Br J Ophthalmol [JOURNAL]
Sun
200 papers
Novel therapeutic strategies to restore vision in ocular hypotony (STRETCH): results from a prospective pilot series.
Orsine Murta Dias K, Yang E, Calcagni A … +9 more , Kawa JR, Gooch J, Shah D, Khalil R, Sutaria A, Jayaram H, Gazzard G, Wickham L, Petrushkin H
Br J Ophthalmol · 2026 Jan · PMID 41521029 · Publisher ↗
BACKGROUND/AIMS: To report visual and anatomical outcomes following intravitreal hydroxypropylmethylcellulose (HPMC) for the treatment of chronic structural hypotony. METHODS: This study is a prospective interventional c...
BACKGROUND/AIMS: To report visual and anatomical outcomes following intravitreal hydroxypropylmethylcellulose (HPMC) for the treatment of chronic structural hypotony. METHODS: This study is a prospective interventional case series. Eight patients with chronic structural hypotony for more than 3 months, defined by an intraocular pressure (IOP) of <6.5 mm Hg. All patients had evidence of visual potential, clear cornea and a clear visual axis.Patients received multiple intravitreal HPMC injections (70 µL-1400 µL), administered every 2-4 weeks until either pre-morbid axial length was achieved, an IOP of 10-15 mm Hg was sustained for 4 weeks without signs of hypotony, or axial length of the contralateral eye was reached. They were followed up for 12 months after the first intravitreal injection. RESULTS: Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (LogMAR) improved in 87.5% of eyes, with one eye remaining stable. The initial BCVA range was 0.3-1.7 LogMAR, and the final range was 0.1-1.6 LogMAR. IOP increased in 87.5% of eyes, from an initial range of 1-5 mm Hg to 3-23 mm Hg. Axial length increased in 75% of eyes, with a median increase of 1 mm (range 0.6-2.9 mm).Two adverse events occurred: uveitis flare-ups leading to loss of HPMC clarity in two eyes, managed with topical and intravitreal steroids, and two cases of temporary vision loss post-injection, resolved after paracentesis. CONCLUSION: This is the first case series to use a structured protocol for intravitreal HPMC in chronic hypotony management. The treatment improved vision and restored ocular anatomy, showing promise for managing structural hypotony in eyes with visual potential.
Evaluation of the frequency, risk factors and outcomes of ROP in preterm infants with a BW >1500 g or GA >32 weeks in Turkiye (TR-ROP 2) and medicolegal fears: a Turkish Neonatal Society multicentre study.
Bas AY, Koc E, Unal S … +2 more , Hirfanoglu IM, TR-ROP 2 Study Group
Br J Ophthalmol · 2026 Jan · PMID 41513433 · Publisher ↗
BACKGROUND: This study aimed to evaluate the prevalence and risk factors of retinopathy of prematurity (ROP) in preterm infants with a birth weight (BW)>1500 g or gestational age (GA) >32 weeks in Turkiye. METHODS: A pro...
BACKGROUND: This study aimed to evaluate the prevalence and risk factors of retinopathy of prematurity (ROP) in preterm infants with a birth weight (BW)>1500 g or gestational age (GA) >32 weeks in Turkiye. METHODS: A prospective cohort study (TR-ROP 2) was conducted in 80 neonatal intensive care units between 30 September 2023 and 1 November 2024. Infants with a BW >1500 g or GA >32 weeks who had an unstable clinical course or were deemed at risk for ROP were included. The effect of medicolegal concerns on the decision to screen was also evaluated. RESULTS: The study included 4140 infants at risk for ROP development; 242 (5.8%) developed any stage of ROP, and 17 (0.4%) developed severe ROP requiring treatment. Risk factors independently associated with ROP included lower GA and BW, being small for GA, red blood cell transfusion, oxygen therapy >5 days, mechanical ventilation >1 day, early neonatal sepsis (ENS) with comorbidities or presence of ≥3 comorbidities (excluding ENS). Of those with BW ≥2000 g, 31.4% were screened for medicolegal reasons; 2.2% developed ROP, but none had severe ROP. CONCLUSIONS: ROP in mature infants is rare but can occur in the presence of multiple risk factors. Medicolegal concerns may contribute to overscreening. Developing evidence-based, risk-adapted screening guidelines is essential to ensure appropriate care without unnecessary interventions.
Exposure-wide approaches identifying modifiable factors for age-related macular degeneration.
Zhou J, He Y, Wang J … +7 more , Wu H, Huang X, Cao J, Tham YC, Zhang C, Cheng CY, Ye J
Br J Ophthalmol · 2026 Jan · PMID 41513432 · Publisher ↗
PURPOSE: The present study aimed to systematically investigate modifiable factors for age-related macular degeneration (AMD) using novel exposure-wide strategies in a large cohort, and then assess the preventability of A...
