Ophthalmology [JOURNAL]
Sun
200 papers
Factors leading to high intraocular pressure in Intraocular Device-Associated Uveitis (IDAU): a retrospective nested case-control study from a tertiary uveitis cohort.
Juhong J, Somkijrungroj T, Kongwattananon W … +2 more , Ueathaweephol S, Pongpirul K
BMC Ophthalmol · 2026 Jun · PMID 42310605 · Full text
BACKGROUND: Intraocular device-associated uveitis (IDAU) - which we propose as a more precise alternative to the traditional term "uveitis-glaucoma-hyphema (UGH) syndrome" - is a rare but potentially sight-threatening co...
BACKGROUND: Intraocular device-associated uveitis (IDAU) - which we propose as a more precise alternative to the traditional term "uveitis-glaucoma-hyphema (UGH) syndrome" - is a rare but potentially sight-threatening complication of intraocular device implantation. Elevated intraocular pressure (IOP) is a major driver of visual morbidity in IDAU, but the risk factors that predispose affected patients to IOP elevation remain poorly characterised. We aimed to describe the clinical spectrum of IDAU and to identify independent risk factors for elevated IOP in this population, using the Chulalongkorn University Uveitis Cohort (CUC) database. METHODS: This first nested case-control study within the Chulalongkorn University Uveitis Cohort (CU²C) enrolled 375 subjects followed at a tertiary uveitis clinic in Thailand over 8 years (August 2014-June 2022). Cases (n = 30) were IDAU patients with elevated IOP (> 21 mmHg); controls (n = 60) were IDAU patients with normal IOP, sampled at a 1:2 ratio from the same cohort. Univariate and multivariate logistic regression were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for candidate risk factors. RESULTS: We retrospectively identified 90 subjects who developed IDAU. Following a one-to-two case-control ratio, 30 case subjects and 60 control subjects were included. Three factors were significantly associated with high intraocular pressure in IDAU. These included intraocular lens (IOL) malposition (AOR: 8.30, 95% CI 1.25 to 54.76), long eye (AOR: 8.08, 95% CI 1.18 to 55.16) and age (AOR: 1.18, 95% CI 1.07 to 1.31). There was no statistical evidence of effects of hypertension, ruptured posterior capsule, vitrectomized eye, transillumination iris defect (TID), pseudophacodonesis and single-piece IOL in sulcus on high IOP in IDAU. CONCLUSION: In this first nested case-control study of IDAU, IOL malposition, long axial length (> 25 mm), and older age were independently associated with elevated IOP. These findings should inform clinician awareness and post-operative monitoring strategies for high-risk IDAU patients.
Short-term visual acuity responder rates after full-thickness macular hole surgery stratified by hole size: a retrospective cohort study.
Timoceanu L, Lang C, Tschuppert S … +3 more , Guber J, Valmaggia C, Ebneter A
BMC Ophthalmol · 2026 Jun · PMID 42310594 · Full text
PURPOSE: To quantify early real-world visual acuity (VA) responder rates at 25-35 days after idiopathic full-thickness macular hole (FTMH) surgery and evaluate the influence of hole size, gas tamponade, and prescribed du...
PURPOSE: To quantify early real-world visual acuity (VA) responder rates at 25-35 days after idiopathic full-thickness macular hole (FTMH) surgery and evaluate the influence of hole size, gas tamponade, and prescribed duration of face-down positioning. METHODS: In this retrospective cohort study, 193 eyes were analyzed after pars plana vitrectomy with internal limiting membrane peeling and SF6 20% or C3F8 12% gas tamponade. Routine Snellen (decimal) best-corrected VA was extracted from the medical record and converted to logarithm of the minimum angle of resolution (logMAR). Primary outcomes were mean VA change from the last preoperative assessment to the postoperative visit at 25-35 days and rates of two and three lines VA improvement (≥ 0.2 and ≥ 0.3 logMAR, respectively). Secondary outcomes were baseline-adjusted postoperative VA and anatomical closure. RESULTS: Overall, 66.8% of eyes improved by ≥ 0.2 logMAR and 52.3% by ≥ 0.3 logMAR. Mean VA improved from 0.774 ± 0.409 to 0.455 ± 0.346 logMAR (mean VA change - 0.318 logMAR; p < 0.001). VA change and responder rates did not differ significantly across International Vitreomacular Traction Study size groups (< 250 μm, 250-400 μm, > 400 μm), and no statistically significant association with gas choice or prescribed face-down positioning duration was detected within the limitations of this retrospective cohort. Baseline-adjusted postoperative VA differed by size, with large holes having worse early postoperative VA than small and medium holes, independent of prescribed face-down positioning duration or vitreomacular traction status. Anatomical closure differed by International Vitreomacular Traction Study size group (small 98.9%, medium 96.7%, large 78.0%; p < 0.001). CONCLUSIONS: In routine care, FTMH surgery results in clinically meaningful early VA improvement at 25-35 days, with approximately two-thirds of eyes gaining ≥ 0.2 logMAR and half gaining ≥ 0.3 logMAR. Although VA improvement was similar across size groups, large holes had lower closure rates and worse early postoperative BCVA. No statistically significant association between gas choice, prescribed face-down positioning duration, and the extent of VA improvement was detected in this retrospective cohort.
Glaucoma in UK Biobank: A Comparison of Diagnostic- Versus Treatment-based Definitions.
