Surv Ophthalmol [JOURNAL]
Sun
200 papers
Inner retinal surface abnormalities: Imaging phenotypes, quantitative features, and mechanistic insights across surgical and nonsurgical conditions.
Quarta A, Feo A, Boscia G … +4 more , Savastano A, Boscia F, Romano MR, Mastropasqua R
Surv Ophthalmol · 2026 Mar · PMID 41825602 · Publisher ↗
Advances in cross-sectional and en face optical coherence tomography have revealed a spectrum of subtle inner retinal changes that occur in both surgical and non-surgical conditions. Among these, inner retinal dimples (I...
Advances in cross-sectional and en face optical coherence tomography have revealed a spectrum of subtle inner retinal changes that occur in both surgical and non-surgical conditions. Among these, inner retinal dimples (IRDs), also referred to as dissociated optic nerve fiber layer (DONFL) appearance, concentric macular dark spots (CMDS), and transient swollen arcuate nerve fiber layer (SANFL) have been described in eyes undergoing internal limiting membrane (ILM) peeling, most commonly for macular hole or epiretinal membrane while paravascular inner retinal defects (PIRD), micro-holes, and clefts have been reported in highly myopic eyes and tractional conditions even without prior surgery. The multiplicity of terms, some modality-dependent, others descriptive of etiology has obscured the relationships among these entities, causing confusion in clinical interpretation and research communication. Herein, we propose a hypothesis-driven conceptual and terminological framework intended to reconcile these disparate observations within a coherent schema grounded in anatomy and imaging phenotype while recognizing that the available evidence remains predominantly retrospective and heterogeneous. By reviewing multimodal imaging studies we clarify that postoperative IRDs, DONFL, CMDS, and SANFL may reflect a remodeling response of the inner retina (largely due to ILM removal/peeling, either surgical or spontaneous) whereas PIRD and its variants stem from chronic biomechanical or tractional stress. The review examines their morphological characteristics, temporal evolution, and available data on structure-function correlations. Standardizing nomenclature and interpretation will enhance clarity in both surgical outcomes assessment and clinical management of myopic or tractional retinal disease.
Aberrant angiogenesis, inflammation, and fibrosis in pediatric vitreoretinal surgical diseases.
Harju N, Kauppinen A, Loukovaara S
Surv Ophthalmol · 2026 Mar · PMID 41825601 · Publisher ↗
Pediatric rhegmatogenous retinal detachment (RRD) is usually caused by trauma or myopia, but can also be a comorbidity of genetic or congenital diseases or a complication after previous eye surgery. Pediatric RRD is chal...
Pediatric rhegmatogenous retinal detachment (RRD) is usually caused by trauma or myopia, but can also be a comorbidity of genetic or congenital diseases or a complication after previous eye surgery. Pediatric RRD is challenging due to late diagnosis, distinct ocular anatomy compared to adults, and a higher prevalence of proliferative vitreoretinopathy (PVR). Late diagnosis due to limited symptom awareness, especially in younger children, ultimately leads to poor surgical outcomes, causing chronic detachment and PVR formation. Pediatric patients are susceptible to more severe PVR due to stronger proliferative and inflammatory responses compared to adults e.g. after trauma or retinal break. To achieve structurally and functionally positive outcomes after surgical intervention, RRD in children must be diagnosed and treated promptly. Surgical treatment options for pediatric RRD include scleral buckling, vitrectomy, laser treatment, and cryotherapy. The success rate of pediatric RRD eye surgery is lower, and the incidence of preoperative or postoperative PVR is higher, compared to adults. PVR causes retinal redetachment and is characterized by contractile proliferative membranes especially at the vitreoretinal interface, but also intraretinally/subretinally. Inflammatory and proliferative responses are more pronounced in pediatric eyes compared to adults. Only a few studies specifically focusing on pediatric cases have been conducted to prevent fibrotic scarring changes in PVR. We present pediatric (aged ≤18 years) fibrotic vitreoretinal diseases and related research from the interface of laboratory and clinical perspectives. Further studies are needed to elucidate the vitreous and retinal diseases in pediatric patients that are associated with inflammatory, proliferative, and fibrotic changes leading to PVR, both preoperatively and postoperatively. More information is needed on how to prevent these conditions and how to improve the anatomical and functional visual acuity of the eye in pediatric retinal diseases.
Peripheral retinal degenerations: A review of peripheral optical coherence tomography applications in their diagnosis and visualization.
Rizzo C, Mercuri S, Savastano MC … +7 more , Govetto A, Nicolosi C, Vicini G, Faraldi F, Virgili G, Giansanti F, Bacherini D
Surv Ophthalmol · 2026 Mar · PMID 41825600 · Publisher ↗
Optical coherence tomography (OCT) has transformed retinal imaging, primarily focusing on the posterior pole; however, its application in assessing peripheral retinal lesions is an evolving field. Recent advances in wide...