PURPOSE: The present study aimed to systematically investigate modifiable factors for age-related macular degeneration (AMD) using novel exposure-wide strategies in a large cohort, and then assess the preventability of AMD. METHODS: Using data from the UK Biobank (UKB), a total of 331 modifiable factors from seven categories were included. Exposures were first screened using Cox proportional hazards models with each examined individually, and associated exposures were then tested in a mutually adjusted model for final validation. We calculated joint effect scores by combining validated exposures based on the category and tested the joint associations with AMD. We eventually estimated population attributable fraction to assess the overall preventability of AMD. RESULTS: A total of 478 867 UKB participants were included. After a median of 13.63 years of follow-up, 10 903 (2.28%) were diagnosed with incident AMD. Among all 331 modifiable factors, 177 passed the exposure-wide association scan, with 34 exposures remaining statistically significant after mutual adjustment, distributed in 5 categories. Joint effects of these categories were significantly associated with AMD even among populations with higher AMD Polygenic Risk Score. Overall, we estimated that 30.4%-45.1% of AMD cases could be prevented by intervening in these factors. CONCLUSIONS: Modifiable factors across multiple categories are associated with AMD, and active interventions targeting these factors can reduce AMD incidence by 30.4%-45.1%. This study also underscores the need for a systematic approach in uncovering modifiable factors and providing population-level knowledge basis for disease prevention.
Systemic and ocular associated factors for pathologic myopia in a highly myopic Chinese population: findings from the Wenzhou pathologic myopia study.
Zhao J, Gong Q, Jiang Y … +5 more , Han J, Zhu X, Li M, Lu F, Hu L
Br J Ophthalmol · 2026 Jan · PMID 41506847 · Publisher ↗
AIMS: This study aimed to explore ocular and systemic factors associated with pathologic myopia in patients with high myopia and develop predictive models for differentiating between simple high myopia and pathologic myo...
AIMS: This study aimed to explore ocular and systemic factors associated with pathologic myopia in patients with high myopia and develop predictive models for differentiating between simple high myopia and pathologic myopia, particularly in its early stage. METHODS: This cross-sectional study was conducted on 2767 patients with bilateral high myopia at baseline follow-up. Demographic, ocular biometric and clinical data were collected, including age, corrected distance visual acuity, axial length (AL), spherical equivalent (SE), myopic atrophy maculopathy (MAM) grading based on the International Meta-Analysis for Pathologic Myopia criteria and ocular and systemic comorbidities. Multimodal imaging techniques were employed to assess plus lesions and posterior staphyloma. Logistic regression was used to identify associated factors and develop predictive models. RESULTS: Among all patients, 1697 (61.33%) were classified as having pathologic myopia. Its prevalence increased with longer AL and more severe SE. Significant ocular comorbid associated factors included cataract, epiretinal membrane, foveoschisis, full-thickness macular hole, retinal detachment and strabismus, and hypertension was the only systemic associated factor identified. Predictive models for differentiating simple high myopia and pathologic myopia, MAM categories 1 and 2, achieved area under the curve values up to 0.978 and 0.964, respectively. CONCLUSION: This study underscores the high prevalence of pathologic myopia in a highly myopic population and identifies ocular and systemic associated factors for pathologic myopia. The developed predictive models provide valuable tools for distinguishing between simple high myopia and pathologic myopia, facilitating early diagnosis and management.
Scleral-fixated intraocular lens in children: a meta-analysis and systematic review.
Alnajjar T, Alsaif A, Aldebasi T … +4 more , Alnajjar S, Karam M, Baeshen M, Alfreihi S
Br J Ophthalmol · 2026 Jan · PMID 41500794 · Publisher ↗
PURPOSE: To compare the outcomes of scleral-fixated intraocular lenses (SFIOLs) in the paediatric population. We included sutureless scleral-fixated intraocular lenses (SLSFIOLs), glued scleral-fixated intraocular lenses...
