Transorbital endoscopic approaches (TEAs) for orbital surgery have gained considerable traction since the concept was first formalized approximately 2 decades ago. While the distinction in the nomenclature between TEAs a...Transorbital endoscopic approaches (TEAs) for orbital surgery have gained considerable traction since the concept was first formalized approximately 2 decades ago. While the distinction in the nomenclature between TEAs and transorbital neuroendoscopic surgery can be at times ambiguous, this review focuses exclusively on TEAs for primary orbital pathology. The current literature on TEAs encompasses preclinical cadaveric dissection studies, clinical case reports and case series. Orbital roof lesions accessed via a superior lid crease incision to enter the subperiosteal space predominated in the early literature. Since then, TEAs have expanded to orbital lesions within both the extraconal and intraconal spaces, and the orbital apex. Clinical series thus far have reported favorable outcomes, with a low risk of permanent functional sequelae. We discuss the advantages and limitations of TEAs.
We evaluated retinal microvascular changes in patients with diabetic retinopathy (DR) treated with panretinal photocoagulation (PRP), using optical coherence tomography angiography (OCTA). Nineteen studies were included...We evaluated retinal microvascular changes in patients with diabetic retinopathy (DR) treated with panretinal photocoagulation (PRP), using optical coherence tomography angiography (OCTA). Nineteen studies were included that assess changes in vessel density (VD) within the superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the foveal avascular zone (FAZ) area. PRP was associated with a significant increase in VD in the SCP, particularly in the foveal region, with greater improvements observed during long-term follow-up. In contrast, changes in the DCP were less consistent; however, a mild increase in foveal VD was noted over time. Additionally, a borderline reduction in FAZ area was observed after PRP, suggesting enhanced macular perfusion. These findings highlight the localized and time-dependent vascular effects of PRP and support the use of OCTA as a non-invasive, layer-specific tool for monitoring treatment outcomes in DR.
Feo A, Tailor PD, Au A
… +5 more, Wu A, Haidar A, Romano MR, Sadda SR, Tsui E
Surv Ophthalmol
· 2026 · PMID 41203085
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Anterior segment optical coherence tomography (AS-OCT) is emerging as an essential tool in the diagnosis and monitoring of uveitis. Offering noninvasive, high-resolution imaging, AS-OCT allows clinicians to visualize and...Anterior segment optical coherence tomography (AS-OCT) is emerging as an essential tool in the diagnosis and monitoring of uveitis. Offering noninvasive, high-resolution imaging, AS-OCT allows clinicians to visualize and quantify subtle changes in the anterior chamber (AC), iris, cornea, sclera, and lens that may be difficult to capture with slit-lamp examination alone. We highlight how AS-OCT improves the detection of AC cells and flare, supports disease monitoring through automated, reproducible metrics, and facilitates care in challenging settings, such as pediatric uveitis or clinical trials. In the cornea, AS-OCT allows detailed evaluation of keratic precipitates and subclinical endothelial dysfunction. It also provides disease-specific metrics of iris thickness and surface smoothness in conditions such as Fuchs uveitis syndrome. In the sclera, AS-OCT can distinguish episcleritis from scleritis, differentiate their subtypes, and monitor inflammation resolution. Emerging applications, including anterior vitreous imaging and artificial intelligence-driven analysis, suggest a growing role for AS-OCT in personalized care. As evidence expands, AS-OCT is poised to become a cornerstone of multimodal imaging in uveitis, enhancing precision, reducing subjectivity, and improving outcomes for patients across a wide spectrum of inflammatory eye disease.
