Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
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200 papers
Association between probiotic prescriptions and the incidence of primary open-angle glaucoma in patients with documented dry eye.
Tsai CY, Weng CH, Sheen YJ … +5 more , Chen JP, Chen HM, Tsai CY, Wang IJ, Chou CC
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42397591 · Publisher ↗
PURPOSE: To examine the association between probiotic prescriptions and the risk of developing primary open-angle glaucoma (POAG). METHODS: A retrospective cohort study was conducted using the TriNetX multinational datab...
PURPOSE: To examine the association between probiotic prescriptions and the risk of developing primary open-angle glaucoma (POAG). METHODS: A retrospective cohort study was conducted using the TriNetX multinational database. Adults aged ≥ 40 years with a diagnosis of dry eye and no prior history of glaucoma were included. Participants were categorized into probiotic and non-probiotic groups based on prescription records. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medication use. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs), and Kaplan-Meier analyses assessed five-year cumulative incidence. Sensitivity and subgroup analyses were performed to examine robustness and consistency across clinical subgroups. RESULTS: Among 15,613 matched pairs, probiotic prescriptions were associated with lower risks of POAG (HR: 0.44; 95% CI: 0.32-0.61). These associations remained consistent in sensitivity analyses and were observed across multiple subgroups stratified by age, sex, race, diabetes status, and obesity. CONCLUSIONS: Probiotic prescriptions were associated with a reduced risk of POAG in this large real-world cohort. These findings highlight the need for prospective studies to confirm causality and explore underlying mechanisms.
Clinical outcomes of 577-nm subthreshold micropulse laser therapy in chronic central serous chorioretinopathy: influence of retinal pigment epithelium alterations and baseline OCT characteristics.
Koyuncu K, Akkul Z, Ulusoy MO … +2 more , Ismayilov AS, Erseven C
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42397590 · Publisher ↗
PURPOSE: To evaluate the 6-month clinical outcomes of 577-nm subthreshold micropulse laser treatment (SMPLT) in patients with chronic central serous chorioretinopathy (cCSCR) and to identify factors associated with compl...
PURPOSE: To evaluate the 6-month clinical outcomes of 577-nm subthreshold micropulse laser treatment (SMPLT) in patients with chronic central serous chorioretinopathy (cCSCR) and to identify factors associated with complete resolution of subretinal fluid (CRSF). METHODS: This retrospective cross-sectional study included patients with cCSCR treated with 577-nm SMPLT using a 15% duty cycle. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), subretinal fluid height (SRFH), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and outer nuclear layer thickness (ONLT) were evaluated at baseline and at 1, 3, and 6 months after treatment. Factors influencing CRSF were analyzed. RESULTS: Thirty-five eyes of 35 patients were included. BCVA improved significantly at all follow-up visits compared with baseline (all p < 0.001). CFT and SRFH decreased significantly at 1, 3, and 6 months after treatment (all p < 0.001). SFCT showed significant reduction at 1 and 6 months (p = 0.001 and p = 0.018), whereas no significant changes were observed in CVI or ONLT. CRSF was achieved in 22.9% of eyes at 1 month, 48.6% at 3 months, and 60% at 6 months. Higher complete resolution rates were observed in eyes without retinal pigment epithelium (RPE) alterations (75% vs. 57.1%). Female sex was associated with lower complete resolution rates, while higher baseline CFT and SRFH and CVI were associated with CRSF. CONCLUSIONS: 577-nm SMPLT using a 15% duty cycle was associated with significant functional and anatomical improvement in cCSCR. Treatment before the development of RPE alterations may be associated with more favorable anatomical outcomes.
Effect of ablation-zone diameter on whole-corneal higher-order aberrations after LASEK: a retrospective study.
Wang H, Xu L, Chen Z … +6 more , Ding P, Zhang M, Tang S, Lin Y, Zheng S, Zhu Y
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390574 · Publisher ↗
PURPOSE: To evaluate whether modest differences in programmed ablation-zone diameter (AZD) during LASEK affect postoperative whole-corneal higher-order aberrations (HOAs), with emphasis on spherical aberration (SA) and c...
PURPOSE: To evaluate whether modest differences in programmed ablation-zone diameter (AZD) during LASEK affect postoperative whole-corneal higher-order aberrations (HOAs), with emphasis on spherical aberration (SA) and coma (CA). METHODS: This retrospective single-center observational study included 120 right eyes that underwent LASEK between January 2020 and June 2025. Eyes were grouped by programmed AZD: 5.75 mm (n = 41), 6.00 mm (n = 40), and 6.25 mm (n = 39). Corneal HOAs were measured by Pentacam at baseline, 1 and 3 months. Analyses included absolute changes, per-diopter normalization, SEQ-matched comparisons, and ablation-depth-matched sensitivity analyses. RESULTS: All groups showed significant postoperative increases in total HOA, SA and CA at 3 months (P < 0.001). In unadjusted analyses, larger programmed AZDs exhibited smaller absolute increases in total HOA, SA and trefoil (P < 0.001). After per-diopter normalization, most zone-dependent differences were largely attenuated (P > 0.05 for most comparisons). SEQ-matched analyses showed that AZD enlargement reduced SA but tended to increase CA, without a uniform reduction in total HOA. After ablation-depth matching, larger programmed AZD was not associated with additional HOA induction. CONCLUSIONS: In LASEK, larger programmed AZDs were associated with smaller unadjusted HOA and SA induction at 3 months; however, these associations were substantially influenced by baseline refractive magnitude and ablation depth. AZD selection should be individualized, balancing refractive correction, tissue removal, corneal safety, and centration strategy.