Optical coherence tomography (OCT) has transformed retinal imaging, primarily focusing on the posterior pole; however, its application in assessing peripheral retinal lesions is an evolving field. Recent advances in widefield (WF) and ultra-widefield (UWF) OCT technology have significantly expanded the ability to image the peripheral retina, allowing for improved detection and characterization of peripheral retinal lesions. We evaluate the effectiveness of OCT in identifying peripheral retinal lesions, assessing vitreoretinal adhesions and tractions, aiding differential diagnosis, and guiding treatment strategies among studies published between 2006 and 2024. WF and UWF OCT have significantly enhanced the visualization and documentation of peripheral retinal abnormalities, facilitating more precise detection of retinal breaks, lattice degeneration, and vitreoretinal traction. These advancements have influenced clinical decisions, ranging from conservative monitoring to laser therapy or surgical intervention. Furthermore, OCT has provided valuable insights into the pathophysiology of these retinal disorders; however, several challenges persist, including the absence of standardized imaging protocols and variability in the interpretation of morphological findings. While peripheral OCT imaging enhances diagnostic accuracy and clinical management, broader adoption requires standardization of acquisition techniques and diagnostic criteria. We explore the role of WF and UWF OCT in visualizing peripheral retinal degenerations, describing their hallmark features on OCT, evaluating their diagnostic value, clinical impact, and current limitations. Future research should focus on refining imaging protocols, developing automated diagnostic tools, and evaluating the prognostic significance of peripheral OCT findings to improve patient outcomes.
William W. Cooper and his epidemiological study "On the conical cornea" of 1850.
Jurkiewicz T, Marty AS
Surv Ophthalmol · 2026 Mar · PMID 41819217 · Publisher ↗
PURPOSE: We present the life and work of William White Cooper, with a focus on his 1850 study On the conical cornea, the earliest known multicentre epidemiological investigation of keratoconus. We contextualise Cooper's...
PURPOSE: We present the life and work of William White Cooper, with a focus on his 1850 study On the conical cornea, the earliest known multicentre epidemiological investigation of keratoconus. We contextualise Cooper's contribution within mid-19th-century ophthalmology, reassessing his findings in light of modern epidemiological knowledge. METHODS: Historical research was conducted using Gallica (the digital platform of the National Library of France (BnF)) and the historical resources of The Lancet website. The keywords used were 'conical cornea' or 'keratoconus,' which were the most common names for keratoconus. RESULTS: William White Cooper, a leading Victorian ophthalmic surgeon and later Surgeon-Oculist in Ordinary to Queen Victoria, conducted what appears to be the first epidemiological study of keratoconus, nearly a century before the earliest study typically cited in modern literature. Drawing on data from multiple ophthalmic hospitals across England, Scotland, Ireland, and Macao, Cooper compiled prevalence figures from over 200,000 examined patients between 1814 and 1850. Prevalence rates, recalculated for comparison with modern standards, varied markedly between regions: from 0 in Edinburgh to 254.0 cases per 100,000 in Plymouth, with an overall prevalence of 85.92 per 100,000 for the United Kingdom. The highest prevalence was observed in Macao (324.15 per 100,000), leading Cooper to hypothesise that warmer climates might favor the occurrence of keratoconus. Despite the diagnostic limitations of the period, these values are strikingly close to those reported in parts of modern Europe, underscoring the scale and relevance of his pioneering work. CONCLUSION: Cooper's 1850 investigation represents the earliest known multicentre epidemiological study of keratoconus, predating modern reports by nearly a century. Despite methodological limitations inherent to the mid-19th century, his findings anticipated contemporary prevalence patterns and introduced the hypothesis of environmental influences on disease occurrence. This work not only enriches the historical record of keratoconus, but also highlights the enduring value of early clinical observation in shaping epidemiological understanding.
Comparative pathogenesis and management of orbital/conjunctival and gastric MALT lymphoma: Microbial drivers, molecular mechanisms, and therapeutic implications.
Wang IM, Tsai IL
Surv Ophthalmol · 2026 Mar · PMID 41819216 · Publisher ↗
Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of indolent extranodal B-cell non-Hodgkin lymphoma. Orbital and conjunctival MALT lymphomas (OAML) are the most common primary ocular adnexal lymphomas, whil...
Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of indolent extranodal B-cell non-Hodgkin lymphoma. Orbital and conjunctival MALT lymphomas (OAML) are the most common primary ocular adnexal lymphomas, while gastric MALT lymphoma remains a prototypical site linked to Helicobacter pylori infection. Despite the disparate anatomical locations, mounting evidence suggests a shared pathogenesis, including chronic antigenic stimulation, lymphoid accumulation, and genetic events. We explore the epidemiologic, pathophysiologic, and molecular connections between OAML and gastric MALT lymphoma, with particular emphasis on the therapeutic implications. The role of H. pylori as a driver of gastric lymphomagenesis is well-established, and antibiotic eradication therapy has revolutionized treatment. By contrast, the evidence for microbial triggers and antibiotic responsiveness in OAML remains equivocal, although Chlamydia psittaci has been proposed in some populations. We comprehensively evaluate treatment modalities for OAML, including watchful waiting, antibiotic therapy, low-dose radiotherapy, immunochemotherapy (e.g., rituximab, bendamustine), and targeted agents. The differences in natural history, treatment response, and relapse patterns between gastric and ocular MALTomas are reviewed, and a proposed treatment algorithm is presented. Finally, we highlight knowledge gaps and future directions, including molecular profiling, predictive biomarkers, and microbiome-targeted interventions.
Ophthalmic manifestations in preterm children without retinopathy of prematurity: A review.
Sheibani K, Bayat K, Rajavi Z … +8 more , Abdi S, Hatami F, Mirzaei SK, Nikkhah H, Haseli-Mofrad A, Shahriari MH, Bineshfar N, Sabbaghi H
Surv Ophthalmol · 2026 Mar · PMID 41819215 · Publisher ↗
We synthesized current evidence on the spectrum of ophthalmic alterations in prematurely born children without retinopathy of prematurity (ROP). A literature review was conducted in accordance with PRISMA guidelines. Sco...
We synthesized current evidence on the spectrum of ophthalmic alterations in prematurely born children without retinopathy of prematurity (ROP). A literature review was conducted in accordance with PRISMA guidelines. Scopus, PubMed, Web of Science, and Cochrane Library were searched for English-language studies published between 2000 and 2025. Eligible studies included observational designs reporting ophthalmic outcomes in infants born before 37 weeks of gestation without ROP. A total of 32 studies consisting of 4,548 individuals were investigated. Data were qualitatively synthesized across visual, refractive, anterior segment, and posterior segment domains. Mean visual acuity in preterm children without ROP ranged from -0.06 to 0.16 LogMAR and was generally comparable to term peers. Stereoacuity was reduced but showed improvement with age. Strabismus was reported in 5-20% of cases, increasing with age, and most commonly presented as esotropia. Nystagmus incidence ranged from 0-14%. Anisometropia was reported in 1.4-16.7% of preterm children without ROP, with one study demonstrating a higher prevalence compared to term peers. Hyperopia was highly prevalent, ranging from 20.9% to 86.2%, while astigmatism was reported in 14.1-65.1% of cases. Astigmatism predominated at one year of age, whereas hyperopia became the most common refractive error by six years. Hyperopia tends to increase with age, astigmatism gradually declines, and myopia rates remain relatively stable. Anterior segment findings in infancy included greater central corneal thickness, smaller corneal diameter, reduced axial length, shallower anterior chamber depth, and increased lens thickness. Posterior segment alterations included thicker central macula and focal thinning of the retinal nerve fiber layer in some reports. Premature birth, even in the absence of ROP, is independently associated with persistent structural and functional ophthalmic alterations. These findings highlight the need for long-term surveillance and early ophthalmologic intervention in this population.
Efficacy and safety of conbercept, ranibizumab and laser in retinopathy of prematurity: A systematic review and network meta-analysis.
Zhu X, Linghu D, Deng X … +2 more , Liang J, Cheng Y
Surv Ophthalmol · 2026 Mar · PMID 41796650 · Publisher ↗
We evaluate conbercept, ranibizumab, and laser therapy for retinopathy of prematurity (ROP) through 53 studies (14 RCTs, 29 retrospective, 10 single-arm) involving 8787 eyes. Primary endpoints included inactive ROP rates...