W S, A K, E A … +3 more , As B, J D, Hv DM
Ophthalmology · 2026 Jun · PMID 42309491 · Publisher ↗
PURPOSE: To compare, in the context of a population-scale biobank, associations of established risk factors and severity biomarkers with different glaucoma disease definitions. DESIGN: Observational cohort study. SUBJECT...
PURPOSE: To compare, in the context of a population-scale biobank, associations of established risk factors and severity biomarkers with different glaucoma disease definitions. DESIGN: Observational cohort study. SUBJECTS: 503,325 participants in UK Biobank. METHODS: Odds ratios (ORs) for associations of established risk factors (corneal-compensated intraocular pressure [IOPcc], polygenic risk score [PRS]) and clinical biomarkers of disease severity (macular retinal nerve fiber layer [mRNFL], ganglion cell layer [mGCL]) with different glaucoma definitions. MAIN OUTCOME MEASURES: Participants without glaucoma (n=481,772) were compared to those with: (1) a diagnosis of glaucoma based on self-report, hospital inpatient, or primary care records ("diagnosis-only"; n=16,154); or (2) a diagnosis plus evidence of treatment with glaucoma-specific medication or surgery ("diagnosed-and-treated"; n=7,012), either at baseline or during follow-up. RESULTS: For participants in the highest 5% of IOPcc compared with the remainder, ORs were 23.6 (95% CI: 21.3-26.2) in the diagnosed-treated group versus 11.4 (10.6-12.3; p<1x10 for difference) in the diagnosed-only group. Corresponding ORs were: 8.0 (6.9-9.2) in diagnosed-treated vs 4.7 (4.2-5.3; p=2.32x10 for difference) in diagnosed-only for the thinnest 5% mRNFL; 7.1 (6.1-8.3) in diagnosed-treated vs 4.2 (3.7-4.7; p=2.53x10 for difference) in diagnosed-only for the thinnest 5% mGCL; and 8.4 (7.9-8.8) in diagnosed-treated vs 5.6 (5.4-5.9; p<1x10 for difference) in diagnosed-only for the highest 5% PRS. There were similar patterns for the other risk factors studied. CONCLUSION: Definitions of glaucoma that combine both diagnostic and treatment evidence yielded substantially stronger odds ratios with IOPcc, mRNFL, and mGCL than definitions based on diagnostic evidence alone, suggesting implications for studies of glaucoma in population biobanks.
The effects of different forms of omega-3 polyunsaturated fatty acids on dry eye disease resulting from various etiologies: a meta-analysis and systematic review.
Chen G, Yan X, Yang S … +1 more , Li X
BMC Ophthalmol · 2026 Jun · PMID 42304315 · Full text
BACKGROUND: To compare the therapeutic effects of omega-3 polyunsaturated fatty acids (PUFAs) supplements across different formulations and dry eye disease (DED) etiologies. METHODS: Studies were systematically searched...
BACKGROUND: To compare the therapeutic effects of omega-3 polyunsaturated fatty acids (PUFAs) supplements across different formulations and dry eye disease (DED) etiologies. METHODS: Studies were systematically searched in six databases without language restrictions. Dry eye symptom scores, tear break-up time (TBUT), Schirmer test, corneal fluorescein staining (CFS), and meibomian gland dysfunction (MGD) scores were extracted as outcomes. Meta-regression, sensitivity and subgroup analyses were implemented to investigate significant heterogeneity. RESULTS: Twenty-seven randomized controlled trials (RCTs) were included. Systemic omega-3 supplementation appeared to improve all assessed outcomes in the overall pooled analysis; however, subgroup analyses revealed formulation- and etiology-dependent effects. Among systemic long-chain omega-3 formulations, efficacy was etiology-dependent: no significant benefits were observed in MGD-associated dry eye or in cases of unspecified etiology, whereas significant improvements were found in video display terminal-related dry eye and contact lens-associated dry eye. Given the limited evidence, findings were synthesized qualitatively: omega-3 supplements demonstrated beneficial effects in rosacea-associated and Sjögren's syndrome-related dry eye, whereas no clinically meaningful improvement was observed in LASIK-induced dry eye. In contrast, neither systemic short-chain fatty acids nor the combination of long- and short-chain omega-3 PUFAs achieved statistical significance. Furthermore, topical omega-3 delivery failed to demonstrate significant benefits compared with artificial tears. Meta-regression analysis revealed a significant association between omega-3 supplementation and several external factors, including mean age, geographic location, assessment methodologies, omega-3 dose, and publication year. CONCLUSIONS: Our research suggests that omega-3 supplements in different forms fail to demonstrate consistent effectiveness for DED of various etiological origins. Therefore, personalized guidance from healthcare providers regarding the application of omega-3 PUFAs for the management of ocular surface disorders is warranted. PROSPERO REGISTRATION: CRD42024623916.
Management of sliding suction loss during keratorefractive lenticule extraction performed with VisuMax 800 femtosecond laser using CIRCLE software: a case report.
Kim BK, Chung YT
BMC Ophthalmol · 2026 Jun · PMID 42304301 · Full text
BACKGROUND: Keratorefractive lenticule extraction (KLEx) is a widely used refractive procedure, but intraoperative suction loss remains a critical complication. While the faster laser frequency of the VisuMax 800 theoret...