Real-world comparison of faricimab and aflibercept as second-line therapies for neovascular age-related macular degeneration.
Nagar NB, Ostrovsky M, Shoham-Hazon N … +10 more , Tuli R, Lee TKM, Buchnick N, Beluga S, Bramnik L, Shcolnik E, Goldfeather Ben Zaken S, Levy N, Bareket M, Berco E
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390573 · Publisher ↗
PURPOSE: To compare real-world effectiveness of faricimab versus aflibercept as second-line therapies for neovascular age-related macular degeneration (nAMD). METHODS: This multicenter retrospective cohort study included...
PURPOSE: To compare real-world effectiveness of faricimab versus aflibercept as second-line therapies for neovascular age-related macular degeneration (nAMD). METHODS: This multicenter retrospective cohort study included patients with nAMD who switched to faricimab or aflibercept as second-line anti-VEGF therapy and were followed ≥ 12 months. Outcomes included best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), injection intervals, and switching rates. Multivariable linear regression identified predictors of visual and anatomical change. RESULTS: A total of 170 eyes (84 faricimab, 86 aflibercept) were analyzed. Faricimab-treated eyes had worse baseline BCVA (0.60 ± 0.49 vs. 0.47 ± 0.37 logMAR; p = 0.048) and numerically lower baseline CMT (332.7 ± 107.9 vs. 367.5 ± 103.5 μm; p = 0.057). At final follow-up, faricimab achieved a significant BCVA gain (- 0.16 ± 0.42 logMAR; p < 0.001), while aflibercept maintained stable vision (p = 0.923). Both agents significantly reduced CMT (p < 0.001), with a greater mean reduction observed in the aflibercept group (- 96.7 ± 127.5 vs. - 56.8 ± 132.0 μm; p = 0.046). Final BCVA and CMT did not differ significantly between groups. Final injection intervals were similar between groups (7.5 ± 2.9 vs. 7.6 ± 3.1 weeks; p = 0.906), and switching to third-line therapy occurred less frequently in the faricimab group (4.8% vs. 12.8%; p = 0.065). Baseline BCVA predicted visual gain (B = - 0.199; p = 0.010) and baseline CMT predicted anatomical improvement (B = - 0.517; p < 0.001). CONCLUSION: In this real-world multicenter cohort, both faricimab and aflibercept were associated with visual and anatomical improvement after switching to second-line therapy for nAMD. No statistically significant difference in final BCVA, final CMT or injection interval was observed between treatment groups. Baseline disease severity predicted treatment response. Given the retrospective design and residual confounding, these findings should be interpreted as associative rather than causal.
Retinal imaging for cerebrovascular risk stratification: evidence, limitations, and practical thresholds for the ophthalmologist.
Tonella Vezzoli R
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390572 · Publisher ↗
BACKGROUND: The retina shares developmental origin, microvascular anatomy, and barrier physiology with the brain, making non-invasive retinal imaging a candidate window onto cerebrovascular burden. Despite a growing body...
BACKGROUND: The retina shares developmental origin, microvascular anatomy, and barrier physiology with the brain, making non-invasive retinal imaging a candidate window onto cerebrovascular burden. Despite a growing body of association data, translational claims in this field have frequently outpaced the evidence, and clinically actionable guidance for the practising ophthalmologist remains sparse. This review asks a deliberately narrow question: which retinal imaging domains provide evidence mature enough to inform clinical decisions about cerebrovascular risk, and which remain investigational? METHODS: Narrative review of the published literature on five retinal imaging domains: (1) classical fundus signs and quantitative vessel-calibre analysis; (2) retinal vessel geometry including fractal dimension and tortuosity; (3) optical coherence tomography (OCT) structural analysis; (4) optical coherence tomography angiography (OCTA); and (5) artificial intelligence (AI) and oculomics. Evidence was appraised with emphasis on study design, population size, confounding control, external validity, and translational distance from clinical practice. The literature search was updated to March 2026. RESULTS: Classical retinal microvascular abnormalities and quantitative vessel-calibre metrics carry the strongest and most reproducible evidence base, particularly for cumulative vascular burden, lacunar stroke phenotypes, and cerebral small-vessel disease (cSVD). Retinal vessel fractal dimension adds incremental signal for the cSVD phenotype, with recent Mendelian randomisation data suggesting causal rather than purely associative relationships between retinal vascular morphology and stroke. OCT structural analysis shows consistent associations with ischaemic stroke and cSVD-related neurodegeneration, but the absence of validated clinical thresholds limits immediate applicability. OCTA deepens neurovascular phenotyping but is constrained by device heterogeneity, segmentation variability, and ocular confounding. AI-based oculomics, including foundation-model approaches, demonstrates credible discrimination for silent brain infarction and stroke-risk enrichment, though no randomised controlled trial has yet demonstrated that retinal AI improves cerebrovascular outcomes, and current translational limits remain substantial. CONCLUSIONS: Retinal imaging is best positioned as a neurovascular phenotyping tool rather than a stand-alone stroke prediction instrument. The ophthalmologist's highest-value contribution is recognising when embolic, asymmetric, clustered, or disproportionate retinal findings should lower the threshold for broader vascular assessment or neurological referral. Integration with Doppler ultrasound vascular assessment - including ophthalmic artery flow evaluation, carotid haemodynamics, and orbital haemodynamic asymmetry - substantially extends the clinical reach of retinal phenotyping and is highlighted as a mechanistically complementary dimension of extracranial cerebrovascular evaluation. This review provides a practical, pattern-based framework applicable in routine ophthalmic care.