We evaluate conbercept, ranibizumab, and laser therapy for retinopathy of prematurity (ROP) through 53 studies (14 RCTs, 29 retrospective, 10 single-arm) involving 8787 eyes. Primary endpoints included inactive ROP rates (resolution of plus disease/vascular tortuosity), disease regression, recurrence rates, and retreatment needs, with safety assessments covering ocular complications (retinal detachment, vitreous hemorrhage) and systemic events (apnea, arrhythmias). Exploratory analyses examined conbercept dosing regimens (0.15 mg, 0.25 mg, 0.3 mg). Conbercept showed superior cumulative efficacy (SUCRA = 0.815) vs laser (0.533) and ranibizumab (0.152), though initial treatment responses were comparable. Ranibizumab had higher recurrence (RR = 3.62, 95%CI:1.31-11.64) and retreatment rates (RR = 2.31, 95%CI:1.18-5.55) than laser, which ranked best for preventing recurrence (SUCRA = 0.792). Conbercept's ocular AE rate (3.85%) was lower than laser (9.82%) and ranibizumab (5.03%), with fewer systemic complications (3.49% NICU admissions vs 42.17% for laser). Dose-response analysis revealed 0.25 mg conbercept balanced efficacy (82.70% inactivity) and safety (3.84% AEs), while 0.3 mg showed peak efficacy (90.7%) but limited safety data. Higher doses reduced recurrence (22.97% at 0.15 mg vs 17.00% at 0.25 mg).
Update on subthreshold micropulse laser treatment for retinal diseases: A narrative review.
Sim SY, Lim LT, Chaudhary S … +7 more , Musa M, Hamilton R, Nicholson L, Pal B, Saini P, Mankongcharoen P, Sen S
Surv Ophthalmol · 2026 · PMID 41763458 · Publisher ↗
Subthreshold micropulse laser (SML) has emerged as a valuable and effective alternative to conventional laser treatments for a variety of retinal diseases, offering therapeutic benefits while minimizing tissue damage. Un...
Subthreshold micropulse laser (SML) has emerged as a valuable and effective alternative to conventional laser treatments for a variety of retinal diseases, offering therapeutic benefits while minimizing tissue damage. Unlike traditional continuous wave lasers which induce irreversible changes to photoreceptors and retinal pigment epithelial (RPE) cells due to thermal damage, SML delivers energy in short bursts with cooling intervals, maintaining subthreshold temperatures that trigger therapeutic cellular responses without causing visible retinal scarring. We have synthesized the latest evidence on SML's role in managing diabetic macular edema (DME), central serous chorioretinopathy (CSCR), macular edema secondary to retinal vein occlusion, and age-related macular degeneration. Across these conditions, SML demonstrates comparable visual and anatomical outcomes to conventional laser and anti-vascular endothelial growth factor therapies, with notable benefits, including a reduced injection burden in DME and improved choriocapillaris perfusion in CSCR. Additionally, emerging data suggests SML may hold an edge in more complex cases, such as chronic CSCR, pseudophakic macular edema, and dome-shaped maculopathy; however, inconsistencies in laser parameters including wavelength, duty cycle, fluence parameters and spot size continue to pose challenges in standardizing treatment protocols. The "reset theory" of RPE restoration, driven by heat shock protein activation or other described mechanisms, underscores SML's potential to offer sustained, long-term disease control. While current evidence is promising, larger, high-quality studies are still needed to fine-tune treatment settings, improve patient selection strategies, and clarify SML's role alongside other therapies. We provide a comprehensive overview of SML's progress, potential, and future direction in retinal disease management.
Advancements of ultrasound modalities and their clinical potential in ophthalmology.
Zhang C, Xu Z
Surv Ophthalmol · 2026 Feb · PMID 41747839 · Publisher ↗
Ultrasound imaging has played an important role in ophthalmic diagnostics due to its real-time capability, safety, and cost-effectiveness. In recent years several novel ultrasound modalities have been applied to diagnosi...
Ultrasound imaging has played an important role in ophthalmic diagnostics due to its real-time capability, safety, and cost-effectiveness. In recent years several novel ultrasound modalities have been applied to diagnosis of ocular diseases, including contrast-enhanced ultrasound (CEUS), photoacoustic imaging (PAI), 3-dimensional ultrasound (3D-US), microvascular flow imaging (MFI), super-resolution ultrasound localization microscopy (SRULM), ultrasound elastography, and high-frequency ultrasound (HFUS). These technologies offer improvements in spatial resolution, tissue characterization, and functional imaging. Specifically, CEUS, PAI, MFI, and SRULM allow for the evaluation of ocular blood flow and vasculature, while HFUS and elastography enhance the assessment of intraocular structures and tissue stiffness. 3D-US contributes to the volumetric analysis of ocular lesions. In parallel, the integration of artificial intelligence with ultrasound has enabled automated image interpretation and disease classification, with applications in various ocular diseases, such as retinal detachment, intraocular tumor, and glaucoma. Despite these advances, limitations remain, such as the difficulty in balancing image resolution with penetration depth. Further development in multimodal imaging, algorithm optimization, and clinical validation is needed. Therefore, we review the current progress in novel ultrasound modalities, explores the clinical potential of ophthalmic application, and outlines existing challenges as well as future research directions.
Complications of corneal crosslinking: What can go wrong?