BACKGROUND: Keratorefractive lenticule extraction (KLEx) is a widely used refractive procedure, but intraoperative suction loss remains a critical complication. While the faster laser frequency of the VisuMax 800 theoretically reduces this risk, it can still occur, occasionally presenting as sliding suction loss. In this phenomenon, the globe shifts while partial suction is maintained, resulting in a complete but decentered lamellar plane. This creates a surgical dilemma where standard re-docking protocols risk double cuts. In this report, we describe the first case of using the CIRCLE software as a rescue strategy specifically for sliding suction loss. CASE PRESENTATION: A 30-year-old male with - 4.25 diopter (D) myopia and - 0.25 D astigmatism underwent KLEx surgery using the VisuMax 800. During the peripheral cap cut, a sudden Bell's phenomenon caused the eye to shift, resulting in a sliding suction loss. The cap cut was completed in an inferiorly decentered position, while the subsequent incision was interrupted at 48.5%. To avoid corneal irregularities from standard re-initiation, the procedure was aborted. The following day, a rescue procedure was performed using CIRCLE software. By creating a junction (5.5 mm diameter, with a vertical offset of ± 5 μm) that precisely integrated with the existing decentered cap plane, the surgeon successfully bypassed the irregular incision and extracted the lenticule uneventfully. One month postoperatively, the patient achieved an uncorrected distance visual acuity of -0.04 logMAR, with stable refraction and a well-centered treatment zone confirmed by tomography. CONCLUSION: Sliding suction loss represents a specific intraoperative challenge that can occur even with high-speed laser systems. This case demonstrates that the CIRCLE software is a highly effective rescue tool for managing such complex interfaces. By enabling safe access to existing lamellar planes, CIRCLE software extends its utility from refractive enhancement to a vital intraoperative rescue strategy, preventing permanent corneal irregularities and ensuring excellent visual outcomes.
Clinical efficacy of intrastromal voriconazole injection in fungal keratitis involving different corneal stromal depths.
Huang H, Mo C, Zhou Z … +15 more , Jiang L, Chen G, Li Y, Chen B, Li Y, Tang F, Shen C, Lv M, Su N, Li F, Cui L, Xu F, Chen Q, Zhong H, Lan Q
BMC Ophthalmol · 2026 Jun · PMID 42304296 · Full text
PURPOSE: To evaluate the clinical efficacy of intrastromal injection of 0.5% (5 mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths. METHODS: This was a non-randomized, retrospective s...
PURPOSE: To evaluate the clinical efficacy of intrastromal injection of 0.5% (5 mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths. METHODS: This was a non-randomized, retrospective study based on patient treatment preferences. A total of 53 patients (53 eyes) with confirmed fungal keratitis treated between March 2021 and December 2023 were enrolled. Based on anterior segment optical coherence tomography (AS-OCT) findings, lesions were stratified by depth into superficial stromal involvement (Group A, n = 29) and deep stromal involvement (Group B, n = 24). Each group was further subdivided according to treatment modality: non-injection group (conventional antifungal therapy) (subgroups A1 and B1) versus injection group (conventional antifungal therapy combined with intrastromal voriconazole injection) (subgroups A2 and B2). The following clinical parameters were compared among the four subgroups: reduction ratio of corneal epithelial staining area at 7 days post-treatment initiation, best-corrected visual acuity (BCVA), corneal epithelial healing time, clinical cure time, and final clinical outcomes. RESULTS: All groups demonstrated significant reduction in ulcer area after 7 days of treatment (P < 0.05). In superficial stromal fungal keratitis, ulcer improvement rates were comparable between groups A1 (37.19%) and A2 (36.11%) (P = 0.838). In deep stromal fungal keratitis, group B2 (41.30%) showed significantly greater improvement compared to B1 (14.95%) (P < 0.0001). Final BCVA improved significantly in all groups, with no significant intergroup differences. Epithelial healing time and clinical cure time showed no significant differences across groups. The overall clinical cure rate was 98.1%, achieved through the non-injection group in 79.2% of cases and the injection group in 18.9% of cases. Treatment failure occurred in one case (1.9%). CONCLUSIONS: Intrastromal voriconazole injection provides no additional benefit for superficial stromal fungal keratitis compared with conventional topical therapy and is therefore not recommended as routine treatment given its invasive nature. For deep stromal fungal keratitis, intrastromal injection demonstrates superior early lesion control but does not reduce overall disease duration or improve final visual outcomes. Further large-scale prospective studies are warranted to establish its optimal indications and clinical value.
Standardized Classification System for Dysphotopsia Reporting.
Huang RS, Verhoeff N, Balas M … +25 more , Popovic MM, Chan CC, Costa VP, Filipe HP, Galor A, Henderson BA, Ing E, Iovieno A, Muzychuk AK, Ramulu PY, Rudnisky CJ, Saheb H, Schallhorn JM, Teichman JC, Tipperman R, Ursell P, Vinod K, Waring GO, Watson SL, Yeung SN, Zebardast N, Hutnik CML, Kherani IN, Schlenker MB, Mathew DJ
Ophthalmol Glaucoma · 2026 Jun · PMID 42302897 · Publisher ↗
PURPOSE: To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures. DESIGN: Systematic review and Delphi consensus...