PURPOSE: To compare the outcomes of scleral-fixated intraocular lenses (SFIOLs) in the paediatric population. We included sutureless scleral-fixated intraocular lenses (SLSFIOLs), glued scleral-fixated intraocular lenses (GSFIOLs) and sutured scleral-fixated intraocular lenses (SSFIOLs) using polypropylene and Gore-Tex sutures. METHODS: A systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed to include studies from 1999 to 2023. We included 1-18-year-old studies. The analysis was based on fixed and random-effect models. Primary outcomes included visual acuity, refraction and intraocular pressure (IOP). Secondary outcomes were lens tilt and extrusion of suture material. RESULTS: 33 studies (1531 eyes) were included (GSFIOLs n=75, SLSFIOLs n=162, SSFIOLs n=1294 (Gore-Tex n=30 and polypropylene n=1264)). Vision improved from preoperative (mean 0.75±0.50 SD) to postoperative (mean 0.39±0.19 SD) logarithm of the minimal angle of resolution. The mean spherical equivalent was 0.59±0.91. Transient high IOP post-OP was highest among polypropylene SSFIOLs, 8.1%. Polypropylene SSFIOLs had glaucoma in 0.31% and corneal decompensation in 0.15%. A suture break or erosion was reported in 1.19%. None of the other groups developed glaucoma or corneal decompensation. Suture erosion was not reported in Gore-Tex SSFIOLs. GSFIOLs had a 5.3% reoperation rate, mostly for IOL repositioning. CONCLUSION: All types of scleral lens fixation showed improvement in initial outcomes. SLSFIOLs and Gore-Tex SSFIOLs have low complication rates.
Intravitreal dexamethasone implant for refractory stromal choroiditis in birdshot retinochoroiditis: efficacy and therapeutic implications.
Patel A, Testi I, Petrushkin H … +1 more , Pavesio C
Br J Ophthalmol · 2026 Jun · PMID 41494812 · Publisher ↗
This retrospective, single-centre observational study evaluated the efficacy of intravitreal dexamethasone implant in the management of stromal choroiditis in Birdshot retinochoroiditis refractory to systemic immunosuppr...
This retrospective, single-centre observational study evaluated the efficacy of intravitreal dexamethasone implant in the management of stromal choroiditis in Birdshot retinochoroiditis refractory to systemic immunosuppression. Four patients with bilateral stromal choroiditis unresponsive to systemic treatment received bilateral dexamethasone implant. Therapeutic response was assessed using indocyanine green angiography, demonstrating resolution of hypofluorescent dots, corresponding to active stromal choroidal lesions, in all cases.While intravitreal dexamethasone is not recommended as monotherapy for this chronic condition requiring long-term systemic immunosuppression, it proved to be effective in cases of refractory stromal involvement, particularly when systemic corticosteroids are contraindicated or during periods of therapeutic transition.
Fields from home: device-independent online perimetry with Melbourne Rapid Fields.
Montesano G, Nathwani N, Yu J … +4 more , Kong YXG, Vingrys A, Gazzard G, Jayaram H
Br J Ophthalmol · 2026 Jan · PMID 41494811 · Publisher ↗
AIMS: To assess the short-term reliability and agreement of home-based visual field (VF) testing using web-based Melbourne Rapid Fields (MRF-web) software compared to standard in-clinic Humphrey Field Analyzer (HFA) peri...
AIMS: To assess the short-term reliability and agreement of home-based visual field (VF) testing using web-based Melbourne Rapid Fields (MRF-web) software compared to standard in-clinic Humphrey Field Analyzer (HFA) perimetry. To evaluate the feasibility and patient acceptance of home VF monitoring and whether increased testing frequency with home monitoring could detect progression earlier. METHODS: Cross-sectional study with a repeated measures design of one eye of 100 adult participants from the Laser in Glaucoma and Ocular Hypertension trial with stable VFs with a questionnaire capturing participant feedback. Participants performed VF tests at home using MRF-web on their own computers. Each testing session included visual acuity, two 10-2 VFs and two 24-2 VFs. Analysis compared the MRF 24-2 with the two most recent HFA 24-2 from prior clinic visits. Bland-Altman plots and mixed linear models assessed test-retest variability and agreement, while simulations estimated the power to detect progression. Patient feedback was collected via online questionnaire. RESULTS: MRF-web showed greater test-retest variability than HFA for point-wise values, with a significant learning effect. There was a significant proportional bias, with MRF underestimating damage compared to HFA. The SE for MTD progression was higher for MRF at a 6-month testing interval. Four-monthly MRF testing achieved similar progression detection power to 6-monthly HFA: more frequent testing enabling earlier detection of progression. Most participants preferred home monitoring due to convenience. CONCLUSIONS: Home-perimetry produced more variable results than in-clinic testing, but the increased testing frequency enabled the potential earlier detection of progression compared to standard in-clinic testing.
Macular pigment optical density following lutein scleral iontophoresis in intermediate age-related macular degeneration: A six-month pilot study.