Korkmaz I, Palamar M
Surv Ophthalmol · 2026 · PMID 41747838 · Publisher ↗
Corneal cross-linking (CXL) is a widely used treatment that is effective in halting the progression of corneal ectasias. Although its therapeutic efficacy is well established, various short- and long-term complications f...
Corneal cross-linking (CXL) is a widely used treatment that is effective in halting the progression of corneal ectasias. Although its therapeutic efficacy is well established, various short- and long-term complications following CXL have been reported. We evaluate the potential complications of the CXL procedure and summarize their management. The most common post-CXL complications include corneal haze, sterile corneal infiltrates, microbial infection, endothelial dysfunction, limbal damage, Herpes simplex reactivation, and treatment failure. These complications may arise from alterations in the microscopic structure and properties of the cornea, as well as from the surgical procedure itself. A preoperative thin (<400 microns) and steep (maximum K reading >58.00 D) cornea, accompanying ocular surface problems (e.g., blepharitis, dry eye), advanced age, and a history of atopy are key factors that increase the risk of complications after CXL. While most of these complications can be reversed with short-term topical treatments, serious surgical intervention may occasionally be required. Therefore, the treatment approach for each complication should be individualized and disease-specific. Appropriate patient selection, addressing preexisting ocular surface conditions, adherence to the safety protocols of the procedure, a comprehensive postoperative treatment regimen, and early recognition of complications are crucial for minimizing risks after CXL.
Infection post strabismus surgery: A review and case series.
Bansal AA, Sachdeva V, Kekunnaya R
Surv Ophthalmol · 2026 · PMID 41747837 · Publisher ↗
Surgical site infection is a relatively rare complication of strabismus surgery; however, if it occurs, it can have permanent impact on the patient. Prior existing case reports and questionnaire-based studies have descri...
Surgical site infection is a relatively rare complication of strabismus surgery; however, if it occurs, it can have permanent impact on the patient. Prior existing case reports and questionnaire-based studies have described different types of surgical site infections that can occur post strabismus surgery. It is not only important to know how to identify and treat such cases, but also to know how to prevent them, in addition to identifying the causative risk factors. In this review, we discuss 10 such cases of various types of infection that occurred post strabismus surgery and how they were managed. Our aim is to provide a comprehensive guideline by which clinicians can appropriately manage such cases.
Levodopa in retinal disease: Dopamine pathways, neuroprotective mechanisms, and clinical evidence.
Murati F, Ghahari P, Zvavamwe T … +6 more , Williams WW, Curran K, Peto T, Lengyel I, McKay BS, Kozak I
Surv Ophthalmol · 2026 Feb · PMID 41747836 · Publisher ↗
We review the role of levodopa (L-DOPA), a dopamine precursor used to treat Parkinson disease, as a candidate for retinal neuroprotection, focusing on retinal dopamine biology, mechanisms of action, and evidence from pre...
We review the role of levodopa (L-DOPA), a dopamine precursor used to treat Parkinson disease, as a candidate for retinal neuroprotection, focusing on retinal dopamine biology, mechanisms of action, and evidence from preclinical and clinical studies. Selected experimental and clinical studies indicate that L-DOPA and related dopaminergic interventions influence multiple retinal pathways relevant to degeneration. L-DOPA, synthesized in the pigmented retinal pigment epithelium, activates GPR143 signaling and promotes the release of neuroprotective factors. In animal studies, L-DOPA supplementation rescued retinal development in albinism and reduced oxidative damage to photoreceptors. Epidemiologic analyses showed that patients on systemic L-DOPA had a delayed onset and a lower incidence of age-related macular degeneration (AMD). Small clinical studies in neovascular AMD demonstrated that adjunctive oral L-DOPA improved vision and reduced the burden of anti-vascular endothelial growth factor injections. Larger controlled trials are needed to define efficacy, optimal dosing, and long-term tolerability. Given its established pharmacology and ability to cross the blood-retinal barrier, L-DOPA is a promising candidate for therapeutic repurposing in ophthalmology.
Effective communication strategies in intravitreal therapy: How to listen and how to talk to people who need injections in their eyes.
Ziemssen F, Loewenstein A, Aslam TM
Surv Ophthalmol · 2026 · PMID 41747835 · Publisher ↗
Effective communication between patients and their ophthalmologists is a key determinant of long-term success in intravitreal therapy (IVT). Because patients must accept repeated invasive procedures and frequent visits,...