Layer-by-layer macular, peripapillary retinal nerve fiber layer thickness and minimum rim width changes in PLWH with undetectable viral load: an OCT-based study.
Toygar Deniz M, Yılmaz Tuğan B, Karaca G … +3 more , Balci S, Yüksel N, Akhan S
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390571 · Publisher ↗
PURPOSE: To evaluate layer-by-layer macular thickness and optic nerve head parameters including the peripapillary retinal nerve fiber layer and Bruch's membrane opening minimum rim width in virologically suppressed peopl...
PURPOSE: To evaluate layer-by-layer macular thickness and optic nerve head parameters including the peripapillary retinal nerve fiber layer and Bruch's membrane opening minimum rim width in virologically suppressed people living with HIV and compare them with healthy controls. METHODS: This prospective cross-sectional study included 94 eyes from virologically suppressed people living with HIV and 80 eyes from age- and sex-matched healthy controls. All participants underwent spectral-domain optical coherence tomography. Layer-by-layer macular thickness, peripapillary retinal nerve fiber layer, Bruch's membrane opening minimum rim width, and subfoveal choroidal thickness parameters were analyzed. RESULTS: Most layer-by-layer thickness parameters in macular regions, as well as subfoveal choroidal thickness, were significantly thinner in people living with HIV than in controls (p < 0.05, for all). Also, significant thinning observed in global, temporal, and nasal inferior sectors of the peripapillary retinal nerve fiber layer and all sectors of the Bruch's membrane opening minimum rim width (p < 0.05) in people living with HIV compared to the controls. Using robust multivariable regression analyses, after adjustment for age, intraocular pressure, and axial length, HIV status remained independently associated with significantly reduced central/global retinal parameters. Correlation analysis revealed that baseline HIV RNA levels were moderately negatively correlated with the thickness of the inner temporal nerve fiber layer (r = - 0.542, p < 0.001), inner nasal nerve fiber layer (r = - 0.516, p < 0.001), central nerve fiber layer (r = - 0.553, p < 0.001) and central inner retinal layer (r = - 0.503, p < 0.001). In addition, longer disease duration was significantly associated with reduced inner plexiform layer thickness (r = - 0.351, corrected p = 0.007) and reduced inner nuclear layer thickness (r = - 0.306, corrected p = 0.035). CONCLUSION: People living with HIV exhibited significant thinning in macular and peripapillary retinal layers, along with reduced subfoveal choroidal thickness compared to controls. These changes remained independently associated with HIV status after adjusting for key confounders. Higher HIV RNA levels and longer disease duration were linked to greater inner retinal thinning. Overall, the findings suggest subclinical neuroretinal involvement in HIV infection.
Initial aqueous suppressant therapy after glaucoma drainage device implantation: a systematic review.
Silva AC, Alves D, Barbosa-Breda J
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390570 · Publisher ↗
PURPOSE: Aqueous suppressants (AS) are commonly used after glaucoma drainage device (GDD) surgery to limit early rises in intraocular pressure (IOP). This review aims to evaluate whether the timing or regimen of postoper...
PURPOSE: Aqueous suppressants (AS) are commonly used after glaucoma drainage device (GDD) surgery to limit early rises in intraocular pressure (IOP). This review aims to evaluate whether the timing or regimen of postoperative aqueous suppression influences IOP control, the hypertensive phase (HP) incidence, surgical success, postoperative complications and visual outcomes. METHODS: A systematic review of PubMed, Scopus, and Web of Science was conducted. Studies evaluating postoperative AS initiation after GDD surgery were included. Studies involving combined procedures, except clear-cornea phacoemulsification, were excluded. RESULTS: Seven studies were included: three randomized clinical trials (RCT), three retrospective cohort studies, and one case series. All studies involved exclusively Ahmed glaucoma valve (AGV) implantation. Regarding timing, early AS initiation was evaluated in five studies and was associated with a significantly lower HP incidence in two of them. Despite heterogeneous definitions of surgical success and failure, three studies showed either higher success rates or lower failure rates compared with delayed initiation. Only one RCT demonstrated consistently lower IOP values across all follow-up visits up to 1 year. In a paediatric RCT, prolonged aqueous suppression resulted in lower IOP and reduced hyperencapsulation at 1 year. Regarding IOP-lowering drug class, one study found that AS achieved better IOP control, reduced long-term need for glaucoma medications, and higher success rates compared with prostaglandin analogues. Earlier initiation did not increase the rates of hypotony or major complications. CONCLUSION: Early AS initiation after AGV implantation is associated with lower HP incidence in several studies, but the certainty of evidence is low to moderate and long-term benefit remains uncertain.
Eye care workforce density by provider type in urban and rural counties in the United States, 2010 to 2021.
Shah J, Ahmed H, Weiss MB … +4 more , Serhan H, Dias CG, Kiss S, Kovacs KD
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42390569 · Publisher ↗
PURPOSE: Healthcare provider geographic density patterns have been shown to play a role in healthcare disparities in the United States. This study examines these patterns specifically in ophthalmology and optometry acros...