Mastropasqua R, Quarta A, Passamonti M … +11 more , Lorenzi C, Ruggeri ML, Gironi M, Persavalli C, Belloni Baroni L, De Santis Ciacci C, Aloia R, Della Penna N, Toto L, Carpineto P, Mastropasqua L
Br J Ophthalmol · 2026 Jan · PMID 41490968 · Publisher ↗
PURPOSE: To evaluate the effects of scleral iontophoresis lutein delivery on macular pigment optical density (MPOD), retinal anatomy and function in patients with intermediate age-related macular degeneration (iAMD). MET...
PURPOSE: To evaluate the effects of scleral iontophoresis lutein delivery on macular pigment optical density (MPOD), retinal anatomy and function in patients with intermediate age-related macular degeneration (iAMD). METHODS: This prospective pilot study included 15 phakic eyes from patients with iAMD. All participants underwent a single session of trans-scleral iontophoresis with a liposomal lutein formulation. MPOD, central macular thickness (CMT), choroidal vascularity index (CVI) and retinal sensitivity (RS) were assessed at baseline (T0), and at 1 month (T1), 3 months (T2) and 6 months (T3). RESULTS: MPOD showed a significant overall change across time points (χ²=11.01, p=0.012), with significant differences between T1 and T3 (p=0.006) and T2 and T3 (p=0.018). CMT significantly decreased at T3 compared with earlier visits (p≤0.002). RS declined at early time points (T1 and T2 vs T0; p=0.027 and p=0.002, respectively), while CVI exhibited modest reductions by T2 and T3 (p=0.021 and p=0.017). A significant inverse correlation was found between ΔMPOD and ΔRS at T2-T0 (ρ=-0.520, p=0.035). Best-corrected visual acuity remained stable across all visits. CONCLUSIONS: The inverse correlation between MPOD change and RS decline at 3 months raises the possibility that early augmentation of MP may provide a protective functional effect. These data support the short-term feasibility of scleral iontophoresis for targeted lutein delivery.
Reshaping ocular health: How does outdoor time in early life counteract intrauterine environmental risk of myopia susceptibility?
Tao S, Tong J, Lu M … +7 more , Zhu D, Jiang L, Gao G, Yan S, Wu X, Huang K, Tao FB
Br J Ophthalmol · 2026 Jun · PMID 41490967 · Publisher ↗
PURPOSE: To clarify the associations of placental inflammatory response and oxidative stress with myopia in the offspring and explore the modifying role of outdoor time trajectories at early childhood. METHODS: Data were...
PURPOSE: To clarify the associations of placental inflammatory response and oxidative stress with myopia in the offspring and explore the modifying role of outdoor time trajectories at early childhood. METHODS: Data were from the Ma'anshan Birth Cohort Study established in 2013. A total of 1256 mother-child pairs were analysed. Placental inflammation and oxidative stress biomarkers mRNA expression were tested using real-time quantitative PCR. Outdoor time was measured annually from 4 to 7 years. Children underwent cycloplegic refraction and ocular biometry to obtain spherical equivalent (SE) and axial length at 7-8 years. Binary logistic regression, generalised linear and Quantile g-Computation models were used to examine the associations. RESULTS: Among the children, 306 (24.4%) children were myopic. Each unit increase in monocyte chemoattractant protein-1 was correlated to a 1.6% higher risk of myopia (OR=1.016, p=0.025), 0.008 D lower SE (β=-0.008, p=0.024) and a 0.006 mm elongation in AL (β=0.006, p=0.014). Each unit elevate in interleukin-4 increased SE by 0.003 D (β=0.003, p=0.043) and decreased AL by 0.003 mm (β=-0.003, p=0.017), with similar trends in outdoor time declining trajectory. However, all associations were not significant after false discovery rate adjustment. Furthermore, each unit increase in the mixed exposure of oxidative stress was associated with a 0.070-0.074 D reduction in SE. CONCLUSIONS: Parsing insights into the potential relationships between placental inflammation and oxidative stress and myopia in the offspring and exploring the nurture effect of outdoor time based on life-cycle conceptual models will facilitate the early prevention of childhood myopia for clinical and public health practice.
Ocular injuries following the pager explosion mass casualty event in Lebanon: a large single-centre case series.
Saade J, Kheir WJ, Hassoun M … +16 more , Al Hassan S, Bou Ghannam A, Noureddine B, Bashshur Z, Awwad ST, Hamam RN, Mansour AM, Haddad R, Massoud V, Gendy JE, Khalil A, Ibrahim H, Tabaja J, Bteich Y, Ismail A, M Alameddine R
Br J Ophthalmol · 2026 Feb · PMID 41490966 · Full text
BACKGROUND/AIMS: On 17 September 2024, over 3000 pager devices containing explosives were remotely detonated across Lebanon in a coordinated mass-casualty event, causing unprecedented ocular trauma. This study aims to ch...