Effective communication between patients and their ophthalmologists is a key determinant of long-term success in intravitreal therapy (IVT). Because patients must accept repeated invasive procedures and frequent visits, understanding, trust, and sustained adherence are essential. In contemporary IVT services, all members of the ophthalmology team contribute substantially to information transfer, reassurance, and continuity of care. This narrative review summarizes practical, therapy-specific communication strategies tailored to the needs and challenges of patients receiving repeated IVT. It translates established communication principles into concrete guidance for ophthalmologists and their teams, with a particular focus on strengthening the ophthalmologist-patient partnership in IVT. We outline typical stages of the IVT care trajectory, from diagnosis and the first injection through long-term follow-up, treatment fatigue, and potential discontinuation, and link each stage to distinct communication tasks. Building on models of patient-centered communication and shared decision-making, we describe how to explain the chronic nature of disease, prepare patients for the procedure, address fears and misconceptions about injections, and set realistic expectations regarding visual outcomes and treatment burden. We highlight how structured consultations, clear and jargon-free language, visual aids, and coordinated teamwork in the ophthalmology service can support understanding, trust, and adherence. Specific attention is given to assessing decision-making capacity, involving relatives or legal representatives, navigating best-interest decisions in patients with dementia or learning disabilities, and discussing non-response as well as switching or stopping therapy in older, comorbid patients. Throughout, we integrate evidence on adherence and persistence in IVT and illustrate how communication can mitigate common reasons for non-adherence. The review provides concrete, IVT-specific communication guidance intended to strengthen the ophthalmologist-patient relationship and supports sustained engagement in care.
Ocular inflammation after intraocular drug delivery: Mechanisms, risk factors, and implications for clinical practice.
Ferro Desideri L, Fukuhara PS, Wintergerst MWM … +4 more , Meyer CH, Emerson GG, Anguita R, Melo GB
Surv Ophthalmol · 2026 · PMID 41702513 · Publisher ↗
Ocular inflammation is a well-known complication of intraocular drug delivery. While relatively rare, it can lead to serious outcomes, including retinal vasculitis and vascular occlusion that are among the most feared ad...
Ocular inflammation is a well-known complication of intraocular drug delivery. While relatively rare, it can lead to serious outcomes, including retinal vasculitis and vascular occlusion that are among the most feared adverse events in ophthalmic practice. These reactions have received increasing attention with the widespread use of anti-vascular endothelial growth factors and, more recently, anti-complement therapies. In this review, we discuss current concepts of post-injection inflammation, linking experimental findings with clinical experience. We consider how drug formulation, immune responses, delivery techniques, and the use of silicone oil-coated syringes may contribute to inflammatory risk, and how these factors differ between agents. Particular emphasis is placed on distinguishing infectious from sterile inflammation, a critical step for timely and appropriate management. Using evidence from clinical trials and real-world studies, we compare patterns of intraocular inflammation reported with different intraocular therapies and outline practical considerations for prevention, recognition, and treatment. As intraocular therapies continue to evolve, understanding and addressing these complications remains essential for safe and effective ophthalmic care.
Safety and efficacy of anti-vascular endothelial growth factor (VEGF) plus corticosteroids versus anti-VEGF alone for macular edema from retinal vein occlusion: A systematic review and meta-analysis.
Khilji M, Hira S, Ahmed Z … +10 more , Ansar S, Idrees SA, Zafar W, Rekham SY, Jawad A, Fayyaz F, Amyn M, Batool SS, Haider ST, Bach BB
Surv Ophthalmol · 2026 · PMID 41698436 · Publisher ↗
We evaluate the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) and corticosteroid combination therapy versus anti-VEGF monotherapy for both branch retinal vein occlusion (BRVO) and central ret...
We evaluate the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) and corticosteroid combination therapy versus anti-VEGF monotherapy for both branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO)-related macular edema. A systematic search identified randomized controlled trials (RCTs) comparing the 2 modalities. Non-RCTs, studies with steroid monotherapy as the only comparator and macular edema from other causes were excluded. Visual, anatomical, safety, and injection-related outcomes were assessed. Twenty RCTs comprising 2040 patients were included. Combination therapy showed better best-corrected visual acuity (BCVA) (Mean Difference [MD] -0.09; 95 % CI -0.12 to -0.07; p < 0.00001), reduced central macular thickness (CMT) (MD -24.42; 95 % CI -35.32 to -13.52; p < 0.0001), lower edema recurrence (Odds Ratio [OR] 0.49; 95 % CI 0.30-0.80; p = 0.004), reduced need for PRN anti-VEGF injections (OR 6.77; 95 % CI 3.41-13.46; p < 0.00001), higher intraocular pressure (IOP) within normal range up to 6 months (MD 0.64; 95 % CI 0.20-1.07; p = 0.004) and increased cataract surgery risk (OR 7.95; 95 % CI 1.35-46.75; p = 0.02). Subgroup analysis showed BCVA improvement, fewer injections, reduced PRN need, and higher IOP in CRVO, and reduced recurrence in BRVO. Triamcinolone acetonide improved BCVA while intravitreal dexamethasone implant lowered CMT, and both agents reduced PRN injections. Combination therapy provides modest improvement in efficacy outcomes and fewer injections, particularly in CRVO, but increases risk of IOP elevation and cataract surgery. Reduced injection frequency may not necessarily translate to overall lower treatment burden and costs due to frequent monitoring of steroid-related complications.