PURPOSE: Healthcare provider geographic density patterns have been shown to play a role in healthcare disparities in the United States. This study examines these patterns specifically in ophthalmology and optometry across urban and rural communities. METHODS: A cross-sectional study evaluating the Area Health Resource File was conducted according to the National Center for Health Statistics' Urban-Rural Classification Scheme. Ophthalmologist and optometrist density per 100 000 persons in each county was assessed annually, and a Chow test was conducted to evaluate the urban-rural distribution trend. RESULTS: 3218 counties (472 large metropolitan, 763 small/medium metropolitan, and 1983 rural) were evaluated from 2010 to 2021. In this timeframe, it was found that urban counties had greater provider density than rural counties for both ophthalmology and optometry. Additionally, ophthalmologist density per 100 000 persons decreased from 2010 to 2021, while optometrist density increased in all county types. Counties with zero practicing nonfederal ophthalmologists ("dead zones") increased modestly from 60.7% in 2010, to 62.7% in 2021, disproportionately concentrated in rural counties. CONCLUSIONS: Geographic disparities in eye care access persist and may be widening, particularly in rural communities where ophthalmologist shortages are most pronounced. Although optometrist availability has increased, growing "dead zones" for specialty eye care raise concern for populations already at higher risk for vision-threatening disease, highlighting the need for targeted workforce and policy interventions.
Measured corneal astigmatism vs. predicted refractive astigmatism in determining astigmatism correction in cataract patients with low astigmatism.
Xie X, Lin H, Han X … +5 more , Chen X, Qiu X, Tan X, Zhang J, Luo L
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42384181 · Publisher ↗
PURPOSE: To determine which parameter best identifies those at risk of clinically significant postoperative residual astigmatism among eyes classified as low-astigmatism by SimK. METHODS: Patients with preoperative simul...
PURPOSE: To determine which parameter best identifies those at risk of clinically significant postoperative residual astigmatism among eyes classified as low-astigmatism by SimK. METHODS: Patients with preoperative simulated keratometric (SimK) astigmatism < 0.75 D were included. All participants underwent phacoemulsification and monofocal intraocular lens (IOL) implantation. Preoperative SimK astigmatism, total keratometric (TK) astigmatism, predicted refractive astigmatism (PRA) calculated by Barrett Toric with predicted posterior corneal astigmatism (PCA) and measured PCA were evaluated with a 0.75D indication for astigmatism correction. Receiver Operating Characteristic (ROC) curves were further constructed to determine whether a suitable indication was better than 0.75D. Sensitivity analysis was also conducted with 0.50 D as a threshold value. RESULTS: In total, 723 patients (723 eyes) were included with a mean age of 63.34 ± 10.26 years. Of these, 275 eyes (38.04%) had postoperative refractive astigmatism ≥ 0.75 D and 504 eyes (69.71%) had residual astigmatism ≥ 0.50 D when SimK was applied in preoperative evaluation. Using TK astigmatism and PRA yielded significantly lower mean centroid and mean absolute prediction errors than SimK astigmatism (P < 0.05). ROC curves indicated that by lowering the threshold value (range: 0.45-0.64D), the sensitivity of PRA and TK astigmatism raised significantly (TK: from 39.27% to 62.73%, PRA: from 50.55% to 65.45%). CONCLUSIONS: Among eyes preoperatively classified as low-astigmatism by SimK, PRA and TK showed better risk-stratification performance than SimK. Astigmatism correction should be considered when PRA or TK values exceed 0.6 D. TRANSLATIONAL RELEVANCE: The threshold of TK astigmatism and PRA can serve as a quick reference for risk identification of residual astigmatism.
Impact of intravitreal bevacizumab on immune cells in neovascular age related macular degeneration.
Iskin AE, Simsek A, Kizmaz MA … +5 more , Kaçmaz E, Bozkurt T, Ucan Gunduz G, Baykara M, Budak F
Graefes Arch Clin Exp Ophthalmol · 2026 Jul · PMID 42384180 · Publisher ↗
PURPOSE: Age-related macular degeneration (AMD) is a multifactorial disease that leads to progressive central vision loss. Bevacizumab (Avastin), a therapeutic agent used in the treatment of AMD, exerts its effect by bin...
PURPOSE: Age-related macular degeneration (AMD) is a multifactorial disease that leads to progressive central vision loss. Bevacizumab (Avastin), a therapeutic agent used in the treatment of AMD, exerts its effect by binding to all isoforms of vascular endothelial growth factor (VEGF), thereby inhibiting angiogenesis. This study aimed to investigate the effects of Bevacizumab on immune system cells in the context of neovascular AMD (nAMD) treatment. METHODS: Patients with nAMD receiving Bevacizumab treatment (n = 18) and a control group of individuals undergoing cataract surgery (n = 19) were included in the study. Peripheral blood samples were collected from nAMD patients before Bevacizumab treatment (baseline, 0 month) and after three monthly intravitreal injections. Following staining with monoclonal antibodies, innate immune cell, T cell, and B cell subsets were analyzed using flow cytometry panels. RESULTS: In the innate immune cell subsets of patients with neovascular AMD (nAMD), immature and suppressive neutrophils were significantly increased, whereas intermediate and non-classical monocytes were significantly decreased. Following intravitreal bevacizumab (IVB) treatment, these cell populations tended to return toward baseline levels. In the adaptive immune compartment, effector memory (EM) T cell subsets, particularly EM1 (effector memory 1) and EM3 (effector memory 3), exhibited opposing dynamics, showing significant changes both before and after IVB treatment. CONCLUSION: In conclusion, the findings from this study provide preliminary evidence that various immune cell subsets in both innate and adaptive compartments show associations with AMD pathogenesis and with IVB treatment.
Tomographic phenotypes and conditional time to atrophic conversion in dry age-related macular degeneration among progressors: an interval-censored study.