BACKGROUND/AIMS: On 17 September 2024, over 3000 pager devices containing explosives were remotely detonated across Lebanon in a coordinated mass-casualty event, causing unprecedented ocular trauma. This study aims to characterise the nature and extent of ophthalmic injuries treated at a tertiary care centre following this unique attack. METHODS: A retrospective chart review was conducted of patients presenting to the American University of Beirut Medical Centre on the day of the explosion. Only patients who underwent ophthalmic surgical exploration were included. Data were collected from clinical notes, imaging and operative reports. Injuries were categorised using the Birmingham Eye Trauma Terminology (BETT) classification, and descriptive statistics were applied. RESULTS: 79 patients (158 eyes) underwent surgical exploration. Severe globe trauma was identified in 111 eyes (70.3%), including 61 eyes (55%) with open globe injuries and 50 (45%) with traumatic eviscerations. Bilateral injuries were noted in 45.6% of patients. Intraocular foreign bodies were confirmed in all traumatic eviscerations and 81.9% of open globe injuries. Evisceration was performed in 49 eyes (31%). Adnexal injuries requiring reconstruction occurred in 27.3% of eyes. Among eyes that underwent globe-sparing repair, 71.7% had postoperative visual acuity of no light perception or light perception. CONCLUSION: This case series describes an unprecedented volume and severity of ocular injuries from a novel blast mechanism. The combination of thermal, chemical and penetrating trauma resulted in high rates of globe loss and poor visual outcomes. Preparedness for future unconventional mass-casualty scenarios must include rapid imaging, specialised ophthalmic teams and coordinated multidisciplinary care.
Surgical outcomes of intermittent and constant exotropia in an adult population between 18 and 60 years old.
Wang J, Tibi C, McKeown C … +1 more , Capó H
Br J Ophthalmol · 2026 Jun · PMID 41490965 · Publisher ↗
BACKGROUND: Comitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment appro...
BACKGROUND: Comitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment approaches and help establish realistic expectations for patients and clinicians. METHODS: Retrospective chart review of adults 18-60 years old who underwent surgery for comitant exotropia between 2014 and 2024 at a single institution. Patients were classified as intermittent (X(T)) or constant exotropia (XT) and divided into three groups: basic exotropia (BXT), divergence excess (DEXT) and convergence insufficiency (CIXT). Surgical motor success was defined as a postoperative deviation≤10 prism dioptres (PDs) and sensory success as resolution of diplopia. RESULTS: 165 patients (mean age 38.2±12.1 years, 50.3% male) were included. The mean preoperative deviation was 44.8±17.5 PD at distance and 48.3±20.1 PD at near. After initial surgery, the overall motor success was 62.4%, highest in BXT (69.4%), followed by CIXT (52.8%) and DEXT (50%) (p=0.08). Motor success was significantly higher in X(T) than XT (69.2% vs 52.2%, p=0.026), and in cases with adjustable sutures rather than non-adjustable (p=0.033), however, similar in unilateral recess-resect and bilateral lateral rectus recessions (62.7% vs 59.1%, p=0.81). Preoperative diplopia was present in 28.5% (47/165) and resolved in 89.4% (42/47). The final motor success was 66.7% after a second surgery in nine patients. CONCLUSIONS: The motor outcomes in adults are comparable to those reported in children. Higher motor success is found in X(T) and with the use of adjustable sutures. Surgical intervention provides relief of diplopia and meaningful gains in stereopsis.
Severe visual loss and ocular complications after intra-arterial chemotherapy for retinoblastoma.
Solera-de-Andrés C, Spang-Valencia P, Peralta-Calvo J
Br J Ophthalmol · 2026 Jun · PMID 41475972 · Publisher ↗
BACKGROUND: Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual out...
BACKGROUND: Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual outcomes following this treatment. This study evaluates final visual acuity (VA) in patients with RB treated with IAC, identifying factors contributing to vision loss. METHODS: A retrospective review was conducted at La Paz University Hospital in Madrid, including 71 eyes from 60 patients treated with IAC from 2016 to 2025. Data collected included the International Classification of Retinoblastoma and foveal involvement at diagnosis. VA was assessed using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR). The primary outcome was VA. The secondary outcome was the incidence of choroidal occlusive vasculopathy (COV). RESULTS: Of the 71 eyes, 24 belonged to patients too immature for VA assessment, and 20 were enucleated due to disease progression. Among the 27 eyes with measurable VA, 7 had a healthy fovea at diagnosis. 23 (85.2%) had a VA≥1.0 logMAR, including 10 (37%) with no light perception. Only four eyes (14.8%) achieved a VA<1.0 logMAR, all with a healthy fovea at diagnosis. Linear regression showed significant association between foveal involvement at diagnosis and reduced final VA. 16 of 71 eyes (22.5%) developed COV, with statistically significant correlation with the number of IAC cycles. CONCLUSION: IAC is effective for tumour control and eye preservation but often yields poor visual outcomes in advanced RB due to pre-existing damage and complications like COV. These findings emphasise the importance of counselling families regarding the visual limitations of IAC treatment.