A 76-year-old man with advanced non-small cell lung carcinoma undergoing treatment with carboplatin and paclitaxel plus pembrolizumab presented to the emergency department with a one-week history of rapidly progressive,...A 76-year-old man with advanced non-small cell lung carcinoma undergoing treatment with carboplatin and paclitaxel plus pembrolizumab presented to the emergency department with a one-week history of rapidly progressive, severe bilateral visual loss and pain on eye movement. Ocular movements were full, with no other neurological deficits noted. Visual acuity was reduced bilaterally: 20/63 right eye, 20/200 left eye. Color vision testing was borderline normal, bilateral visual fields were constricted, while both funduscopy and optical coherence tomography were unremarkable. Urgent magnetic resonance imaging of the brain revealed patchy FLAIR hyperintensities in both optic nerves and faint post-contrast enhancement. By the time of neurological assessment one week later, the patient had experienced partial spontaneous improvement in vision. A comprehensive neuro-oncological differential diagnosis was performed, prompting the request for further diagnostic tests. This case illustrates the evolving landscape of neuro-oncology, where advances in diagnostic approaches and the use of immunotherapies such as pembrolizumab may alter immune tolerance, leading to immune-related adverse events such as myelin oligodendrocyte glycoporotein antibody-associated disease.
Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery that may rarely result in vision loss. In most cases PCME resolves spontaneously, which makes it challenging to establish the efficac...Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery that may rarely result in vision loss. In most cases PCME resolves spontaneously, which makes it challenging to establish the efficacy of therapeutic and prophylactic interventions. Although no consensus exists regarding management or prevention, most surgeons advocate prophylaxis primarily for high-risk eyes. Nevertheless, the costs associated with preventive measures have risen substantially in recent years. In this review, we summarize the current evidence on the epidemiology, pathogenesis, diagnosis, risk factors, treatment, and prophylaxis of PCME, to provide a comprehensive understanding of its clinical indications and the cost-effectiveness of available strategies.
Keratoconus (KC) is a progressive corneal disorder that typically manifests during adolescence characterized by corneal thinning and irregularity. Recent studies have revealed that pathoanatomical abnormalities may not b...Keratoconus (KC) is a progressive corneal disorder that typically manifests during adolescence characterized by corneal thinning and irregularity. Recent studies have revealed that pathoanatomical abnormalities may not be limited to the anterior segment. Posterior segment alterations may also occur in KC patients. We provide a comprehensive review of the posterior segment changes in KC and assess the role of optical coherence tomography (OCT) in detecting these alterations. An initial systematic search of PubMed, EMBASE, and Web of Science was conducted on November 28, 2024. To identify any newly published literature, the search was updated on September 1, 2025. Random-effects models were employed to calculate pooled effect estimates. A total of 38 studies involving 4584 eyes were reviewed, and 26 studies (3124 eyes) met our eligibility criteria for meta-analysis. The remaining 12 studies, although not included in the quantitative synthesis, were reviewed and their findings integrated. Our systematic analysis revealed significant reductions in several macular measurements, including average and temporal parafoveal (inner ring) thickness as well as temporal and superior perifoveal (outer ring) thickness. Peripapillary parameters also showed notable decreases, specifically in lamina cribrosa thickness, average retinal nerve fiber layer (RNFL) thickness, and RNFL thickness in the superior, temporal, and inferior quadrants. By contrast, subfoveal choroidal thickness was significantly increased in KC patients. Additionally, optic nerve head parameters, including cup area and cup volume, showed significantly greater values. When comparing different stages of the disease, patients with moderate KC exhibited significantly higher superotemporal RNFL thickness than those with severe disease. This meta-analysis underscores the concept that keratoconus, primarily a corneal disease, is associated with retinal and choroidal structural abnormalities. Changes in the posterior segment were similar across mild and advanced stages of the corneal disease. OCT monitoring in KC patients can facilitate detection of these alterations.