Gagliardi OM, Sahoo NK, Gregori G … +5 more , Hasan N, Lall SR, Lupidi M, Iannetta D, Chhablani J
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42377419 · Publisher ↗
PURPOSE: Identifying progression trajectories of intermediate age-related macular degeneration (iAMD) is crucial to determine candidates for future therapies. This study assessed whether the OCT phenotype could predict t...
PURPOSE: Identifying progression trajectories of intermediate age-related macular degeneration (iAMD) is crucial to determine candidates for future therapies. This study assessed whether the OCT phenotype could predict the progression to complete retinal pigment epithelium and outer retinal atrophy (cRORA). METHODS: This retrospective study included eyes with dry AMD progressing to cRORA. Baseline OCT phenotypes were assigned with a stepwise clinical rationale: incomplete RORA (iRORA) > acquired vitelliform lesions (AVL) > drusenoid pigment epithelial detachment (dPED) > subretinal drusenoid deposits (SDD) > soft drusen, with soft drusen as the reference group. Time to cRORA was estimated with accelerated failure time models. RESULTS: Among the 129 eyes of 89 patients progressing to cRORA, the median time to cRORA for the overall cohort was 4.83 years. Eyes with iRORA showed the shortest median time to cRORA (0.75 years), followed by dPED (2.53 years) and AVL (4.07 years). SDD and soft drusen demonstrated the slowest progression (6.76 and 6.48 years, respectively). In adjusted AFT models baseline hyperreflective foci (HRF), iRORA (TR, 0.21; 95% CI, 0.13-0.33; p < 0.001) and dPED (TR, 0.59; 95% CI, 0.40-0.86; p = 0.007) independently predicted shorter time to cRORA. Presence of HRF was independently associated with faster progression (TR, 0.57; 95% CI, 0.44-0.74; p < 0.001). CONCLUSION: In eyes with dry AMD progressing to cRORA, baseline OCT phenotypes were associated with different temporal trajectories to cRORA. These findings will help prognostic stratification and the selection of candidates for emerging therapeutic interventions.
A real-world study of Faricimab: efficacy and biomarkers in treatment-experienced neovascular age-related macular degeneration(nAMD) and diabetic macular edema (DME) patients.
Fan R, Liu D
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42377418 · Publisher ↗
BACKGROUND: Faricimab, a monoclonal bispecific antibody, has recently been incorporated into clinical practice in China. This study main to evaluate the efficacy and safety of intravitreal faricimab in patients with prev...
BACKGROUND: Faricimab, a monoclonal bispecific antibody, has recently been incorporated into clinical practice in China. This study main to evaluate the efficacy and safety of intravitreal faricimab in patients with previously treated nAMD and DME under real-world clinical conditions, and to investigate potential associations. METHODS: In this study, patients with nAMD or DME previously treated with other anti-VEGF (Anti-vascular endothelial growth factor) agents or Ozurdex received faricimab. Changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), and central subfield maximum thickness (CSMT) were assessed. For nAMD, choroidal neovascularization cross-sectional area (CSA) was measured. Optical coherence tomography (OCT) biomarkers were analyzed, and their correlation with BCVA was examined using Spearman analysis. RESULTS: At week 16, BCVA improved from 0.92 to 0.76 logMAR in nAMD and from 0.86 to 0.68 logMAR in DME. CST and CSMT significantly decreased from week 4 to 16 (CST: 539.38 to 408.50 μm in nAMD, 502.81 to 292.64 μm in DME; CSMT: 710.18 to 526.79 μm in nAMD, 586.96 to 356.82 μm in DME). CSA reduced from 9.06 to 7.26 mm². BCVA positively correlated with subretinal fluid in nAMD and with external limiting membrane/ellipsoid zone integrity in DME, but negatively with subretinal hyperreflective material. No serious adverse events occurred. No serious adverse events were observed. CONCLUSIONS: In a real-world setting, intravitreal faricimab demonstrated a favorable safety profile and robust anatomical response in treating treatment-experienced nAMD and DME. However, the anatomical response was stronger than the visual gain in these treatment-experienced eyes, which often have limited visual potential. TRIAL REGISTRATION: This study was a Retrospective observational study that approved by the Second Affiliated Hospital of Chongqing Medical University(2025IIT904).
Diagnostic performance of optical coherence tomography-derived structural parameters in differentiating pediatric papilledema from pseudopapilledema.
Zaher E, Sayed Ahmad N, Hilf S … +3 more , Karny T, Kardosh N, Duvdevan-Strier N
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42377417 · Publisher ↗
PURPOSE: To evaluate whether optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) thickness measurements can aid in differentiating papilledema from pseudopapilledema in pediatric pat...
PURPOSE: To evaluate whether optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) thickness measurements can aid in differentiating papilledema from pseudopapilledema in pediatric patients, to assess the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both conditions, and to examine the diagnostic utility of Bruch's membrane opening (BMO) parameters. METHODS: Retrospective cohort study. Medical records of pediatric patients (aged 4-18 years) evaluated for suspected papilledema at a tertiary center between 2016 and 2023 were reviewed. All included patients underwent OCT imaging at initial presentation prior to lumbar puncture or treatment. RNFL thickness parameters were compared between patients diagnosed with papilledema and pseudopapilledema. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves. PHOMS prevalence was compared using Fisher's exact test. Bruch's membrane opening (BMO) diameter measurements were compared using a Welch t-test. RESULTS: Eighty-four patients met inclusion criteria, including 49 with papilledema and 35 with pseudopapilledema. RNFL thickness was significantly greater in papilledema across all analyzed parameters. Superior quadrant RNFL thickness averaged across both eyes demonstrated the highest diagnostic performance (area under the curve (AUC) 0.92), followed by worse-eye global average RNFL thickness (AUC 0.89). RNFL-based diagnostic performance remained robust after exclusion of patients with severe papilledema. PHOMS were observed in both groups, with no significant difference in prevalence (p = 0.21). No significant differences were found in BMO measurements between the groups. CONCLUSIONS: Peripapillary RNFL thickness measurements derived from OCT demonstrate meaningful diagnostic value in differentiating papilledema from pseudopapilledema in pediatric patients and may serve as a useful adjunct to clinical evaluation, particularly in diagnostically uncertain cases. In contrast, PHOMS and BMO measurements did not reliably distinguish between these entities. Prospective studies are needed to validate these findings and refine clinically applicable diagnostic thresholds.