Clade-specific ophthalmic manifestations of mpox: an umbrella review and meta-analysis of systematic reviews.
Kallay O, Ji L, Uthman OA … +6 more , Mills EJ, Zumla A, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Motulsky E, Nachega JB
Br J Ophthalmol · 2025 Dec · PMID 41469169 · Publisher ↗
BACKGROUND: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden...
BACKGROUND: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health. METHODS: We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180). RESULTS: Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals. CONCLUSIONS: Mpox-related ophthalmic disease can cause substantial-and potentially preventable-visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II-particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.
Efficacy and safety of anti-VEGF monoclonal antibody 601 for macular oedema in retinal vein occlusion: two phase IIa randomised clinical trials.
Zhao S, Wu M, Zhong J … +18 more , Chen B, Song Z, Ming Z, Han Q, Yu S, Wang H, Yuan S, Yao J, Zhao M, Meng X, Wang F, Lou J, Liu Y, Huang H, Zhou Q, Xu Y, Dai H, Li X
Br J Ophthalmol · 2026 Jun · PMID 41448868 · Full text
BACKGROUND: While anti-vascular endothelial growth factor (VEGF) therapies are effective for macular oedema secondary to retinal vein occlusion (RVO), there remains a need for additional treatment options. This study eva...
BACKGROUND: While anti-vascular endothelial growth factor (VEGF) therapies are effective for macular oedema secondary to retinal vein occlusion (RVO), there remains a need for additional treatment options. This study evaluated the novel anti-VEGF agent 601 versus ranibizumab in patients with branch RVO (BRVO) or central RVO (CRVO). METHODS: In two multicentre, randomised, double-masked, active-controlled phase IIa trials (NCT04667897, NCT04667910) conducted at 12 Chinese sites (2021-2022), 120 patients were assigned 1:1 to receive intravitreal 1.25 mg 601 or 0.5 mg ranibizumab every 4 weeks until week 20, followed by pro re nata dosing through week 48. Eligible patients had best-corrected visual acuity (BCVA) of 78-19 Early Treatment Diabetic Retinopathy Study letters and central subfield thickness ≥250 µm. The primary endpoint was change in BCVA at week 24. RESULTS: At week 24, the adjusted mean BCVA change from baseline was +16.52 letters for 601 versus +17.79 letters for ranibizumab (adjusted mean difference: -1.27 letters (95% CI -5.439 to 2.891 letters)) in BRVO, and +13.81 letters versus +16.79 letters (adjusted mean difference: -2.97 letters (95% CI -10.488 to 4.540 letters)) in CRVO. Central retina thickness (CST) reduction was similar for both treatments. Both groups showed sustained improvements from week 24 to 52 with similar adverse event profiles. CONCLUSIONS: These trials demonstrate that 601 is as effective and safe as ranibizumab for improving vision and reducing CST in RVO-related macular oedema. Phase III trials are warranted.
Analysis of full-field electroretinography parameters and potential for monitoring functional retinal deterioration in unilateral retinal vasculitis.
Park S, Yoo WS, Karaca I … +18 more , Khojasteh H, Akhavanrezayat A, Uludag G, Tran ANT, Lyu X, Yasar C, Ongpalakorn P, Mobasserian A, Bromeo AJ, Ghoraba H, Shin YU, Thng ZX, Gupta AS, Khatri Kc A, Hung JH, Or C, Do DV, Nguyen QD
Br J Ophthalmol · 2026 Jun · PMID 41448867 · Publisher ↗
To elucidate changes of full-field electroretinography (ffERG) tests in active unilateral retinal vasculitis, using the unaffected fellow eye as an internal control. Despite no significant differences in best corrected v...
To elucidate changes of full-field electroretinography (ffERG) tests in active unilateral retinal vasculitis, using the unaffected fellow eye as an internal control. Despite no significant differences in best corrected visual acuity (p=0.100) or central subfield macular thickness (p=0.084) at baseline, ffERG showed significant reductions in five of eight amplitudes (i.e. DA10 a-wave, p<0.001) and delays in six of eight implicit times (i.e. light-adapted Flicker, p=0.002). At follow-up ffERG, following management for retinal vasculitis, the implicit times normalised, coinciding with inflammation reduction. However, the amplitude reductions persisted. In ffERG, the implicit time might be a sensitive biomarker for retinal vasculitis activity and the amplitude might be one for permanent functional loss.
