β-catenin pathway arises from its crucial role in maintaining BRB integrity through the activation of the FZD4 receptor and LRP5/6 co-receptors, leading to the stabilization of endothelial junctional complexes and the maintenance and restoration of retinal vascular barrier properties, particularly following vascular endothelial growth factor (VEGF)-induced barrier disruption modulation of this pthway may represent a novel therapeutic approach aimed at protecting and regenerating the BRB in degenerative retinal diseases. We identify current research directions regarding new therapeutic strategies for ophthalmic diseases associated with BRB dysfunction, with particular emphasis on the role of norrin protein, Frizzled-4 (FZD4) receptors, and β-catenin. A comprehensive search was conducted in electronic databases (PubMed, Google Scholar) using the following keywords: blood-retinal barrier, norrin protein, Frizzled-4 receptors (FZD4), β-catenin, Wnt signaling, retinal diseases, Wnt signaling agonists, Wnt signaling inhibitors, monoclonal antibodies, gene therapy. English-language publications from 2015 to 2025 were analyzed, focusing on the role of norrin, FZD4, and β-catenin in maintaining BRB integrity and their potential therapeutic applications in retinal diseases. Additionally, reference lists of selected publications were reviewed Current research directions focus on 3 potential therapeutic strategies: modulation of Wnt/norrin signaling using pathway agonists and inhibitors, application of monoclonal antibodies targeting receptors, and gene therapy. Although all these approaches demonstrate promising therapeutic potential, further clinical studies are required to assess their long-term efficacy and safety.
Pharmacologic principles behind eye drop dosing: From pharmacokinetics to clinical practice.
Lucchino L, Giuliano E, Giuliano F … +5 more , Chiorrini R, Semeraro F, Drago L, Ferrara M, Romano V
Surv Ophthalmol · 2026 Mar · PMID 41862005 · Publisher ↗
Topical ocular therapy plays a crucial role in managing infectious and inflammatory diseases of the anterior segment. Its therapeutic efficacy depends not only on the intrinsic potency of the drug, but also on the approp...
Topical ocular therapy plays a crucial role in managing infectious and inflammatory diseases of the anterior segment. Its therapeutic efficacy depends not only on the intrinsic potency of the drug, but also on the appropriateness of the dosing regimen in relation to ocular pharmacokinetics and pharmacodynamics principles. Because less than 5% of an instilled dose reaches the intraocular tissues, achieving therapeutic efficacy requires tailoring dosing schedules to tear dynamics, barrier permeability, and formulation characteristics. Despite its central relevance to clinical outcomes, the application of pharmacokinectics/pharmacodynamics (PK/PD) principles to topical ocular therapy remains under-recognized and often inconsistently applied in routine practice. In this light, this review integrates experimental and clinical evidence on how pharmacologic principles guide the dosing of anti-microbial and anti-inflammatory agents. Among antibiotics, aminoglycosides benefit from high early peaks (peak concentratio/minimum inhibitory concentration [MIC]-driven), fluoroquinolones from sustained exposure (area under the curve/MIC-driven), and β-lactams from continuous time above MIC (T > MIC). These PK/PD parameters must also take into account the pathogen's susceptibility in addition to the intrinsic bacteriostatic or bactericidal activity of the drug. Similarly, corticosteroid and immunomodulator regimens require controlled loading and tapering to balance efficacy and safety, particularly in graft care and ocular surface disease. Advances in preservative-free systems, nanocarriers, and stimuli-responsive formulations promise greater precision, lower toxicity, and improved adherence. Integrating PK/PD-guided strategies into daily practice offers a rational framework for optimizing topical ocular pharmacotherapy across drug classes.
Atopic keratoconjunctivitis: From molecular mechanisms to clinical implications.
Vera-Duarte GR, Ortiz-Morales G, Guerrero-Acosta JC … +5 more , Carrete-Corral SA, Ramirez-Miranda A, Graue-Hernandez EO, Rodriguez-Garcia A, Navas A
Surv Ophthalmol · 2026 Mar · PMID 41856175 · Publisher ↗
Atopic keratoconjunctivitis (AKC) is a chronic, bilateral inflammatory disease of the ocular surface that primarily affects young adults with a history of atopic dermatitis, asthma, or allergic rhinitis. AKC is considere...
Atopic keratoconjunctivitis (AKC) is a chronic, bilateral inflammatory disease of the ocular surface that primarily affects young adults with a history of atopic dermatitis, asthma, or allergic rhinitis. AKC is considered the most severe form of ocular surface allergy and can result in serious complications that threaten vision, such as corneal ulceration, neovascularization, and scarring. Genetic predisposition, through regulatory genes that impact skin barrier function, immune system regulation, and allergic responses, plays a crucial role in the development and severity of AKC. Recent research has highlighted the roles of epithelial barrier dysfunction, gastrointestinal and eyelid/conjunctival dysbiosis, Th2-driven cytokines, and eosinophilic inflammation in disease perpetuation. Diagnosing AKC requires a high level of suspicion, careful integration of clinical signs, and a thorough assessment of coexisting atopic conditions. Management is often challenging and involves a stepwise approach, beginning with topical antihistamines and mast cell stabilizers, progressing to corticosteroids, calcineurin inhibitors, and, in severe or refractory cases, systemic immunosuppressive therapy or surgical intervention. Novel therapies, including biologics targeting IL-4 and IL-13, show promise in selected patients. A multidisciplinary approach and long-term follow-up are crucial for minimizing complications and preserving visual function. We provide a comprehensive update on the epidemiology, clinical manifestations, immunopathogenesis, diagnostic approach, and therapeutic strategies for AKC.
Beyond keratoplasty: The role of Descemet stripping only in the management of Fuchs endothelial dystrophy-a systematic review and meta-analysis.
Sahin Vural G, Akgun Z, Barut Selver O
Surv Ophthalmol · 2026 Mar · PMID 41856174 · Publisher ↗
The clinical role of Descemet stripping only (DSO) in treating Fuchs endothelial corneal dystrophy (FECD) remains uncertain. The literature varies regarding patient selection, timing of intervention, and use of additiona...
The clinical role of Descemet stripping only (DSO) in treating Fuchs endothelial corneal dystrophy (FECD) remains uncertain. The literature varies regarding patient selection, timing of intervention, and use of additional therapies. We evaluate the efficacy and safety of DSO through a systematic review and meta-analysis, focusing on visual outcomes, corneal clearance, and the need for subsequent keratoplasty. It was conducted following PRISMA guidelines and registered with PROSPERO (ID: CRD420251160540). Comprehensive searches of MEDLINE, Scopus, Web of Science, and Embase were performed from inception to August 2025. Eligible studies included prospective or retrospective clinical series with at least 5 patients who underwent DSO for FECD and had a minimum follow-up of 6 months. Data extraction focused on best-corrected visual acuity (BCVA), corneal clearance rates, complications, and reoperation rates. Risk of bias was assessed using the Newcastle-Ottawa Scale and the Egger test. After a multistage screening process, 15 studies meeting the inclusion criteria were included. The pooled mean difference in BCVA, estimated using a random-effects model, was 0.23 LogMAR (95% Confidence Interval [CI] -0.30 to -0.17). The corneal clearance rate after DSO was found to be 0.91 (95% CI, 0.85-0.96). Subgroup analysis based on postoperative Rho-kinase inhibitor (ROCKi) use showed that the corneal clearance rate was higher in the group that used ROCKi prophylactically than in the group that did not (96% vs. 85%), with a statistically significant difference (p = 0.0012). The need for secondary endothelial keratoplasty (EK), considered surgical failure after DSO, was 10 % (95% CI, 0.05-0.15). In conclusion, DSO presents a promising alternative to EK in certain FECD patients, decreasing dependence on donor tissue and eye banks, reducing immunological risks, and minimizing the need for complex surgeries. Although the results generally support its clinical value, the variation in outcomes emphasizes the importance of patient selection and complementary therapies. We consolidate the available evidence and underscore the necessity for prospective studies to establish standard indications for DSO and enhance its clinical application.
Photodynamic therapy and anti-vascular endothelial growth factor for acute central serous chorioretinopathy: An updated systematic review and meta-analysis.
Algodi HS, Al-Burak SA, Zeng E … +4 more , Tannar B, Sadek K, Butt F, Malvankar-Mehta MS
Surv Ophthalmol · 2026 Mar · PMID 41833620 · Publisher ↗
Acute central serous chorioretinopathy (CSC) may resolve spontaneously, but risks progression to chronic disease with visual impairment. We performed a PRISMA-compliant meta-analysis evaluating photodynamic therapy (PDT)...
Acute central serous chorioretinopathy (CSC) may resolve spontaneously, but risks progression to chronic disease with visual impairment. We performed a PRISMA-compliant meta-analysis evaluating photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) agents versus observation in acute CSC (<6 months), searching PubMed, EMBASE, and CENTRAL (October 2014 - May 2025) for comparative studies. Eleven studies (5 randomized, 6 non-randomized; 464 eyes) were included. PDT demonstrated robust superiority over observation, achieving significant best-corrected visual acuity gains and sustained central macular thickness reductions at 1, 3, and 12 months. Notably, PDT-treated eyes were nearly 4 times more likely to achieve complete fluid resolution at 1 month, a benefit maintained across all follow-up intervals. Conversely, anti-VEGF therapy provided only a transient anatomical reduction at 1 month, without significant visual improvement or sustained benefit. Both interventions were well tolerated. In conclusion, half-dose PDT provides durable anatomical and functional improvements for acute CSC, significantly accelerating fluid resolution and visual recovery. While observation remains a valid initial approach, early PDT is practically advantageous for patients requiring rapid visual rehabilitation or to mitigate permanent photoreceptor damage from persistent fluid. Anti-VEGF therapy offers limited, transient anatomical effects without functional benefit and should be reserved for atypical cases or when PDT is unavailable.
Optical coherence tomography angiography in pediatric and adult populations: A comprehensive review.
Busza AM, Lyons CE, Hamzeh N … +2 more , Mohammadi SS, Gill MK
Surv Ophthalmol · 2026 Mar · PMID 41825603 · Publisher ↗
Optical coherence tomography angiography (OCT-A) is a non-invasive retinal imaging tool with expanding clinical and research applications, including potential uses as a biomarker for systemic diseases. The influence of a...
Optical coherence tomography angiography (OCT-A) is a non-invasive retinal imaging tool with expanding clinical and research applications, including potential uses as a biomarker for systemic diseases. The influence of age on OCT-A parameters, however, remains incompletely understood. To address this, we conducted a comprehensive review across seven databases, screening 271 full-text articles, of which 156 met inclusion criteria. Extracted data included participant demographics, study design, OCT-A device type, measured parameters, and outcomes across retinal layers in the macula and optic nerve head. Normative OCT-A values for pediatric and older adult populations were also reviewed. Evidence consistently demonstrated an age-related decline in macular vessel density among adults, even after accounting for signal strength. In contrast, pediatric studies showed variable associations between age and vascular parameters. Across all populations, foveal avascular zone size remained largely unaffected by age. These findings highlight the importance of considering age when interpreting OCT-A metrics in both clinical and research settings.
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