Age-related macular degeneration (AMD) is one of the most common types of eye diseases that generally affect the elderly population over 50 years of age. The effects of AMD on the quality of vision and life are devastati...Age-related macular degeneration (AMD) is one of the most common types of eye diseases that generally affect the elderly population over 50 years of age. The effects of AMD on the quality of vision and life are devastating. We systematically review applications and performance of machine/deep learning algorithms for AMD detection and prediction using color fundus photos. We reviewed the studies that focused on machine learning and deep learning techniques and algorithms to analyze the fundus images for AMD. The data were collected by searching Scopus, PubMed (Medline), Web of Science and IEEE Xplore databases. After screening, 42 papers were included. The findings showed that the studies used different architectures for model training and testing. Convolutional neural networks (CNN) are used mostly in the diagnosis of AMD. ResNet architecture (11 studies) was used more than other architectures. Twenty-two studies used AREDS dataset. CNN algorithm with ResNet architecture had the highest performance compared to other architectures. Studies have shown that machine learning can diagnose AMD from fundus images with high accuracy; however, calibration, fairness, explainability, external validation, generalization, prospective validation in clinical settings and regulatory requirements should be considered in the future.
Dry anophthalmic socket syndrome (DASS) is a complex and multifaceted condition that commonly affects patients who have undergone enucleation or evisceration and wear an ocular prothesis. The diagnosis and management of...Dry anophthalmic socket syndrome (DASS) is a complex and multifaceted condition that commonly affects patients who have undergone enucleation or evisceration and wear an ocular prothesis. The diagnosis and management of DASS poses significant challenges due to the absence of a standardized diagnostic criteria and evidence-based treatment protocol. Though DASS symptoms can be disproportionate to observable clinical signs, patient-reported outcomes and scoring systems remain the cornerstone of its diagnostic framework. While a dearth of literature exists, parallels can be drawn from other ocular surface conditions, including dry eye disease and contact lens-associated dry eye, regarding inflammatory pathways and surface interactions. DASS is postulated to be related to disruptions to tear film homeostasis, lid margin disease, and chronic inflammation driven by mechanical friction between the prosthesis and socket tissues. We provide a comprehensive review of the pathophysiological processes underlying DASS, discussing current and evolving diagnostic approaches, including use of symptom questionnaires and objective biomarkers such as tear film osmolarity and matrix metalloproteinase-9. Emerging concepts, such as detailed mechanisms of chronic inflammation and the precise nature of mechanical interactions will also be evaluated, alongside future directions for research aimed at optimising guidelines to improve patients' quality of life.
Degenerative retinoschisis (RS) can mimic retinal detachment (RD), posing a diagnostic challenge. We summarize the utility and limitations of current retinal imaging modalities in evaluating degenerative RS. We conducted...Degenerative retinoschisis (RS) can mimic retinal detachment (RD), posing a diagnostic challenge. We summarize the utility and limitations of current retinal imaging modalities in evaluating degenerative RS. We conducted a systematic search of PubMed, Embase, Scopus, Cochrane Library, and Google Scholar from January 1, 1973, to February 5, 2025. Studies evaluating imaging modalities in degenerative RS were reviewed, including spectral-domain OCT (SD-OCT), B-scan ultrasound (US), ultrasound biomicroscopy (UBM), fundus autofluorescence (FAF), infrared reflectance (IR), OCT angiography (OCTA), and color doppler ultrasound (CDUS). Twenty-two studies met inclusion criteria. SD-OCT remains the most reliable modality, providing high-resolution layer differentiation and detection of schisis-detachment, though its peripheral reach is limited. B-scan ultrasonography and UBM can overcome this limitation and are particularly useful in cases with media opacity. where FAF and IR imaging yield inconsistent and non-reproducible results, limiting their diagnostic utility. CDUS and CEUS may offer additional diagnostic value, particularly in perfusion-based differentiation of RS from RD, though they remain underexplored in schisis-detachment. OCTA is useful in characterising the vascular abnormalities seen in RS; its added B-scan capability may offer advantages over UBM in select cases. We apply the use of different multimodal imaging approaches to cases with diagnostic uncertainty, and apply the use of new imaging options for cases where OCT was unavailable. A multimodal imaging approach is recommended in diagnostically uncertain cases of degenerative RS. Larger prospective studies are needed to validate newer modalities, particularly in schisis-detachment.