PURPOSE: To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures. DESIGN: Systematic review and Delphi consensus process. PARTICIPANTS: Twenty ophthalmic specialists with expertise in glaucoma, cataract/refractive surgery, and cornea participated in this Delphi consensus survey. METHODS: A systematic literature search was conducted using Ovid MEDLINE and Embase to identify randomized controlled trials and observational studies reporting on dysphotopsias. Reported symptoms, assessment questionnaires, and individual question items were extracted to create a comprehensive list of potential classification items. These items were refined through iterative Delphi consensus surveys involving ophthalmic specialists, who evaluated each item for inclusion, exclusion, or rewording, and could propose the addition of new items. Consensus was defined a priori as ≥80% agreement among panelists. This iterative process allowed for progressive refinement of the classification system and continued until at least 80% of all proposed items achieved consensus. MAIN OUTCOME MEASURES: The proportion of ophthalmic specialists who chose to include or exclude specific dysphotopsia symptoms, and additional items of the questionnaire including baseline characteristics, environmental modifiers, quality of life, and attempted management strategies. RESULTS: Following the screening of 5,059 articles, 142 studies met inclusion criteria, identifying 34 unique dysphotopsia symptoms and 76 individual questionnaire items. Participants reached consensus on 53 of 63 items (84.1%) over two rounds of Delphi surveys. Items that did not meet inclusion or exclusion thresholds after the second round were excluded from the final classification system. The finalized classification system included 11 baseline clinical variables, 7 positive dysphotopsia symptoms (halos, glare/dazzle, starbursts, arcs, lines/streaks, ghosting, and flickering/shimmering), 1 negative dysphotopsia symptom (peripheral crescent/shadow), 5 environmental modifiers, 2 quality-of-life and mental health items, and 8 attempted interventions. These elements were consolidated into the DYsphotopsia Symptom Questionnaire and Outcomes (DYSQO) intended for clinical and research applications. CONCLUSION: A standardized classification system for the reporting of dysphotopsias following ophthalmic procedures was developed using the Delphi consensus process. The adoption of this tool in research and clinical practice may enhance the consistency, clarity, and quality of dysphotopsia reporting, enabling comparisons across interventions and enhancing evidence-based patient care.
Association between GLP-1 receptor agonist use and NAION with optic disc drusen.
Abboud I, Madani R, Chacko JG … +3 more , Phillips PH, Elhusseiny AM, Gaier ED
Ophthalmology · 2026 Jun · PMID 42302889 · Publisher ↗
In adults with optic disc drusen and type-2-diabetes or obesity, glucagon-like peptide-1 receptor agonists exposure was not associated with increased nonarteritic anterior ischemic optic neuropathy hazard, though moderat...
In adults with optic disc drusen and type-2-diabetes or obesity, glucagon-like peptide-1 receptor agonists exposure was not associated with increased nonarteritic anterior ischemic optic neuropathy hazard, though moderate risk increases could not be excluded statistically.
The Flip Sides of Interventional Glaucoma.
De Francesco T, Tanna AP, Ahmed IIK
Ophthalmol Glaucoma · 2026 Jun · PMID 42301180 · Publisher ↗
Abstract loading — click title to view on PubMed.
Bilateral microsporidial keratoconjunctivitis in an orthokeratology lens wearer: a case report and literature review.
Liang R, Zhang B
BMC Ophthalmol · 2026 Jun · PMID 42298529 · Full text
BACKGROUND: Microsporidial keratoconjunctivitis is a rare but serious ocular infection that can occur in contact lens wearers, particularly in individuals exposed to certain environmental or behavioral risk factors. Earl...
BACKGROUND: Microsporidial keratoconjunctivitis is a rare but serious ocular infection that can occur in contact lens wearers, particularly in individuals exposed to certain environmental or behavioral risk factors. Early and accurate diagnosis is crucial to ensure effective treatment and prevent long-term complications. This report presents a case of bilateral microsporidial keratoconjunctivitis in a pediatric patient who wore orthokeratology lenses, accompanied by a review of relevant literature. CASE PRESENTATION: A 9-year-old female presented with bilateral eye redness and a persistent foreign body sensation lasting for 3 weeks. The patient had recently started raising a pet parrot at home. Upon examination, conjunctival congestion was observed, along with papillary and follicular hypertrophy and diffuse punctate staining of the corneal epithelium. Corneal scraping and gene sequencing confirmed the diagnosis of Encephalitozoon hellem infection. CONCLUSION: This case underscores the rare occurrence of bilateral microsporidial keratoconjunctivitis in an immunocompetent child wearing orthokeratology lenses. Environmental exposure and lens wear may have contributed to infection. Clinicians should consider microsporidiosis in the differential diagnosis of persistent keratoconjunctivitis that does not respond to conventional therapies.
Regenerative effects of RKI-1447 on human corneal endothelial cells: a comparative study.
Akkaya HS, Kilic-Toprak E, Cort A … +2 more , Parca O, Toprak I
BMC Ophthalmol · 2026 Jun · PMID 42298479 · Full text
BACKGROUND: To evaluate and compare the effects of two Rho-associated protein kinase (ROCK) inhibitors (Y-27632 and RKI-1447) on human corneal endothelial cell (HCEC) proliferation and wound healing. METHODS: Using a com...