Archetypal analysis quantifies changes in patterns of visual field loss in eyes with acute non-arteritic anterior ischaemic optic neuropathy.
Szanto D, Woods B, Wang JK … +3 more , Wall M, Elze T, Kupersmith M
Br J Ophthalmol · 2026 Jun · PMID 41448866 · Publisher ↗
AIMS: We characterised visual field (VF) spatial loss patterns in acute non-arteritic anterior ischaemic optic neuropathy (NAION) using archetypal analysis (AA). METHODS: We performed standard automated perimetry on 727...
AIMS: We characterised visual field (VF) spatial loss patterns in acute non-arteritic anterior ischaemic optic neuropathy (NAION) using archetypal analysis (AA). METHODS: We performed standard automated perimetry on 727 participants with acute NAION at screening, day 1 of enrolment, months 2, 6 and 12. We applied AA, an unsupervised machine learning technique, to identify and quantify distinct VF loss patterns (archetypes, ATs). We used Mann-Whitney U tests and Wilcoxon signed-rank tests to assess demographic differences and longitudinal changes in discrete variables, and linear regression to analyse continuous variables. RESULTS: AA identified 10 distinct ATs, with three especially prevalent patterns: global VF loss (AT1), inferior altitudinal loss (AT2) and inferior altitudinal with macular sparing (AT3). Between day 1 and month 2, AT1 RW significantly increased from 15.7% to 28.1% (false discovery rate, FDR-adjusted p<0.001). Asian participants consistently exhibited greater RW for AT1 compared with White participants (day 1: 40.7% vs 17.7%; FDR-adjusted p<0.001). Sex differences emerged modestly at months 2 and 6, with females having a higher RW for superior altitudinal loss (FDR-adjusted p=0.049). Older participants showed slightly greater frequency of central horizontal and mild central depression patterns (FDR-adjusted p<0.001). CONCLUSIONS: AA effectively quantifies distinct, clinically significant VF spatial loss patterns in NAION, revealing significant temporal changes and demographic differences. Global VF loss represents the predominant AT, increasing notably within 2 months of disease onset. Prominent racial disparities, particularly higher severity in Asian individuals, underscore potential differences in NAION aetiology or susceptibility. These findings provide a foundation for improved disease characterisation and prognosis.
The retinal nerve fibre layer thickness slope: a localised biomarker of the structure-function relationship in early glaucoma.
Steiner S, Frommlet F, Schwarzhans F … +5 more , Fischer G, Pirrung M, Pircher M, Hitzenberger C, Vass C
Br J Ophthalmol · 2026 Jun · PMID 41443963 · Full text
BACKGROUND/AIMS: To describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes. METHODS: This prospecti...
BACKGROUND/AIMS: To describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes. METHODS: This prospective cross-sectional study of 50 early glaucoma and 139 healthy eyes analysed RNFL-S locally along retinal nerve fibre trajectories that were automatically traced and centred on 24-2 and 10-2 visual field (VF) test points. Corresponding virtual B-scans were extracted from stitched wide-field polarisation-sensitive optical coherence tomography images. A linear mixed-effects model (LMM) assessed the association between VFS and the factors RNFL-S, glaucoma status and age. RESULTS: The average VF mean deviation was -3.11±1.51 dB in glaucoma (mean age: 63.0±9.3 years) and -0.36±1.10 dB in healthy eyes (mean age: 47.9±16.3 years). In healthy subjects, VFS and the corresponding RNFL-S were 31.8±2.4 dB (12.5±2.9 µm/mm) in the upper hemisphere and 32.4±2.2 dB (12.5±2.5 µm/mm) in the lower hemisphere. In glaucoma patients, these values were significantly lower: 27.5±7.0 dB (8.6 ± 3.9 µm/mm, p<0.001) in the upper hemisphere and 30.1±4.3 dB (10.5±3.3 µm/mm, p<0.001) in the lower hemisphere. Significant point-wise Spearman correlation coefficients (up to r=0.61) were observed, particularly in the upper VF hemisphere within the central 10° and close to the optic nerve head. The LMM showed a positive association between VFS and RNFL-S (β=0.0415, SE=0.0023, p<0.001, R²=0.1885). Glaucoma was significantly associated with lower VFS (β=-2.468, SE=0.069, p<0.001). Age negatively correlated with VFS (β=-0.048, SE=0.002, p<0.001). CONCLUSION: Local RNFL-S is significantly correlated with VFS, highlighting its potential as a biomarker for focal glaucoma damage.