Our study aims to assess the utility of various next-generation sequencing (NGS) technologies and explore their role in primary glaucoma genetic research. We conducted a systematic review as of January 19, 2025, using Pu...Our study aims to assess the utility of various next-generation sequencing (NGS) technologies and explore their role in primary glaucoma genetic research. We conducted a systematic review as of January 19, 2025, using PubMed, Scopus, and Web of Science, with study quality evaluated using the QUADAS-2 checklist. We assessed the diagnostic rates of various NGS technologies across different glaucoma subtypes. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024614663). We included 19 studies utilizing whole exome sequencing (WES), whole genome sequencing (WGS), and panel sequencing for assessing genetic features in primary angle-closure glaucoma (PACG), primary congenital glaucoma (PCG), primary open-angle glaucoma (POAG), and juvenile open-angle glaucoma (JOAG). The overall diagnostic rate of NGS technologies was 26.2 % (95 % CI: 15.9 %-36.5 %). WES showed superior performance in PCG (46.7 %), POAG (8.9 %), and JOAG (12.4 %), while panel sequencing achieved a higher rate in PACG (56.4 %). Subtype-specific genes included CYP1B1 in PCG, MYOC in JOAG, and WDR36 in POAG/PACG. Notably, all CYP1B1 gene variant loci are concentrated in 2 specific regions on chromosome 2. This study underscores the significance of NGS in primary glaucoma genetic research, advocating for subtype-specific sequencing strategies to facilitate precise diagnosis and treatment.
Tao BK, Hwang J, Park S
… +17 more, Mikhail D, Hanna A, Huang RS, Mihalache A, Xie JS, Popovic MM, Jin Y, Grewal P, Hurley B, Kertes P, Kherani A, Tennant M, Chen J, Navajas EV, Lam WC, Muni RH, Yan P
Optimally, syringe-filling technique may reduce the risk of post-injection endophthalmitis (PIE), yet there is wide variation between ophthalmologists and jurisdictions regarding syringe-filling practices. This frequenti...Optimally, syringe-filling technique may reduce the risk of post-injection endophthalmitis (PIE), yet there is wide variation between ophthalmologists and jurisdictions regarding syringe-filling practices. This frequentist network meta-analysis (PROSPERO: CRD42024555196) of rare events sought to compare the odds of PIE between manufactured prefilled syringes (PFS), compounded syringes, and traditional vial preparation of syringes (VPS) for intravitreal anti-vascular endothelial growth factor therapy. Given outcome rarity, we included studies whose primary outcome was PIE incidence. From 20 observational studies (3746 PIE events; 41,611,960 injections), the odds of PIE were significantly lower with PFS (OR: 0.45, 95 % confidence interval [CI]: 0.40-0.49) and compounded syringes (OR: 0.69, 95 % CI: 0.64-0.74) compared to VPS. The odds of PIE were significantly lower with PFS compared to compounded syringes (OR: 0.65, 95 % CI: 0.58-0.72). The odds of culture-positive PIE were significantly lower with PFS than both VPS (OR: 0.15, 95 % CI: 0.06-0.41) and compounded syringes (OR: 0.15, 95 % CI: 0.05-0.44). No significant difference in culture-positive PIE was observed between VPS and compounded syringes (OR: 1.02, 95 % CI: 0.66-1.58). Low certainty evidence supports that PFS significantly reduce the rate of clinical and culture-positive PIE compared to VPS and compounded syringes. Future studies should further characterize the role of confounding.