BACKGROUND: To evaluate and compare the effects of two Rho-associated protein kinase (ROCK) inhibitors (Y-27632 and RKI-1447) on human corneal endothelial cell (HCEC) proliferation and wound healing. METHODS: Using a commercial primary HCEC line, three groups of HCECs were created; control (no treatment), Y-27,632-treated, and RKI-1447-treated. The control, Y-27,632, and RKI-1447 groups were compared regarding cell proliferation (5-bromo-2-deoxyuridine [BrdU] incorporation), wound healing (ImageJ analysis), and ROCK activity (enzyme-linked immunosorbent assay [ELISA]). RESULTS: Both RKI-1447 (1 µM) and Y-27,632 (10 µM) significantly enhanced HCEC proliferation when compared to the control group (p < 0.05). However, RKI-1447 showed a more potent effect than Y-27,632 in terms of stimulating cell proliferation under the experimental conditions tested (p < 0.05). Furthermore, endothelial wound healing was faster in the RKI-1447 group compared to the control and Y-27,632 groups (p < 0.05). Y-27,632 was found to stimulate wound healing more than the control group only in the first 24 h (p < 0.05). CONCLUSION: This pilot study demonstrated that RKI-1447 was more potent than Y-27,632 regarding HCEC proliferation, endothelial wound healing and suppressing ROCK activity. However, further in vitro and in vivo preclinical studies are required to validate the efficacy and ocular safety profile of RKI-1447 before any consideration of clinical translation.
Three-year outcomes of customized transepithelial corneal cross-linking with oxygen supplementation in keratoconus.
Kojima T, Lin Y, Hishida A … +1 more , Nakamura T
BMC Ophthalmol · 2026 Jun · PMID 42298463 · Full text
BACKGROUND: Customized corneal cross-linking (CXL) has primarily been performed using the epithelium-off technique. Evidence on epithelium-preserving (transepithelial or epi-on) customized procedures remains limited, par...
BACKGROUND: Customized corneal cross-linking (CXL) has primarily been performed using the epithelium-off technique. Evidence on epithelium-preserving (transepithelial or epi-on) customized procedures remains limited, particularly with high oxygen concentrations (> 90%) beyond 1 year. We evaluated the 3-year clinical outcome and safety of customized transepithelial CXL (custom TE-CXL) with oxygen supplementation in patients with progressive keratoconus. METHODS: This retrospective study included 74 individuals (90 eyes) with progressive keratoconus who underwent custom TE-CXL with oxygen supplementation and were followed for at least 3 years. Outcomes included visual acuity, keratometric parameters, corneal thickness, and total corneal higher-order aberrations (HOAs). Examinations were performed at baseline and at 1, 2, and 3 years postoperatively. Longitudinal changes were analyzed using a linear mixed-effects model adjusted for baseline values. RESULTS: From 1 year onward, uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) showed significant improvement compared with preoperative values. Least squares mean (LSMean) Kmax values decreased from 56.2 D at baseline to 54.9 D, 54.4 D, and 54.2 D at 1, 2, and 3 years, respectively (all P < 0.01). UCVA improved at 1 year and remained stable thereafter, whereas corrected distance visual acuity (CDVA) showed no significant changes. Total HOAs, including coma and spherical aberration, decreased progressively over time. Apical corneal thickness decreased gradually, and thinnest corneal thickness showed significant reductions from 1 year onward. No adverse events, such as infection or corneal haze, were observed during follow-up. CONCLUSIONS: This descriptive, non-comparative analysis showed that custom TE-CXL with oxygen supplementation may be associated with stabilization of keratoconus over a 3-year period without observed adverse events. Further randomized controlled studies are warranted to evaluate its comparative effectiveness.
The Effects of a Digital Mindfulness Intervention on Mental Health and Vision-Related Quality of Life in Non-infectious Uveitis.
Shantha JG, Ray I, Kumar A … +10 more , Yan D, Da Silva K, Choo C, Coyne AB, Tang E, Gonzales JA, Doan T, Arnold BF, Lietman T, Acharya NR
Ophthalmology · 2026 Jun · PMID 42297306 · Publisher ↗
OBJECTIVE: To evaluate the effect of a digital mindfulness-based program (Calm Health) on mental health outcomes in adults with non-infectious uveitis (NIU). DESIGN: Single-center, single-masked, waitlist-controlled rand...
OBJECTIVE: To evaluate the effect of a digital mindfulness-based program (Calm Health) on mental health outcomes in adults with non-infectious uveitis (NIU). DESIGN: Single-center, single-masked, waitlist-controlled randomized clinical trial. PARTICIPANTS: One hundred adults aged ≥18 years with active or inactive NIU and baseline mild or greater anxiety or depression were randomized 1:1 to immediate access to a mindfulness app (Calm Health) or to a waitlist control group. METHODS: Participants in the intervention group were instructed to use the Calm Health mobile app for ≥10 minutes daily for 8 weeks. Controls received no new mindfulness intervention during this period. Outcomes were assessed at baseline and 8 weeks using validated surveys. MAIN OUTCOME MEASURES: The primary outcome was the mean difference in the anxiety symptom severity score measured by the Generalized Anxiety Disorder-7 (GAD-7) at 8 weeks. Secondary outcomes included changes in depression (Patient Health Questionnaire-9 [PHQ-9]), perceived stress (Perceived Stress Scale-10 [PSS-10]), and vision-related quality of life (National Eye Institute Visual Function Questionnaire-25 [NEI VFQ-25]). Outcomes were analyzed using linear analysis of covariance (ANCOVA) models, adjusting for baseline scores. RESULTS: Of 100 randomized participants (median age 43.5 years; 75% female), 70 completed the primary endpoint assessment. Median [Q1, Q3] total app use among intervention participants was 579 [397.79, 923.00] minutes over 8 weeks. After adjustment for baseline scores, the intervention group had a significantly lower GAD-7 score at 8 weeks compared with controls (mean difference -1.7 points; 95% CI: -3.17, -0.23, p=0.02). Secondary analyses showed significantly greater reductions in PHQ-9 scores (-1.90 points; 95% CI: -3.04, -0.76, p=0.001) and PSS-10 scores (-3.69 points; 95% CI: -6.00, -1.37, p=0.002) in the intervention group. Changes in NEI VFQ-25 scores were not statistically significant between groups (mean difference 1.98 points; 95% CI: -0.90, 4.86, p=0.18). Sensitivity analyses accounting for missing data and clinical covariates yielded similar results. CONCLUSIONS: A digital mindfulness-based intervention (Calm Health) significantly reduced anxiety, depression, and perceived stress in adults with NIU. Digital mindfulness tools may serve as a feasible, scalable adjunct to uveitis care, particularly in settings with limited access to traditional mental health services.