Functional assessment of the XEN Gel Stent relative to the implant position using non-invasive stress testing and automated gonioscopy.
Mahrenholtz L, Hörle R, Winterhalter S … +3 more , Kruse DS, Guthoff R, Maier AB
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42377416 · Publisher ↗
PURPOSE: To evaluate whether XEN Gel Stent position within the anterior chamber angle influences aqueous humor outflow and complication rates during the early postoperative period. METHODS: 51 consecutive glaucomatous ey...
PURPOSE: To evaluate whether XEN Gel Stent position within the anterior chamber angle influences aqueous humor outflow and complication rates during the early postoperative period. METHODS: 51 consecutive glaucomatous eyes of 51 patients (mean age 72.0 ± 11.4, 49.0% female) undergoing XEN-63 Gel Stent implantation between 09/2024 and 07/2025 at Charité - Universitätsmedizin Berlin, Germany were included in this single-center, prospective cohort study. Eyes were categorized postoperatively according to stent position within the anterior chamber angle (Grades 0-4). Stent position was evaluated 12 weeks postoperatively through automated gonioscopy (GS-1, Nidek). Aqueous humor outflow was assessed using a standardized non-invasive stress test. Primary outcome was the intraocular pressure (IOP) reduction during stress test. Secondary outcomes included IOP reduction from baseline to 12 weeks postoperatively, number of glaucoma medications, complications and need for additional interventions. RESULTS: Mean IOP decreased significantly after XEN Gel Stent implantation from 22.2 ± 7.5 mmHg to 12.1 ± 5.1 mmHg 12 weeks postoperatively measured with Goldmann applanation tonometry (p < 0.001, Z -5.6). Stress test induced IOP reduction increased from 14.8 ± 13.3% pre-implantation to 32.7 ± 19.7% at 12 weeks (p < 0.001, CI -24.1 to -11.8). Eyes with stent placement within the scleral spur or ciliary body band (Grading 3 + 4, n = 34) had greater aqueous humor outflow improvement compared with eyes graded 0-2 (stent above scleral spur, n = 12) (p = 0.010, 95% CI -28.6 to -4.2). Postoperative transient hypotony occurred in 85.3% vs. 61.5% of eyes in Grading group 3 + 4 vs. 0-2 (p = 0.08). 4 eyes were considered non-functional due to malposition (Grading x). Mean number of glaucoma medications decreased from 2.8 ± 1.3 preoperatively to 0.2 ± 0.9 postoperatively. CONCLUSION: The positioning of the XEN Gel Stent within the scleral spur or ciliary body band (Grade 3 + 4) was associated with greater pressure reduction during stress testing, suggesting an increased aqueous humor outflow in this study cohort. Such placement was associated with high treatment success and no increase in major complications, except the risk of misplacement, while transient hypotony was common.
Deep learning approach for analyzing regional scheimpflug corneal images to assess keratoconus progression.
Karaatlı M, Yıldırım N, Özalp O … +1 more , Çelik Ö
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42371030 · Publisher ↗
PURPOSE: To use deep learning models on baseline Scheimpflug corneal images from three different corneal regions to discriminate progressive from nonprogressive keratoconus. METHODS: A total of 562 eyes of 325 keratoconu...
PURPOSE: To use deep learning models on baseline Scheimpflug corneal images from three different corneal regions to discriminate progressive from nonprogressive keratoconus. METHODS: A total of 562 eyes of 325 keratoconus patients were included in the study. The eyes were classified as those with progression (n = 300) and without progression (n = 262) according to the Pentacam Belin ABCD progression display (Oculus, Wetzlar, Germany). Images of the whole cornea, central 5-mm zone, and central 3-mm zone from Pentacam tomography maps (anterior and posterior axial/sagittal curvature, anterior and posterior tangential curvature, anterior and posterior elevation, corneal thickness) obtained at the patients' baseline visit were used to train and test two convolutional neural network models (YOLOv8L and YOLOv8X). RESULTS: The central 3-mm zone of the posterior axial/sagittal curvature map (in YOLOv8L) and posterior tangential curvature map (in YOLOv8X) had the highest test accuracy in discriminating progressive from nonprogressive cases (70% [95% CI, 57-80%] for both). Sensitivity and specificity values were 74% (95% CI, 56-86%) and 68% (95% CI, 49-83%) for the posterior axial/sagittal curvature map; 92% (95% CI, 77-98%) and 63% (95% CI, 44-79%) for the posterior tangential curvature map, respectively. CONCLUSIONS: Using the YOLOv8L and YOLOv8X deep learning models, the central 3-mm zone of the posterior axial/sagittal and posterior tangential curvature maps appeared comparatively more informative in identifying progressive keratoconus. These preliminary findings suggest that deep learning models may have the potential to distinguish keratoconus progression by analyzing the central 3-mm posterior corneal maps, although further studies incorporating clinical risk factors are needed.