We systematically review and characterize cases of tattoo-associated uveitis without systemic sarcoidosis, focusing on clinical presentation, diagnostic workup, management, and outcomes. We conducted a comprehensive lite...We systematically review and characterize cases of tattoo-associated uveitis without systemic sarcoidosis, focusing on clinical presentation, diagnostic workup, management, and outcomes. We conducted a comprehensive literature search across PubMed, Google Scholar, Scopus, Web of Science, and Embase from 1969 to April 2025, following PRISMA guidelines. Eligible studies included case reports and series documenting tattoo-related uveitis in the absence of confirmed systemic sarcoidosis. Thirty-three studies encompassing 44 patients (86 eyes) were included. Most patients were male (75 %), with a mean age of 31.9 ± 11.5 years. Tattoos were typically permanent (97.7 %), extensive in size (61.4 %), and placed on the arms (77.3 %), with black pigment most common (61.3 %). Skin inflammation was reported in 88.6 % of patients, typically preceding or coinciding with uveitis onset. Anterior uveitis (52.3 %) and bilateral involvement (95.5 %) were predominant. Common findings included anterior chamber inflammation (56.8 %), vitritis (38.6 %), and cystoid macular edema (27.3 %). No significant associations were found, except between number of tattoos and uveitis laterality (p = 0.046). Work-up frequently involved chest imaging (72.7 %), skin biopsy (88.6 %), and infectious screening. Management included corticosteroids (70.5 %), immunosuppressants (38.6 %), and tattoo excision (15.9 %). Inflammation was controlled in 70.5 %, though 50 % required long-term corticosteroids and 15.9 % required intraocular pressure management. Tattoo-associated uveitis is an emerging entity that can mimic sarcoidosis, often presenting with delayed ocular inflammation and concurrent skin findings. Clinicians should inquire about tattoos in uveitis patients and monitor for potential systemic involvement. Multidisciplinary evaluation and tailored treatment, including immunosuppression or tattoo removal, may be needed to achieve disease control.
Age-related macular degeneration (AMD) remains among the leading causes of blindness in industrialized nations, with fibrosis secondary to macular neovascularization (MNV) significantly contributing to visual decline des...Age-related macular degeneration (AMD) remains among the leading causes of blindness in industrialized nations, with fibrosis secondary to macular neovascularization (MNV) significantly contributing to visual decline despite treatment with anti-vascular endothelial growth factor therapy. Although traditionally viewed as detrimental, fibrosis may reflect a delicate balance between beneficial vessel stabilization and harmful scarring. We critically evaluate the pathophysiology of fibrosis in AMD and introduces the novel hypothetical concept of "fibrogliosis", which emphasizes the central role of Müller glia and retinal microglia activation following disruption of the outer blood-retinal barrier. According to this concept, fibrogliosis manifests differently among MNV subtypes, influenced largely by their impact on outer blood-retinal barrier integrity. Recognizing this variability underscores the importance of further investigation into the hypothetical concept of fibrogliosis, which in theory could guide future therapeutic strategies to balance vascular stabilization with the modulation of neovascularization and fibrosis.
A substantial number of corneal transplantations are performed in the vascularized and inflamed environments of high-risk recipients, which increases the risk of graft rejection. Managing high-risk keratoplasty is challe...A substantial number of corneal transplantations are performed in the vascularized and inflamed environments of high-risk recipients, which increases the risk of graft rejection. Managing high-risk keratoplasty is challenging and encompasses numerous pre-, intra-, and post-operative measures. Preoperative measures include treating ocular surface inflammation and corneal neovascularization. Intraoperative measures mainly involve performing lamellar keratoplasty, if possible, to reduce the loads of alloantigens introduced to the recipient's immune system. The key step in the prevention of immunologic rejection in high-risk recipients is the administration of topical and systemic immunosuppressive medications for a long term. Topical corticosteroids are frequently administered after corneal transplantation; however, they are insufficient to prevent graft rejection following high-risk keratoplasty. In such cases, various systemic immunosuppressive medications can be employed with inconstant success rates. Nonetheless, these agents can result in potentially serious and sometimes life-threatening adverse reactions. Furthermore, the ideal method of administration, dosage, frequency, and duration of application of these medications have not been identified for individual cases of high-risk keratoplasty. New strategies, including targeted biological treatments and tolerance-inducing protocols, may hold promise in decreasing the risk of corneal graft rejection in high-risk settings without the adverse reactions of systemic immunosuppressive treatment.