Trabeculotomy outcomes in paediatric patients with steroid-induced ocular hypertension or glaucoma: a case series and literature review.
von Arenstorff MM, Kessel L, Rasmussen MLR … +2 more , Riise P, Bach-Holm D
Br J Ophthalmol · 2026 Jun · PMID 41423324 · Full text
BACKGROUND: The purpose of this study is to assess the 24-month outcomes of trabeculotomy in paediatric patients with steroid-induced ocular hypertension or glaucoma who did not achieve adequate intraocular pressure (IOP...
BACKGROUND: The purpose of this study is to assess the 24-month outcomes of trabeculotomy in paediatric patients with steroid-induced ocular hypertension or glaucoma who did not achieve adequate intraocular pressure (IOP) control under maximal medical therapy. METHODS: A retrospective case series was conducted at Copenhagen University Hospital-Rigshospitalet between February 2018 and January 2022. 13 eyes of eight consecutive paediatric patients (aged 7-17 years) undergoing trabeculotomy for steroid-induced ocular hypertension or glaucoma were included. IOP, the number of pressure-lowering medications (PLMs) used, steroid exposure, visual acuity and postoperative complications were documented over a 24-month follow-up. Complete success was defined as achieving IOP of ≤21 mm Hg without the need for PLMs. RESULTS: Mean preoperative IOP was 29.7 mm Hg despite intensive use of PLMs. Postoperatively, mean IOP decreased significantly, remaining below 16 mm Hg at all postoperative follow-ups with a mean IOP of 15.1 mm Hg at 24 months. All eyes were off PLMs postoperatively, and complete success was achieved in all eyes through 24 months with no postoperative complications. Visual acuity showed slight improvement, though this was not statistically significant. Despite continued corticosteroid use for underlying conditions, no IOP elevation recurred. CONCLUSION: Trabeculotomy is a safe and effective surgical option for paediatric steroid-induced ocular hypertension or glaucoma, ensuring long-term IOP control without the need for further medication or surgical intervention. This procedure should be considered early in paediatric steroid responders when medical therapy fails to manage IOP adequately, minimising the risk of steroid-induced glaucoma.
Use of preoperative imaging in open globe injury management: a systematic review.
Mair J, Bush L, Halliday S … +23 more , McMaster D, Sellon E, Colyer MH, McClellan SF, Justin GA, Hoskin AK, Cavuoto KM, Leong J, Rousselot A, Woreta F, Miller KE, Gensheimer WG, Williamson TH, Dhawahir-Scala FE, Shah P, Sundar G, Mazzoli RA, Kuhn F, Woodcock M, Watson S, Gomes RSM, Agrawal R, Blanch RJ
Br J Ophthalmol · 2026 Jun · PMID 41423323 · Publisher ↗
IMPORTANCE: Primary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign...
IMPORTANCE: Primary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB. OBJECTIVE: The primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion. DATA SOURCES: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov. STUDY SELECTION: Prospective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023. DATA EXTRACTION AND SYNTHESIS: Eleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. MAIN OUTCOMES AND MEASURES: Sensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT. RESULTS: CT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied. CONCLUSIONS AND RELEVANCE: CT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.
Evaluation of automated pupillometry for early detection of ethambutol-induced optic neuropathy.
Dutta P, Verma S, Patni P … +6 more , Jain P, Singla S, Anand K, Singh S, Kedia N, Rao Y
Br J Ophthalmol · 2026 Jun · PMID 41423322 · Publisher ↗
Automated pupillometry (AP) has been studied in established optic neuropathies. This prospective, sequential AP evaluation of 62 newly diagnosed adult patients with pulmonary/extra-pulmonary tuberculosis, showed a statis...
Automated pupillometry (AP) has been studied in established optic neuropathies. This prospective, sequential AP evaluation of 62 newly diagnosed adult patients with pulmonary/extra-pulmonary tuberculosis, showed a statistically significant change in the amplitude of contraction (p=0.018), percent pupillary contraction and velocity of dilation (p=0.003). Although there was a significant decrease in retinal nerve fibre layer thickness in three quadrants (p<0.001) and an increase in the latency of pattern visual evoked potential (p<0.001), none of these changes reached the pre-defined cut-off values for subclinical ethambutol-induced optic neuropathy. Temporal quadrant retinal nerve fibre layer change is correlated with pupillometry changes. AP holds promise for the early detection of ethambutol-induced optic neuropathy.
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