Intraocular Pressure Measurement Variability in the Ocular Hypertension Treatment Study.
Shukla AG, Leshno A, De Moraes CG … +5 more , Kass M, Gordon M, Tsamis E, Cioffi GA, Liebmann JM
Ophthalmol Glaucoma · 2026 Jun · PMID 42297140 · Publisher ↗
PURPOSE: To characterize intra-visit variability of Goldmann applanation tonometry (GAT) and identify factors associated with intraocular pressure (IOP) measurement variability using longitudinal data from the Ocular Hyp...
PURPOSE: To characterize intra-visit variability of Goldmann applanation tonometry (GAT) and identify factors associated with intraocular pressure (IOP) measurement variability using longitudinal data from the Ocular Hypertension Treatment Study (OHTS). DESIGN: Post hoc analysis of a multicenter, randomized clinical trial. SUBJECTS, PARTICIPANTS, CONTROLS: OHTS trial participants. MAIN OUTCOME MEASURES: Intra-visit IOP variability and measurement variability. METHODS: Intra-visit IOP measurements obtained using a standardized GAT protocol in OHTS were analyzed over 15 years of follow-up. Two measurements (IOP and IOP) were obtained per eye at each visit, with a third measurement (IOP) performed if IOP and IOP differed by >2 mm Hg. The intra-visit differences in IOP measurements were assessed. Multivariable mixed-effects logistic regression models were used to identify factors associated with the need for IOP measurement during follow-up. RESULTS: The analysis included 1,636 OHTS participants who had 35,636 patient visits (71,249 eye-visits, defined as a visit when at least one IOP measurement was performed for a given eye) and 145,236 IOP measurements. The first two measurements were within 2 mm Hg in 96.2% of eye-visits. Although 44.8% of paired measurements were identical, IOP was more often higher than IOP (54.4%, P<0.001). IOP was performed in 3.8% of eye-visits and lowered the final recorded IOP in 63.4%. Baseline need for IOP (OR 1.52; 95% CI, 1.14-2.03; P=0.004), higher current visit IOP (OR 1.06 per 1 mmHg higher IOP; 95% CI, 1.04-1.09; P<0.001), and baseline higher pattern standard deviation (OR 1.26 per 1 dB higher; 95% CI, 1.04-1.52; P=0.02) were independently predictive of need for IOP during follow-up, while randomized treatment assignment was not (OR 1.02; 95% CI, 0.88-1.19; P=0.78). CONCLUSIONS: GAT remains the most common procedure in ophthalmology. In the OHTS, GAT demonstrated modest measurement variability. IOP measurement variability was associated with characteristics known to be risk factors for the development of primary open-angle glaucoma. These findings have implications for clinical decision-making, trial design, and the application of the OHTS risk calculator. Clinicians should maintain a low threshold for repeating measurements when intra-visit measurements are inconsistent or when making a clinical decision based on a single IOP measurement.
Influence of angle kappa and angle alpha on visual outcomes after implantation of a nondiffractive extended-depth-of-focus intraocular lens: a prospective observation study.
Wu N, Yao Y, Zhou B … +3 more , Liu S, Zhang Y, Wang X
BMC Ophthalmol · 2026 Jun · PMID 42289663 · Full text
BACKGROUND: While large angle kappa (chord µ) and angle alpha (chord α) have been reported to adversely affect visual quality with diffractive multifocal intraocular lenses (MIOLs), their impact on the postoperative visu...
BACKGROUND: While large angle kappa (chord µ) and angle alpha (chord α) have been reported to adversely affect visual quality with diffractive multifocal intraocular lenses (MIOLs), their impact on the postoperative visual outcomes of nondiffractive extended depth of focus (EDOF) IOLs remains unclear. This study aimed to evaluate the influence of postoperative angle kappa and angle alpha on visual and optical outcomes following implantation of a nondiffractive EDOF IOL. METHODS: This prospective observational study included 115 cataract patients (115 eyes) who underwent implantation of the AcrySof IQ Vivity nondiffractive wavefront-shaping EDOF IOL. At 3 months postoperatively, photopic and mesopic angle kappa and angle alpha were measured using the OPD-Scan III. Visual outcomes included uncorrected visual acuity at different distances, objective optical quality parameters, contrast threshold, and patient-reported subjective visual disturbance scores. We performed partial correlation analyses to examine the relationships of angle kappa and angle alpha with postoperative visual outcomes, while controlling for potential confounding variables. Subgroup analyses based on clinically relevant offset thresholds were additionally conducted. RESULTS: At 3 months postoperatively, most postoperative angle kappa and angle alpha values were within physiological ranges, with only a small number of eyes having values ≥ 0.5 mm (photopic angle kappa: n = 7; mesopic angle kappa: n = 10; angle alpha: n = 29). Partial correlation analyses demonstrated no significant associations between photopic or mesopic angle kappa and postoperative visual acuity, objective optical quality metrics, or subjective visual disturbance scores (all P > 0.05). Angle alpha showed weak but statistically significant positive correlations with uncorrected distance visual acuity and contrast threshold (P < 0.05), indicating slightly better visual performance with larger angle alpha values. No significant differences in visual outcomes were observed among angle kappa and angle alpha subgroups. CONCLUSIONS: Within the observed postoperative range, angle kappa and angle alpha were not associated with clinically meaningful deterioration in visual performance following implantation of a nondiffractive EDOF IOL. These findings suggest that wavefront-shaping EDOF designs may be tolerant to moderate angular offsets in routine clinical practice.
Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment.
Kremser F, Yan W, Khoramnia R … +2 more , Auffarth GU, Łabuz G
BMC Ophthalmol · 2026 Jun · PMID 42288831 · Full text
BACKGROUND: To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL) - Extend (Hanita), against a well-established IOL - Eyhance (ICB00, J&J Vision) - through in vitro benchmarking. METHODS:...
BACKGROUND: To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL) - Extend (Hanita), against a well-established IOL - Eyhance (ICB00, J&J Vision) - through in vitro benchmarking. METHODS: Optical benchmarking was conducted using the OptiSpheric IOL PRO2 device in compliance with International Organization for Standardization (ISO) guidelines. Optical quality was assessed using the modulation transfer function (MTF), point spread function (PSF), area under the MTF (MTFa), and 1951 USAF test charts. Measurements were taken at 3.0 mm and 4.5 mm apertures using a model cornea that induced 0.13 μm of spherical aberration to simulate clinical performance. RESULTS: Both IOLs demonstrated comparable optical performance. At a 3 mm aperture, the Extend produced an average MTF at 50 lp/mm of 0.38 ± 0.01, while the ICB00 produced 0.36 ± 0.01. The MTFa and derived logMAR visual acuity (VA) curves showed nearly complete overlap for defocus levels less than - 1.25 D, with both lenses yielding identical VA at far focus (-0.09 logMAR). At higher defocus levels, the observed difference between the models accounted for < 0.02 logMAR, which is small and below the resolution threshold of standard VA testing. Point spread function assessments revealed comparable light distribution for both IOLs. CONCLUSION: Under laboratory conditions, the Hanita Extend IOL shows comparable results to the Eyhance ICB00 regarding MTF function, USAF-Chart images, and PSF assessment.
Targeted CYP27A1 gene analysis for early identification of cerebrotendinous xanthomatosis in juvenile cataract patients: report of a novel variant.
Ceylan A, Güler S, Aydin FO … +3 more , Akbas YB, Yildiz BK, Yildirim Y
BMC Ophthalmol · 2026 Jun · PMID 42288808 · Full text
BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early...
BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early diagnosis. This study evaluated the prevalence of CYP27A1 variants in patients with bilateral juvenile cataracts and described related clinical findings. METHODS: This single-center retrospective study was conducted between May 2022 and April 2025 at Başakşehir Çam and Sakura City Hospital, Istanbul. Patients aged 6 months to 21 years with bilateral juvenile cataracts of undetermined etiology were included. Those with congenital, traumatic, or defined metabolic cataracts were excluded. All underwent ophthalmic evaluation and targeted CYP27A1 sequencing (exons 1-9, exon-intron boundaries) with confirmatory Sanger sequencing. Variants were classified per ACMG/AMP guidelines using ClinVar, HGMD, VarSome, and Franklin databases. RESULTS: Among 128 patients (42.2% male, 57.8% female; mean age 10.9 ± 9.4 years), two (1.5%, 95% CI: 0.2-5.4) carried a novel homozygous CYP27A1 c.398G > A (p.W133*) pathogenic variant, and three (2.4%, 95% CI: 0.5-6.9) had a heterozygous c.884 C > T (p.A295V) variant of uncertain significance. Both families had parental consanguinity. Both patients with homozygous pathogenic variants presented with bilateral cerulean cataracts. DISCUSSION: The absence of systemic symptoms at diagnosis highlights the feasibility of ophthalmology-based genetic screening for CTX. Identifying affected individuals before neurological onset enables timely initiation of oral chenodeoxycholic acid replacement therapy, which may reduce cholestanol and bile alcohol accumulation and help prevent irreversible complications. CONCLUSION: Incorporating CYP27A1 sequencing into the evaluation of bilateral juvenile cataracts may facilitate earlier detection of CTX and timely referral for appropriate management, especially in high-consanguinity regions.
Comparative outcomes of endoscopic dacryocystorhinostomy under local versus general anesthesia in elderly patients.
Chang YH, Liao YL, Tsai YJ … +1 more , Chu YC
BMC Ophthalmol · 2026 Jun · PMID 42288789 · Full text
BACKGROUND: Endoscopic dacryocystorhinostomy (DCR) is a common procedure, typically performed under general anesthesia (GA), while performing it under local anesthesia (LA) may offer benefits to elderly or high-risk pati...