Sandwich therapy combining photodynamic therapy and adjunctive anti-VEGF for juxtapapillary retinal capillary hemangioblastoma.
Chou HD, Downie C, Anguita R … +2 more , Negretti GS, Sagoo MS
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42371029 · Publisher ↗
PURPOSE: To report the outcomes of verteporfin photodynamic therapy (PDT) with adjuntive pre- and post-PDT intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections ("Sandwich PDT") for juxtapapillary r...
PURPOSE: To report the outcomes of verteporfin photodynamic therapy (PDT) with adjuntive pre- and post-PDT intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections ("Sandwich PDT") for juxtapapillary retinal capillary hemangioblastoma (RCH). METHODS: A retrospective case review of eyes with juxtapapillary RCH that underwent "Sandwich PDT" in a national referral center. The clinical features were evaluated with fundus photography, optical coherence tomography, and ultrasonography. RESULTS: Five eyes were analyzed. The median follow-up time was 42 (range, 12-77) months. Adjunctive anti-VEGFs were given 4.0 weeks (range, 1 day-12 weeks) before PDT and 6.0 weeks (3 days to 8 weeks) after PDT. One of the five eyes (20%) that had anti-VEGF injection 8 weeks before PDT developed macular exudation after PDT but resolved within 1 month. Following Sandwich PDT, tumor size regressed in 3/5 eyes (60%) and stabilized in 2/5 eyes (40%). Subretinal fluid and exudates completely resolved in the three eyes that had these features before PDT, whereas intraretinal fluid stabilized or partially responded in 4/5 (80%). Reactivation of disease activity was noted in two eyes (40%), one resolved after a second Sandwich PDT. At the last follow-up, visual acuity improved 10 ETDRS letters or more in one eye (20%), stabilized in two (40%), and worsened 10 ETDRS letters or more in two (40%). CONCLUSION: The treatment of juxtapapillary RCH remains challenging. PDT with adjunctive anti-VEGF injections achieved anatomical control, but the functional outcomes were guarded. Based on the pharmacokinetics, we propose that anti-VEGF be given 1 week before PDT for maximal coverage.
Changes in tomographic parameters across different wearing and cessation periods of apical clearance-fitted rigid gas-permeable contact lenses in keratoconus.
Hsiao FC, Chen YN, Chen JW … +7 more , Tsai TH, Kang EY, Hung N, Liu CF, Hsiao CH, Lee JS, Lin KK
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42371028 · Publisher ↗
PURPOSE: To characterize the temporal profile of corneal recovery following apical clearance-fitted rigid gas-permeable (RGP) lens cessation in keratoconus and define a clinically feasible and sufficient period for relia...
PURPOSE: To characterize the temporal profile of corneal recovery following apical clearance-fitted rigid gas-permeable (RGP) lens cessation in keratoconus and define a clinically feasible and sufficient period for reliable baseline morphology. METHODS: This retrospective longitudinal study included 42 eyes of 23 patients with keratoconus newly fitted with standard aspheric (n = 18) or Rose K2 (n = 24) corneal lenses using an apical clearance approach. Corneal tomography was assessed at baseline, at 1st, 4th, and 12th week of daily lens wear (30 min after lens removal), and at 1st, 2nd, and 4th week after complete lens cessation. Longitudinal changes in sagittal corneal power and seven Pentacam indices were analyzed using linear mixed models. RESULTS: In the standard aspheric group, central corneal flattening was observed 30 min after lens removal; K2 at 4.0 mm decreased significantly from a baseline of 49.54 ± 0.81 D to 49.15 ± 0.82 D, and to 49.14 ± 0.81 D at 1st and 4th week (p = 0.005, p < 0.001 respectively, the later survived Bonferroni correction). In the Rose K2 group, no significant change of K1, K2 or Km was noted. Pentacam indices also showed significant deviations with the index of surface variance (ISV) decreasing significantly at 1st week in standard aspheric group (p = 0.0016, statistically significant after Bonferroni correction) after 30 min cessation. Following complete lens cessation, no statistically significant differences were observed in any sagittal power parameters or tomographic indices at 1st, 2nd, and 4th week compared with baseline values (all p > 0.05). CONCLUSION: Corneal morphological changes associated with a 12-week regimen of daily-wear apical clearance-fitted RGP lenses in keratoconic eyes were transient and returned to values not significantly different from baseline after one week of lens cessation.
Lens epithelial cell damage and reduced aquaporin-1 immunoreactivity in liquefied mature cataracts.
Ichihara K, Komatsu K, Masuda Y … +8 more , Tohma A, Iida M, Iwauchi A, Kubota H, Nakazawa Y, Yamamoto N, Shimoda M, Nakano T
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42371027 · Publisher ↗
PURPOSE: To investigate the pathological characteristics of lens epithelial cells (LECs) in liquefied versus non-liquefied mature cataracts. METHODS: Twenty-one unilateral and one bilateral mature cataract cases underwen...
PURPOSE: To investigate the pathological characteristics of lens epithelial cells (LECs) in liquefied versus non-liquefied mature cataracts. METHODS: Twenty-one unilateral and one bilateral mature cataract cases underwent surgery. Based on intraoperative findings, eyes were classified into a liquefied (11 eyes) and non-liquefied (11 eyes) groups. Patient history, ocular morphology, and histopathological evaluation of the anterior lens capsule were analyzed. Cross-sectional and flat-mounted LEC specimens were examined using upright microscope (UM), and aquaporin-1 (AQP1) immunostaining was assessed via confocal laser scanning microscope (CLSM). RESULTS: UM showed extensive LEC nuclear deficiency/flattening in all liquefied cases and a higher prevalence of subcapsular fibrosis (82% vs. 9%) compared with the non-liquefied group. CLSM revealed significantly lower AQP1 immunostaining scores in the liquefied group compared to the non-liquefied group (1.76 ± 0.59 vs. 4.48 ± 0.60, p = 0.00054). In this small cohort, atopic dermatitis was present in 5 of 11 eyes (45.5%) in the liquefied group, whereas diabetes mellitus was present in 4 of 11 eyes (36.4%) in the non-liquefied group. Given the uneven distribution of these systemic backgrounds, disease-specific differences in LEC nuclear deficiency/flattening, subcapsular fibrosis, and AQP1 immunostaining could not be assessed separately. CONCLUSIONS: Lens liquefaction in mature cataracts was associated with a marked paucity of identifiable LECs and lower AQP1 immunostaining scores. The potential roles of these epithelial changes in lens liquefaction warrant further study.
Associations between psychiatric disorders and medication use, and retinal occlusion: a large-scale retrospective cohort study.
Sadeghi E, Kozlov M, Hasan N … +2 more , Lall SR, Chhablani J
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42371026 · Publisher ↗
PURPOSE: To evaluate associations between psychiatric disorders, psychotropic medication use, and retinal vascular occlusion (RAO and RVO) risk using a large real-world database. METHODS: This retrospective cohort study...
PURPOSE: To evaluate associations between psychiatric disorders, psychotropic medication use, and retinal vascular occlusion (RAO and RVO) risk using a large real-world database. METHODS: This retrospective cohort study used the TriNetX Research Network (~ 149 million patients). Psychiatric patients were identified via ICD-10 codes and grouped into three cohorts: (1) psychiatric disorders without pharmacologic treatment versus matched healthy controls, (2) medicated versus unmedicated psychiatric patients, and (3) single-class psychotropic medication users versus matched untreated patients. Extensive exclusions minimized confounding. Cohorts were propensity score-matched for demographic and clinical factors. The primary outcome was retinal occlusion within one year of treatment initiation. RESULTS: Among 3,389,889 matched pairs, psychiatric disorders without medication were not associated with increased RO risk compared with controls (HR 0.97, 95% CI 0.87-1.07, p = 0.49). In contrast, among 2,990,601 matched pairs, psychotropic medication use was associated with a modest increase in RO risk (HR 1.20, 95% CI 1.09-1.33, p < 0.001). Class-specific analyses demonstrated a small but statistically significant association for selective serotonin reuptake inhibitors (SSRIs) (HR 1.17, 95% CI 1.03-1.32, p = 0.013), while no significant associations were observed for other medication classes. Patients who developed RO were older and had a higher burden of vascular comorbidities, including hypertension, diabetes, hyperlipidemia, and obstructive sleep apnea. CONCLUSIONS: Psychiatric disorders alone were not associated with increased RO risk, whereas psychotropic medications, particularly SSRIs, showed a modest increase. Despite low absolute incidence, medication exposure may contribute, warranting cardiovascular risk assessment and ophthalmologic monitoring.
Automated iridocorneal angle classification using a multimodal large language model.
Rubegni G, Romano D, Colizzi B … +7 more , Castellino N, Cartocci A, Luschi A, Rabiolo A, De Cillà S, Tosi GM, Rossetti L
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42363984 · Publisher ↗
PURPOSE: To evaluate the diagnostic performance of a general-purpose vision-language model (GPT-4o) in interpreting gonioscopic images of the anterior chamber angle, with a focus on angle configuration classification and...
PURPOSE: To evaluate the diagnostic performance of a general-purpose vision-language model (GPT-4o) in interpreting gonioscopic images of the anterior chamber angle, with a focus on angle configuration classification and Shaffer grading. METHODS: A total of 80 slit-lamp goniophotographs representing a range of anterior chamber angle (ACA) configurations were collected from a digital image repository and a specialized textbook. Each image was evaluated by three glaucoma specialists (reference standard), three comprehensive ophthalmologists, and GPT-4o across three trials. GPT-4o was prompted with a standardized diagnostic instruction and shown one example per Shaffer grade prior to evaluation. Performance metrics included accuracy, sensitivity, specificity, Quadratic Weighted Kappa (QWK), and Fleiss' Kappa. Descriptive analyses and confusion matrices were used to assess misclassification patterns. RESULTS: GPT-4o demonstrated high accuracy in classifying angle configuration (91.3%, 91.3%, and 90.0% across trials) with perfect or near-perfect specificity (> 98%) but moderate sensitivity (56.3%) for detecting closed angles. In Shaffer grading, GPT-4o showed moderate agreement with expert consensus (QWK = 0.471-0.573) and fair inter-trial consistency (Fleiss' Kappa = 0.235). Misclassifications occurred predominantly between adjacent grades, particularly underestimating wide angles. Comprehensive ophthalmologists achieved higher sensitivity and agreement with the reference standard in both classification tasks. CONCLUSION: GPT-4o was able to produce structured, clinically relevant assessments of gonioscopic images without domain-specific training. Although outperformed by comprehensive ophthalmologists and previous task-specific AI models, GPT-4o demonstrated consistent performance with potential utility as a supportive tool in settings with limited specialist access. Further refinement and clinical validation are needed to improve its reliability in grading tasks.
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