Expanding the horizon of oculomics: A narrative review on the emerging roles of the anterior segment and mobile health.
Sung J, Midorikawa-Inomata A, Fujio K … +1 more , Inomata T
Surv Ophthalmol · 2026 · PMID 41692279 · Publisher ↗
Oculomics uses the eye to gain insights into systemic health. Although initially focused on retinal imaging, oculomics now studies various ocular signs beyond the retina for their associations with systemic health. The p...
Oculomics uses the eye to gain insights into systemic health. Although initially focused on retinal imaging, oculomics now studies various ocular signs beyond the retina for their associations with systemic health. The posterior segment receives significant attention because of direct visibility of the optic nerve, retinal vasculature, and neurosensory retina; however, anterior segment oculomics may catalyze the growth of oculomics in clinical practice, particularly considering recent developments in mobile health (mHealth), increasing healthcare costs, and shifting medical paradigms. The anterior segment reflects a wide range of systemic statuses, including autoimmune, cardiovascular, hematologic, neurological, and psychiatric health. With continued research, monitoring systemic diseases using ocular biomarkers may be possible. Direct visibility of the anterior segment without specialized tools is advantageous, as the posterior segment requires equipment to visualize the fundus. The anterior segment's accessibility enables cost-effective evaluation through smartphone cameras or eye-tracking in virtual reality and augmented reality devices. This aligns with mHealth's growth and the shift toward non-intrusive, longitudinal care. We introduce the anterior ocular segment's role in oculomics, discussing current evidence and future directions for biomarker research. We highlight the synergy between anterior segment oculomics and mHealth, along with healthcare trends (e.g., digital twin models, digital transformation, P4 medicine [predictive, preventive, personalized, and participatory medicine], and software as medical devices). Although we acknowledge the posterior segment oculomics importance, the anterior segment may be essential in implementing oculomics in healthcare systems.
Metagenomic sequencing in various ocular infections: A systematic review of diagnostic utility.
Susiyanti M, Febrina F, Putera I … +6 more , Jelita A, Rokim FS, Edwar L, Aziza Y, Sitompul R, Nora RD
Surv Ophthalmol · 2026 · PMID 41655600 · Publisher ↗
Ocular infections are a common cause of visual morbidity worldwide and continue to pose significant diagnostic and therapeutic challenges. Metagenomic next-generation sequencing (mNGS) enables unbiased detection of wide...
Ocular infections are a common cause of visual morbidity worldwide and continue to pose significant diagnostic and therapeutic challenges. Metagenomic next-generation sequencing (mNGS) enables unbiased detection of wide range of pathogens; however, its diagnostic utility in ocular infections warrant further evaluation. We evaluate the diagnostic performance of mNGS, highlighting its advantages, limitations, and future directions for clinical application. Twenty-one studies involving 1219 eyes were included. mNGS positivity rates ranged from 10 % to 94 %. Sensitivity ranged from 15 % to 100 % and specificity from 12 % to 100 %. Viral pathogens were the most frequently detected (15 out of 21 studies), followed by bacteria (14 out of 21), fungi (10 out of 21), and parasites (6 out of 21). A broad spectrum of pathogens at both the genus and species levels was identified. mNGS also helps in assessing AMR-associated genes and mutations linked to therapy susceptibility. mNGS appears to be a valuable tool for pathogen indentification in ocular infections, particularly for organisms undetectable by conventional diagnostic methods, although careful interpretation is required. Overall, mNGS demonstrated promising diagnostic performance across different types of ocular infections. Larger, well-designed studies employing standardized protocols are needed to address current limitations and to enhance the clinical applicability of mNGS in routine clinical practice.
A systematic review on age-related macular degeneration: New insights from multi-omics studies.
Castro-Fernández DC, Cañizo-Outeriño A, Cuartero-Martínez A … +5 more , Gil-Martinez M, Mondelo-Garcia C, González-Barcia M, Álvarez-Barrios A, Fernández-Ferreiro A
Surv Ophthalmol · 2026 · PMID 41643859 · Publisher ↗
Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries and a growing global health concern. The multifactorial nature of AMD calls for integrative multi-omics approaches. We summari...
Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries and a growing global health concern. The multifactorial nature of AMD calls for integrative multi-omics approaches. We summarize studies employing multi-omics in AMD. A comprehensive search in PubMed and Scopus databases identified 561 records with multi-omics criteria, of which duplicates, unrelated and unavailable articles were excluded, resulting in 33 reports. Quality was assessed following the Office of Health Assessment and Translation (OHAT) method, and data was synthesized through standardized evidence tables. Across the reviewed reports, multi-omics approaches were applied to non-clinical and clinical samples, including ocular and systemic fluids. Methodological trends included the widespread use of causal inference approaches (e.g., Mendelian randomization and Bayesian colocalization) and increasing adoption of spatial and single-cell resolution techniques. Converging molecular patterns consistently suggested inflammation, complement activation, angiogenesis, lipid dysregulation, and mitochondrial dysfunction as key processes underlying AMD. Integration of genetic risk with proteomic and metabolomic alterations, enabled the identification of candidate diagnostic and prognostic biomarkers such as carboxyethylpyrrole and PRMT3. Additionally, this review revealed opportunities for personalized medicine in AMD patient stratification, improvement of prediction models, and therapeutic personalization; however, heterogeneity was noted across studies, particularly regarding sample source (systemic vs. ocular), analytical platforms, integration strategies, and ancestry representation. Despite this variability, this review illustrates how integrating multiple omics layers provides a comprehensive and multidimensional understanding of AMD pathology, advancing research towards better diagnosis, prognosis, and therapeutics for these patients.
MicroRNAs as biomarkers and therapeutic targets in pterygia: A systematic review with quantitative synthesis.
Arora K, Gupta M, Gupta H … +1 more , Sikka R
Surv Ophthalmol · 2026 · PMID 41643858 · Publisher ↗
MicroRNAs (miRNAs) are emerging as important regulators in pterygium, a fibrovascular growth of the conjunctiva with high recurrence rates. This systematic review with selective quantitative synthesis aimed to identify d...
MicroRNAs (miRNAs) are emerging as important regulators in pterygium, a fibrovascular growth of the conjunctiva with high recurrence rates. This systematic review with selective quantitative synthesis aimed to identify differentially expressed miRNAs as potential biomarkers and therapeutic targets of pterygium. A comprehensive search of PubMed and Scopus (January 2010-March 2024) identified 17 eligible studies for the systematic review, of which 13 case-control studies, involving 789 pterygium patients and 546 controls, contributed quantitative data for synthesis. Following PRISMA guidelines, 4 miRNAs showed differential expression, with miR-21 and miR-199a-5p upregulated and miR-200a and miR-221-3p downregulated. Quantitative synthesis across independent studies was feasible for miR-200a, whereas miR-21, miR-199a-5p, and miR-221-3p were supported by single-study evidence. A literature review confirmed that the identified miRNAs regulate several target genes-TGF-β1, ZEB1, ZEB2, CDKN1B, and MAP3K11-which are implicated in pterygium pathogenesis. The enriched pathways identified included cell proliferation, inflammation, angiogenesis, and epithelial-mesenchymal transition, which have been associated with pterygium. Despite heterogeneity across included studies, these findings enhance understanding of pterygium pathogenesis. The identified miRNAs represent promising candidates for diagnostic and therapeutic exploration, warranting further validation in large-scale, longitudinal studies. This work lays the foundation for future miRNA-based clinical research in pterygium management.
Foundation models for ophthalmic imaging.
Gharbi K, Wijngaarden PV, Hadoux X
Surv Ophthalmol · 2026 · PMID 41619947 · Publisher ↗
Foundation models represent a new frontier in ophthalmic artificial intelligence, enabling learning of transferable features from large unlabelled imaging datasets for flexible application to varying downstream tasks. We...
Foundation models represent a new frontier in ophthalmic artificial intelligence, enabling learning of transferable features from large unlabelled imaging datasets for flexible application to varying downstream tasks. We systematically analyze the evolution of ophthalmic foundation models across 12 distinct models developed between 2022 and July, 2025. We examine advances in modality integration (unimodal, multimodal to vision-language), pretraining objectives (generative versus contrastive approaches) and supervision strategies (image and text guided). Emerging techniques such as imaging modality agnostic encoders, synthetic data augmentation, and computationally efficient architectures improved model performance and generalisability. Overall, we observed a clear shift from domain-specific unimodal approaches towards modality-agnostic foundation models guided by clinical text. Future directions include wider modality integration, higher dimensional inputs (spatially and temporally), diverse pretraining, and standardised benchmark datasets. In synthesizing these trends, this review offers the conceptual and technical grounding to support both clinicians and researchers in ophthalmic foundation model design, selection, and application.
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