BACKGROUND: Endoscopic dacryocystorhinostomy (DCR) is a common procedure, typically performed under general anesthesia (GA), while performing it under local anesthesia (LA) may offer benefits to elderly or high-risk patients. This study evaluates the feasibility and surgical outcomes of endoscopic DCR under LA, with comparison to GA. METHODS: This retrospective cohort study included patients aged 18 years or older with acquired nasolacrimal duct obstruction who underwent Endoscopic DCR at a tertiary referral center between January 2019 and December 2024. Surgical outcomes were evaluated using multivariable Cox proportional hazards models adjusted for age and sex, with propensity score-matched analyses as sensitivity analyses. Secondary outcomes included operative time, intraoperative bleeding, complications, predictors of failure and revision surgery. Furthermore, potential predictors were screened by univariable analyses, and variables with P < 0.15 were entered into multivariable models. RESULTS: The study enrolled 210 eyes of 162 patients, with 117 patients (159 eyes) in the GA group, and 45 patients (51 eyes) in the LA group. The mean age was 61.7 ± 12.2 years in the GA group, and 72.3 ± 12.7 years in the LA groups. Surgical success was comparable between groups, with the LA group exhibiting a shorter operative time (P < 0.001). No major adverse events were reported. Small lacrimal sac size was identified as an independent associated factor of surgical failure (P < 0.001). CONCLUSIONS: LA offers a feasible alternative to GA for endoscopic DCR, particularly in elderly patient. Potential drawbacks include patient discomfort and an uncontrollable surgical field, which can be mitigated with appropriate patient selection.
Elevated serum high-density lipoprotein is positively associated with incident glaucoma among middle-aged and older adults: a national cohort in China.
Chen Z, Lin H, Zheng X … +4 more , Song X, Feng H, Guo H, Yu X
BMC Ophthalmol · 2026 Jun · PMID 42288781 · Full text
PURPOSE: Emerging evidence challenges the traditional view of high-density lipoprotein (HDL) as uniformly protective in ocular health. This study aimed to evaluate the association between serum HDL levels and glaucoma in...
PURPOSE: Emerging evidence challenges the traditional view of high-density lipoprotein (HDL) as uniformly protective in ocular health. This study aimed to evaluate the association between serum HDL levels and glaucoma in a middle-aged and older Chinese population. METHODS: We conducted a retrospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 7,510 participants aged over 45 years without baseline glaucoma were included. Serum HDL was measured at baseline (2011), and incident glaucoma was ascertained via self-report during follow-up (2013-2018). Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to assess the association, with adjustment for demographic and clinical covariates. RESULTS: Over a 7 years' follow-up, 224 participants (2.98%) developed glaucoma. After multivariable adjustment, each 1 mmol/L increase in HDL was associated with a 57% higher risk of glaucoma (HR = 1.57; 95% CI: 1.10-2.26; p = 0.014). Participants with low HDL level (< 1.0 mmol/L) had a significantly lower glaucoma risk compared to those with normal HDL level (HR = 0.63; 95% CI: 0.38-0.89; p = 0.012). RCS analysis indicated a steeper increase in risk at serum HDL ≤ 1.501 mmol/L. Subgroup analyses revealed consistency across most strata, with a stronger association observed in participants with liver disease (p for interaction = 0.035). CONCLUSION: Elevated serum HDL levels were associated with an increased risk of glaucoma in Chinese middle-aged and older adults, particularly at lower HDL concentrations. These findings challenge the conventional "good cholesterol" paradigm in glaucoma and underscore the need for further research into lipid-related pathways in its pathogenesis.
Cataract after electrical injury: clinical characteristics and surgical management outcomes, a case report of three cases.
Wang Y, Chang X, Li L
BMC Ophthalmol · 2026 Jun · PMID 42288764 · Full text
BACKGROUND: Electric cataract, a rare and vision-threatening complication, is frequently observed in patients following electrical injuries. Current knowledge of its clinical characteristics and treatment is largely deri...
BACKGROUND: Electric cataract, a rare and vision-threatening complication, is frequently observed in patients following electrical injuries. Current knowledge of its clinical characteristics and treatment is largely derived from a limited number of case reports. This report presents three cases of distinct types of electric cataract, with detailed documentation of disease progression, clinical features, individualized surgical management, and corresponding outcomes. CASE PRESENTATION: This case series included three patients: a 30-year-old female with indirect lightning-induced cataract (onset at 2 years), a 64-year-old male with cataract following domestic low-voltage electrical injury (onset at 50 years), and a 54-year-old male with high-voltage electric cataract (onset at 3 months). All three cases presented with characteristic anterior subcapsular opacities (snowflake, sunflower, or moss-like patterns), anterior subcapsular cortical opacities, and posterior subcapsular opacities. Intraoperative zonular laxity was observed in all three cases. Two patients had unilateral involvement, while one had bilateral cataracts. The young patient received implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL), and the middle-aged patient received implantation of a toric monofocal IOL. The patient with bilateral cataracts also had simultaneous macular damage, as well as corneal leukoma; a monofocal IOL was implanted in one eye, while the fellow eye ultimately progressed to a mature cataract. Postoperative corrected distance visual acuity improved to 0.8 in two cases and 0.4 in the third. No significant postoperative complications were observed. CONCLUSION: Cataracts following electrical injury may be insidious at onset and can exhibit progressive worsening. Pupillary dilation examination is essential, and regular follow-up is required. Attention should be paid to concomitant injuries of the cornea, fundus, zonules, and corneal endothelium to guide individualized surgical planning, thereby maximizing patient benefits.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe