Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
Sun
200 papers
27-gauge co-port IOL scleral fixation for severe traumatic crystalline lens subluxation.
Li H, Chen X, Li X
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41874677 · Publisher ↗
PURPOSE: To describe a modified 27-gauge co-port transconjunctival intraocular lens (IOL) scleral fixation technique for the management of severe traumatic crystalline lens subluxation. METHODS: Twelve eyes with severe t...
PURPOSE: To describe a modified 27-gauge co-port transconjunctival intraocular lens (IOL) scleral fixation technique for the management of severe traumatic crystalline lens subluxation. METHODS: Twelve eyes with severe traumatic crystalline lens subluxation were enrolled. Scleral fixation sites were pre-marked at the 3 and 9 o’clock positions, 2 mm posterior to the limbus. Three 27-gauge trocars were inserted at the 3, 9, and 10 o’clock positions. A standard pars plana lensectomy and vitrectomy were performed. A three-piece foldable IOL was inserted through a superior limbal tunnel, and both haptics were externalized via the existing 3 and 9 o’clock trocar incisions using intraocular forceps. Flanged ends were created with cautery and embedded into the sclera for fixation. RESULTS: All procedures were completed successfully without intraoperative complications. The mean follow-up was 13.0 ± 5.1 months (range: 4–20 months). Mean best-corrected visual acuity improved from log MAR 0.72 ± 0.41 preoperatively to 0.25 ± 0.21 postoperatively (t = 4.69, P < 0.01). The mean endothelial cell density preoperatively was 2685.67 ± 292.47 cell/mm2 (range 2263–3027 cell/mm2), decreasing to 2619.08 ± 269.26 cell/mm2 (range 2160–3029 cell/mm2) at three months postoperatively (t = 6.02, P < 0.01). IOP remained stable throughout the postoperative period for most cases, with a mean preoperative IOP of 20.9 ± 7.9mmHg, decreasing to 13.8 ± 3.0 mmHg at the final visit (t = 3.615, P < 0.01). Transient hypotony occurred in 2 cases (16.7%) after surgery, resolving spontaneously within 72 h. All IOLs remained well-centered, with no cases of IOL dislocation, haptic exposure, endophthalmitis, or hemorrhage. CONCLUSION: This novel 27-gauge co-port technique offers a safe, effective, and minimally invasive alternative for IOL fixation in traumatic crystalline lens subluxation.
Chronic changes in acute zonal occult outer retinopathy mimicking non-progressive retinitis pigmentosa: clinical and laboratory characteristics.
Chen YY, Yang CM, Wang WC … +3 more , Chung HH, Hsu CC, Chen TC
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41874676 · Publisher ↗
PURPOSE: To report cases of acute zonal occult outer retinopathy (AZOOR) with chronic retinal pigmentary changes mimicking retinitis pigmentosa (RP) and to identify metabolite biomarkers differentiating AZOOR from RP. ME...
PURPOSE: To report cases of acute zonal occult outer retinopathy (AZOOR) with chronic retinal pigmentary changes mimicking retinitis pigmentosa (RP) and to identify metabolite biomarkers differentiating AZOOR from RP. METHODS: Fifteen eyes from eight patients were diagnosed AZOOR by characteristic trizonal appearance of retina. The data of comprehensive ophthalmologic examination, multimodal imaging, visual field and electrophysiology testing was collected. Next-generation sequencing (NGS) genetic test was performed to screen pathogenic variants. Untargeted metabolomic study with high-resolution mass spectrometry was performed on the plasma samples of seven AZOOR, eight RP and eight controls. RESULTS: The mean age of study subjects was 54.6 ± 12.3 years. Five of the eight patients presented with asymmetric severity of retinal lesion. Segmental peripapillary area involvement was observed in six patients while bilateral extensive, circumferential retinal pigment epithelium degeneration over mid-periphery was found in two patients. No substantial progression was noted during follow-up (11.4 ± 7.7 years). The NGS genetic test revealed no pathogenic variants of RP in 6 patients and one autosomal-recessive variant in 2 patients. Metabolomic analysis showed substantial overlap in global profiles among AZOOR, RP, and controls, while a small subset of putative metabolites (including retinyl acetate, valinol, phosphatidylserine) differed between AZOOR and RP and may warrant further investigation in future. CONCLUSION: Clinical evaluation, including disease course, family history, multimodal fundus imaging, electrophysiological tests, as well as laboratory diagnosis with genetic testing and metabolomic analysis help differentiate chronic AZOOR from RP. Metabolomics offers clues to metabolic changes and may guide future therapeutic target exploration.
Longitudinal changes in peripapillary atrophy and optic disc morphology in preschool children with early-onset high myopia.
Jung KI, Park SH, Shin SY
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41870665 · Publisher ↗
PURPOSE: To investigate longitudinal changes in peripapillary atrophy (PPA) and optic disc morphology in preschool children with early-onset high myopia over more than five years and to identify baseline predictors assoc...
PURPOSE: To investigate longitudinal changes in peripapillary atrophy (PPA) and optic disc morphology in preschool children with early-onset high myopia over more than five years and to identify baseline predictors associated with posterior structural changes. METHODS: This retrospective study included 100 eyes from children diagnosed with high myopia before the age of six. Participants underwent serial ophthalmologic examinations, including measurements of axial length (AL), cycloplegic refraction, keratometry, and fundus photography. The PPA-to-disc area ratio, optic disc tilt, and torsion were quantitatively assessed using ImageJ. Participants were categorized based on longitudinal changes in PPA-to-disc area ratio. RESULTS: Over a mean follow-up of 6.3 ± 0.8 years, 52% of eyes demonstrated a decrease in the PPA-to-disc area ratio, accompanied by a hyperopic shift in SE (from − 8.35 D to − 7.64 D, p < 0.001) and limited AL elongation (from 25.1 mm to 25.9 mm, p < 0.001). Baseline features associated with PPA regression included male sex (p = 0.025), lower prevalence of binocular high myopia (p = 0.003) and parental high myopia (p < 0.001), and larger initial PPA-to-disc area ratio (p = 0.037), tilt ratio (p = 0.042), and torsion (p = 0.010). Conversely, eyes with a stable or increased PPA-to-disc area ratio exhibited greater axial elongation (p= 0.001) and more pronounced corneal flattening (mean K, p= 0.005; steep K, p= 0.019). CONCLUSIONS: A significant proportion of children with early-onset high myopia demonstrated posterior structural regression. Early clinical and structural markers may help predict remodeling potential, supporting personalized, long-term management.
Impaired binocular vision with bangerter foil and its influence on fine motor skills: a clinical observational, randomized and cross-sectional study.
Granados-Delgado P, Casares-López M, Martino F … +2 more , Anera RG, Castro-Torres JJ
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41870664 · Publisher ↗
PURPOSE: To analyze the influence of simulated impaired binocular vision on visual performance and fine motor skills (FMS). METHODS: A total of 33 young and healthy participants were included. A Bangerter foil 0.8 was em...
PURPOSE: To analyze the influence of simulated impaired binocular vision on visual performance and fine motor skills (FMS). METHODS: A total of 33 young and healthy participants were included. A Bangerter foil 0.8 was employed to induce impaired binocular vision. Visual performance was assessed randomized, under three binocular viewing conditions: binocular baseline, wearing a Bangerter foil on dominant eye, and wearing Bangerter foils on both eyes, by visual functions: visual acuity, contrast sensitivity, disability glare, and stereopsis. Five tests evaluated fine motor skills: Purdue, O´Connor, and Grooved Pegboard; water pouring and threading task. The Overall Visual Performance Score (OVPS) and Overall Fine Motor Skills Score (OFMSS) were calculated. RESULTS: Binocular visual performance was significantly worse when deterioration was induced simultaneously on both eyes for all visual functions tested (p < 0.05). There were no significant differences in visual acuity and near contrast sensitivity between deteriorated conditions in only one eye and baseline. However, the two visual impairment conditions differed significantly, except for stereoacuity. For FMS, the deterioration factor was also significant (p < 0.05). In terms of OVPS and OFMSS, the greater the induced binocular dysfunction, the worse the visual performance and ability to perform fine motor tasks (rho = 0.334; p < 0.001). CONCLUSIONS: These findings suggest that mild monocular or binocular induced impairments have an impact on the visual functions measured and also have a marked effect on the performance of manual tasks that require fine motor skills. These results may be comparable to those from patients with recent-onset edema or cataracts; nevertheless, a full reproduction of the optical and neural effects of genuine pathology by the simulations is not achieved.
Safety and efficacy of Esculin and Digitalis glycosides eye drops in individuals with presbyopia.
Zhang Y, Wang J, Hao M … +2 more , Wang C, Zhang X
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41870663 · Publisher ↗
PURPOSE: This proof-of-concept study aimed to detect preliminary signals of efficacy and assess the short-term safety of Esculin and Digitalis glycoside eye drops for the management of presbyopia. METHODS: This study was...
PURPOSE: This proof-of-concept study aimed to detect preliminary signals of efficacy and assess the short-term safety of Esculin and Digitalis glycoside eye drops for the management of presbyopia. METHODS: This study was a 30-day, randomized, double-blind, controlled clinical trial. A total of 62 patients with presbyopia were recruited from the Ophthalmology Hospital in Shanxi Province, China, and randomly assigned to either the treatment group (n = 31) or the vehicle group (n = 31). Participants applied Esculin and Digitalis glycosides Eye Drops or the vehicle three times daily for 30 days. Efficacy and safety assessments were conducted separately under photopic and mesopic conditions at multiple time points on Days 5, 15, and 30. The Near Activity Vision Questionnaire (NAVQ) was used to assess the severity of near vision difficulties and patient satisfaction in presbyopic individuals. The primary and key secondary efficacy endpoints were defined as the percentage of participants demonstrating ≥ 3 lines improvement in distance-corrected near visual acuity (DCNVA) without a loss of one or more lines in corrected-distance visual acuity (CDVA) at 1.5 h and 0.5, 3 h post-dose 1 on Day 30, separately under photopic and mesopic conditions. RESULTS: Of the 62 randomized participants, 23 (37.10%) were male and 39 (62.90%) were female. The mean (SD) age was 50.29 (3.12) years. In the prespecified analysis, the treatment group showed a nominally statistically significant improvement in the photopic DCNVA endpoint (the proportion of participants achieving ≥ 3 lines without CDVA loss) compared to vehicle. At 0.5 h on Day 30, the percentage was 25.81% versus 6.45% (difference, 19.36%; 95% CI, 1.00% to 37.00%; p = 0.04); at hour 1.5, the percentage was 25.81% versus 3.23%, respectively (difference, 22.58%; 95% CI, 2.00% to 42.00%; p = 0.03); and at hour 3, the percentage was 25.81% versus 6.45%, respectively (difference, 19.36%; 95% CI, 1.00% to 37.00%; p = 0.04). However, no such statistically significant signal was detected under mesopic conditions. In the exploratory analysis of the prespecified photopic endpoint, the treatment group showed a nominal statistically significant improvement in mean DCNVA compared to the vehicle group at all tested time points (0.5, 1.5, and 3 h) on Day 30, at 0.5 h (mean difference, -0.06; 95% CI, -0.13 to -0.03; p < 0.01), at 1.5 h (mean difference, -0.08; 95% CI, -0.11 to -0.01; p = 0.02), at 3 h (mean difference, -0.05; 95% CI, -0.09 to -0.01; p = 0.04). No serious adverse events were reported during the 30-day study period. Treatment-related adverse events were generally mild and did not necessitate therapeutic intervention. CONCLUSION: In this exploratory study, prespecified analysis showed a statistically significant improvement in the photopic near visual acuity endpoint for Esculin and Digitalis glycosides Eye Drops compared to vehicle at Day 30, with a favorable short-term safety profile. These findings suggest a potential benefit that warrants further investigation in larger, confirmatory trials, but they do not yet support broad clinical recommendations. This trial was registered at ClinicalTrials. gov (NCT07151612). The trial was registered on 2 September 2025.
Efficacy and safety of intraocular lens removal combined with vitrectomy for acute endophthalmitis in pseudophakic eyes.
Suffo S, Bazido M, Seitz B … +1 more , Abdin AD
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41863600 · Publisher ↗
PURPOSE: To evaluate the efficacy and safety of intraocular lens (IOL) removal during vitrectomy in the treatment of primary endophthalmitis in pseudophakic eyes. METHODS: A comparative retrospective study was conducted...
PURPOSE: To evaluate the efficacy and safety of intraocular lens (IOL) removal during vitrectomy in the treatment of primary endophthalmitis in pseudophakic eyes. METHODS: A comparative retrospective study was conducted on 55 eyes diagnosed with endophthalmitis at the Department of Ophthalmology, Saarland University Medical Center, between the years 2016 and 2020. The study assessed both functional and morphological long-term outcomes in patients undergoing pars plana vitrectomy (PPV) with IOL removal versus those with IOL preserved. Key parameters measured included best corrected visual acuity, duration of hospitalization, and the rate of inpatient and post-discharge complications. RESULTS: The removal of the IOL did not significantly affect treatment outcomes, as there were no notable differences in best corrected visual acuity, hospitalization duration and the postoperative complication rates between both groups. CONCLUSION: IOL removal does not seem to offer additional advantages in the management of endophthalmitis. Thus, PPV IOL preservation seems to be a safe approach. Retaining the IOL may represent a viable and safe option, avoiding unnecessary surgical intervention in acute settings without significantly compromising patient outcomes. However, larger studies are required to confirm these findings.
Evaluation of tube extender use in glaucoma management: insights from a cohort study.
Marin A, Quintero MA, Kaplan TM … +3 more , Macaron MM, Agapov S, Bitrian E
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41860598 · Publisher ↗
PURPOSE: To describe the clinical indications for tube revision with a Tube Extender and to characterize the eyes in which they were used. METHODS: Single-center retrospective cohort of eyes undergoing Tube Extender impl...
PURPOSE: To describe the clinical indications for tube revision with a Tube Extender and to characterize the eyes in which they were used. METHODS: Single-center retrospective cohort of eyes undergoing Tube Extender implantation (2015–2023). Clinical data were collected from medical records, and Fisher’s exact test assessed associations between glaucoma type and revision indication. RESULTS: Twenty-two eyes from 22 patients were included. The mean age at tube revision was 53 years, and 68% of patients were male. The most common glaucoma types were primary open-angle glaucoma (36%), uveitic glaucoma (23%), and neovascular glaucoma (18%). Tube Extenders were most frequently used with Ahmed devices (59%), followed by Baerveldt devices (28%). The mean interval from the original aqueous shunt surgery to Tube Extender implantation was 764 days, with a median of 497 days (IQR 100–582). Eighteen tube revisions were performed for a single indication, while four were performed for two or more indications. The main reasons for implantation were tube retraction (41%), corneal touch (27%), tube exposure (23%), and tube obstruction (13%). The tube was most commonly repositioned back into the anterior chamber (64%), followed by repositioning from the anterior chamber to the sulcus (27%) and repositioning within the sulcus (9%). Out of the 22 tube revisions, two were combined with cataract surgery and one with corneal transplantation. There was no statistically significant association between glaucoma type and indication for tube revision. CONCLUSIONS: Tube Extenders were primarily used to address complications such as tube retraction, corneal issues associated with glaucoma drainage devices, tube exposure, and obstruction. They offer a practical surgical solution to salvage existing aqueous shunt implants without the need for full device replacement, but additional studies are needed to assess long-term outcomes.
Vitrectomy and internal limiting membrane peeling for extensive macular schisis in choroideremia.
Abdalla Elsayed MEA, Barone V, MacLaren RE
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41848840 · Publisher ↗
PURPOSE: To report outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for extensive macular schisis in choroideremia and provide surgical insights. METHODS: Retrospective case series of...
PURPOSE: To report outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for extensive macular schisis in choroideremia and provide surgical insights. METHODS: Retrospective case series of five eyes from four patients with choroideremia and extensive macular schisis who underwent PPV with ILM peeling at a single tertiary center between 2011 and 2025. Data collected included pre- and post-operative best-corrected visual acuity (BCVA), surgical technique, spectral-domain optical coherence tomography (SD-OCT) imaging, intraoperative findings, and post-operative complications. RESULTS: All five eyes showed complete resolution of macular schisis on SD-OCT without foveal retinal pigment epithelium atrophy. BCVA improved in all cases. Intraoperative challenges included retinal fragility, peripheral schisis-like changes, and difficulty with ILM visualization and adherence. No iatrogenic retinal breaks or detachments occurred. CONCLUSION: Vitrectomy for extensive macular schisis in choroideremia can yield favourable anatomical and functional outcomes but requires tailored techniques to address retinal fragility and minimize iatrogenic trauma.
Regional choroidal perfusion deficits and vector-based choroidal associations in adolescent astigmatism.
Wu Y, Wu S, Liu X … +6 more , Zhou M, Gu L, Li M, Zhao T, Jin C, Ke B
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41843081 · Publisher ↗
PURPOSE: To investigate regional choroidal perfusion and structural characteristics in adolescents with astigmatism and to assess their associations with astigmatic vector components (J₀ and J₄₅). METHODS: This cross-sec...
PURPOSE: To investigate regional choroidal perfusion and structural characteristics in adolescents with astigmatism and to assess their associations with astigmatic vector components (J₀ and J₄₅). METHODS: This cross-sectional study included 613 eyes from adolescents aged 6–15 years who underwent swept-source optical coherence tomography/angiography (SS-OCT/OCTA). To assess choroidal microvascular status and structural integrity, we quantified choriocapillaris density (CCD), choriocapillaris perfusion area (CCPA), choroidal vascularity index (CVI), and choroidal thickness (ChT) across macular subfields. Astigmatic eyes ( ≤ − 0.50 D; n = 306) were compared to matched non-astigmatic controls (n = 307). Multivariable models assessed associations between J₀/J₄₅ and choroidal measures. RESULTS: Astigmatic eyes showed reduced CCD in inferior para- and perifoveal areas (P = 0.044/0.008), decreased CCPA (P = 0.017), and lower nasal CVI (P = 0.001), with no ChT difference. Within the astigmatic group, J₀ was negatively associated with CCD (β = − 1.63, P = 0.003), CCPA (β = − 0.01, P = 0.003), and CVI (β = − 0.02, P = 0.048), and positively associated with ChT across macular regions, with the strongest effect observed centrally (β = 34.04, P < 0.001). J₄₅ was negatively associated with CCD (β = − 1.45, P = 0.004), CCPA (β = − 0.33, P = 0.028), and ChT (β = − 35.55, P = 0.045), but positively with CVI (β = 0.029, P = 0.025). CONCLUSIONS: Astigmatism in adolescents correlates with region-specific choroidal perfusion and structural alterations, with vector-based analysis revealing orientation-dependent associations. These patterns may reflect subtle developmental or adaptive changes in choroidal architecture during adolescence.
Changes in corneal epithelial remodeling and associated factors in highly myopic patients after FS-LASIK.
Yang X, Niu J, Ma X … +3 more , Wang M, Song S, Zhou Y
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41843080 · Publisher ↗
BACKGROUND: With the global rise in high myopia, femtosecond laser–assisted LASIK (FS-LASIK) has become a widely used refractive procedure. Postoperative corneal epithelial thickness (CET) remodeling may affect visual st...
BACKGROUND: With the global rise in high myopia, femtosecond laser–assisted LASIK (FS-LASIK) has become a widely used refractive procedure. Postoperative corneal epithelial thickness (CET) remodeling may affect visual stability; however, its spatial distribution and associated factors in highly myopic eyes remain incompletely characterized. Using spectral-domain optical coherence tomography (SD-OCT), we characterized early CET remodeling after FS-LASIK and evaluated its associations with axial length (AL), optical zone (OZ) diameter, and spherical equivalent (SE). METHODS: This prospective study enrolled 99 patients with high myopia, and only right eyes were analyzed. CET was measured preoperatively and at 1 and 3 months postoperatively in 17 sectors within a 6-mm diameter using SD-OCT. Paired t-tests and Spearman correlation analyses were performed to assess relationships between CET changes and AL, OZ, SE, and corneal curvature. RESULTS: Significant CET thickening was observed in the central region (≤ 2 mm: 8.83 ± 4.97 μm at 1 month, 9.80 ± 4.92 μm at 3 months; both P < 0.0001) and paracentral region (2–5 mm), whereas no significant change was found in the mid-peripheral zone (5–6 mm). AL was positively correlated with central and paracentral CET thickening (r = 0.432, P < 0.0001), while a larger OZ diameter was negatively correlated with central CET change (r = − 0.476, P < 0.0001). Female patients showed less paracentral CET remodeling than male patients (P < 0.05). CONCLUSION: Early CET remodeling after FS-LASIK in highly myopic eyes occurs predominantly in the central and paracentral cornea and is associated with AL and OZ diameter. This remodeling may help optimize postoperative optical quality by partially compensating for surgery-induced stromal surface irregularities. Sex-related differences suggest that hormonal factors may influence epithelial repair and warrant further investigation.
Integrated Radiomics-Enhanced machine learning models for accurate diagnosis and prediction of oGVHD-Related ocular complications.
Wang L, Huang Z, Zhuang D … +7 more , Zhuang X, Chen Y, Sun Z, Chen F, Tang X, Chen X, Zhang X
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41843079 · Publisher ↗
OBJECTIVES: To prospectively establish diagnostic models for ocular Graft-versus-Host Disease (oGVHD) and predict ocular complications based on ocular surface features and lacrimal gland magnetic resonance imaging (MRI)...
OBJECTIVES: To prospectively establish diagnostic models for ocular Graft-versus-Host Disease (oGVHD) and predict ocular complications based on ocular surface features and lacrimal gland magnetic resonance imaging (MRI) radiomics features. METHODS: The observational study included 31 oGVHD patients and 26 controls. Demographic data, clinical ocular surface characteristics (clinical-diagnosis model) and lacrimal gland coronal Dixon-T2-weighted images with apparent diffusion coefficient (ADC) radiomics features (mixed-MRI-diagnosis model) were analyzed and constructed by support vector machine (SVM) algorithm using five-fold cross-validation to distinguish between the oGVHD patients and the control participants. Next, independent predictors were employed to construct the complication prediction models, including the clinical-prediction, mixed-MRI-prediction, and combined-prediction models (based on both the clinical and the mixed-MRI features). To evaluate the performances of different models, area under the curve (AUC) with 95% confidence interval (CI) of the receiver operating curve (ROC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated. AUCs between different models were compared using DeLong’s test. RESULTS: There were significant differences in ocular surface features (p < 0.05) and significant differences in certain radiomics features (p < 0.05). The clinical-diagnosis model and mixed-MRI-diagnosis model achieved impressive AUC values of 1.00/0.942 and 1.00/0.99 in the training/validation set, respectively. The combined-prediction model demonstrated superior performance in the test cohort with an AUC of 0.864 and accuracy of 0.9231. CONCLUSION: Machine learning based on the clinical ocular surface characteristics and lacrimal gland mixed-MRI-radiomics features could provide more accurate and comprehensive evaluation of oGVHD, facilitating early intervention and management of ocular complications.
Study of strabismus in young Singaporean males.
Ding J, Tang KWA, Tan WTC … +6 more , Koh TCV, Yip CC, Lim TZ, Yong YKJ, Liu MX, Lim LK
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41838134 · Publisher ↗
PURPOSE: To provide an updated report on the prevalence and impact of strabismus in Singapore, both in terms of visual outcomes and associated psychiatric co-morbidities. METHODS: This retrospective cohort study included...
PURPOSE: To provide an updated report on the prevalence and impact of strabismus in Singapore, both in terms of visual outcomes and associated psychiatric co-morbidities. METHODS: This retrospective cohort study included 70,625 Singaporean males from January 2020 to December 2022. Subjects with strabismus and four learning/psychiatric disorders (autism spectrum disorder [ASD], dyslexia, attention deficit hypersensitivity disorder [ADHD], intellectual disability [ID]) were identified. RESULTS: The approximate prevalence of strabismus was 0.44%, with 72.23% Chinese, 12.66% Malay, and 9.74% Indian. The following misalignment patterns were noted: exotropia (70.13%), esotropia (16.88%), hypertropia (2.60%), hypotropia (0.32%), and mixed horizontal and vertical (3.90%). Myopia was found in 80.09% of exotropia and 73.08% of esotropia patients. BCVA of 6/9 or better was noted in 92.86%, with strabismic amblyopia in only 1.3%. Stereopsis was preserved in 57.79%, and diplopia was reported in 18.18%. 37.66% of patients had previous strabismus surgery, and 95.69% had BCVA of 6/9 or better. Residual tropia was noted in 89.93%, but stereopsis was preserved in 52.59% with 17.24% reporting diplopia. Pre-university certifications (A-levels and diplomas) were obtained by 68.19%, and psychiatric/learning disorders were reported in 16.56% of subjects. The OR for ASD and ID were 2.55 (1.42-4.55) and 4.55 (2.33 – 8.89), respectively in strabismus, but were insignificant for dyslexia and ADHD. CONCLUSION: The prevalence of strabismus in Singapore is low. Majority of these patients have good BCVA, no diplopia, but lack stereopsis. Given the association with ASD and ID, Ophthalmologists should also monitor the learning and behaviour of children with strabismus.
Comparative efficacy of glaucoma drainage device versus ab-interno trabeculotomy in vitrectomized eyes with secondary glaucoma.
Pathak AK, Ganesh M, Virani B … +2 more , Gupta V, Gupta S
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41831001 · Publisher ↗
PURPOSE: To compare surgical outcomes of Ahmed glaucoma valve (AGV) implantation with Gonioscopy-assisted transluminal trabeculotomy (GATT) over a 12-month period in eyes with secondary glaucoma following vitreoretinal s...
PURPOSE: To compare surgical outcomes of Ahmed glaucoma valve (AGV) implantation with Gonioscopy-assisted transluminal trabeculotomy (GATT) over a 12-month period in eyes with secondary glaucoma following vitreoretinal surgery (SGVR). METHODS: This retrospective comparative study included 45 eyes with medically uncontrolled SGVR following silicone oil removal, followed up for 12 months. Nineteen eyes underwent AGV implantation and 26 eyes underwent GATT. Primary outcome measures were postoperative intraocular pressure (IOP) reduction and surgical success. Absolute success was defined as achievement of an IOP between 6 and 18 mmHg with a ≥ 20% reduction from baseline without antiglaucoma medications (AGMs); qualified success required the same IOP criteria with AGMs. Secondary outcomes included changes in best-corrected visual acuity (BCVA), AGM burden, postoperative complications, and need for secondary interventions. Kaplan–Meier survival analysis and exploratory regression analyses were performed. RESULTS: Both procedures resulted in significant IOP and AGM reduction at 12 months (p < 0.001 for both), with comparable cumulative surgical success (74% for AGV vs. 69% for GATT; log-rank p = 0.8), including in eyes with advanced glaucoma. Vision-threatening complications occurred exclusively in the AGV group (26% vs. 0%, 95%CI: 7–46%, p = 0.01). Secondary interventions were significantly more frequent after AGV implantation than after GATT (42% vs. 8%; OR:8.7, 95%CI:1.58–48.05, p = 0.01). In adjusted analyses, treatment group consistently remained associated with the need for secondary intervention across parsimonious models. CONCLUSIONS: GATT was as efficacious for IOP control as AGV, irrespective of disease severity, with fewer complications at 12-months.
Abnormal white matter in the visual pathways of strabismus with and without amblyopia.
Huang Y, Liu Z, Wu Y … +4 more , Chen Z, Deng D, Dai Z, Yu M
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41831000 · Publisher ↗
PURPOSE: Strabismus, one of the leading causes of amblyopia, is associated with widespread perceptual and neural abnormalities in the visual system, yet its impact on white matter in the visual pathways remains unclear....
PURPOSE: Strabismus, one of the leading causes of amblyopia, is associated with widespread perceptual and neural abnormalities in the visual system, yet its impact on white matter in the visual pathways remains unclear. Here, we employed diffusion tensor imaging and tract-estimating algorithms (fiber tractography) to investigate white matter abnormalities in the visual pathways of strabismic individuals, both with and without amblyopia. METHODS: We compared the microstructural properties—mean diffusivity (MD) and fractional anisotropy (FA)—of four major visual pathways: the optic tract (OT), optic radiation (OR), interhemispheric primary visual cortex (V1-V1) and medial temporal complex (hMT+-hMT+). The study included 25 participants with esotropic strabismus (10 with amblyopia and 15 without amblyopia) and 14 age-matched healthy controls. RESULTS: Strabismic participants, both with and without amblyopia, exhibited higher MD values with significant differences in the OT, OR, V1-V1 and hMT+-hMT+ pathways and lower FA values with significant differences in the OT and OR pathways compared to controls. Notably, the severity of white matter abnormalities did not differ significantly between strabismic participants with amblyopia and those without. Additionally, partial correlation analyses controlling for the effects of age revealed that the magnitude of MD/FA changes correlated significantly with the duration of ocular deviation. CONCLUSIONS: Our study demonstrates that long-term ocular misalignment induces abnormal white matter in both precortical and cortico-cortical visual pathways, and strabismus-induced amblyopia does not appear to exacerbate these microstructural abnormalities. These findings provide a neurological basis for understanding the pathophysiology of strabismus and strabismus-induced amblyopia and highlight the importance of early ocular alignment correction.
OCTA in age-related macular degeneration: consensus on practical guidelines for optimal imaging strategies across different clinical scenarios.
Neri G, Bacherini D, Mastropasqua R … +5 more , Dolz-Marco R, Gallego-Pinazo R, Reiter GS, Reibaldi M, Borrelli E
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 41830999 · Full text
PURPOSE: To provide expert-driven, practical guidelines for the optimal use of optical coherence tomography angiography (OCTA) in the clinical management of age-related macular degeneration (AMD). Given the heterogeneity...
PURPOSE: To provide expert-driven, practical guidelines for the optimal use of optical coherence tomography angiography (OCTA) in the clinical management of age-related macular degeneration (AMD). Given the heterogeneity of AMD and the versatility of OCTA, clinicians require scenario-specific recommendations to navigate imaging strategies effectively across various stages and phenotypes of the disease. METHODS: An expert panel from the European Young Retinal Imaging and Retina Study Group conducted a consensus-based review integrating the latest evidence and extensive clinical experience. The panel focused on developing OCTA-based protocols tailored to distinct clinical scenarios in AMD, including neovascular subtypes, geographic atrophy, non-exudative neovascularization, and ambiguous fluid accumulations. Recommendations emphasize appropriate scan sizes, slab selections, and strategies for interpreting flow signals across disease presentations. RESULTS: The expert panel delineated structured OCTA protocols for a range of AMD phenotypes to enhance diagnostic accuracy and clinical decision-making. In neovascular AMD, OCTA enables detailed characterization of macular neovascularization (MNV) subtypes—types 1, 2, and 3—through high-resolution, depth-resolved imaging. Recommendations include the use of cross-sectional OCTA to localize flow and appropriate selection of en face slabs to optimize lesion visualization. In geographic atrophy (GA), while structural OCT remains the primary modality, OCTA may assist in identifying subclinical or complicating MNV and in assessing choriocapillaris perfusion in the peri-atrophic zone, which may have prognostic implications. In cases of early and intermediate AMD, OCTA plays a critical role in detecting non-exudative MNV—particularly type 1 and type 3 lesions—providing valuable prognostic information given the risk of exudative conversion. Additionally, OCTA contributes to the differential diagnosis of pseudovitelliform lesions, detection of deep retinal age-related microvascular anomalies (DRAMAs), and exclusion of neovascularization in cases presenting with atypical intraretinal or subretinal fluid. CONCLUSIONS: This expert consensus offers a pragmatic framework for applying OCTA in AMD clinics, advocating for individualized imaging approaches based on lesion type and anatomical complexity. By enhancing diagnostic precision and enabling tailored monitoring strategies, OCTA integration into clinical workflows may significantly improve patient outcomes across the AMD spectrum.
Lens extraction combined with circumferential ab interno trabeculotomy to treat pigmentary glaucoma.
Sharkawi E, Artes PH, Dari ML … +1 more , Guarnieri A
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41824025 · Publisher ↗
PURPOSE: To evaluate the 24-month outcomes of lens extraction combined with circumferential, 360-degree trabeculotomy in patients with progressive pigmentary glaucoma. METHODS: This prospective, interventional case serie...
PURPOSE: To evaluate the 24-month outcomes of lens extraction combined with circumferential, 360-degree trabeculotomy in patients with progressive pigmentary glaucoma. METHODS: This prospective, interventional case series included 32 eyes of 32 patients with progressive pigmentary glaucoma. All patients underwent phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (GATT). Outcome measures included intraocular pressure (IOP), number of glaucoma medications, and success rates at 24 months. Qualified success was defined as IOP ≤ 18 mm Hg with a 20% IOP reduction from baseline, without requiring further glaucoma surgery. RESULTS: The mean preoperative IOP was 21.4 (SD 6.3) mm Hg on a mean of 2.2 (SD 1.5) glaucoma medications. At 24 months, mean IOP was reduced to 13.0 (SD 3.5) mm Hg (a 39% reduction), and mean medication use was reduced to 0.8 (SD 1.0). The Kaplan-Meier estimated probability of qualified success at 24 months was 75.0% (95% CI: 61.4% − 91.6%). CONCLUSION: Combined lens extraction and GATT effectively lowers IOP and medication use in pigmentary glaucoma. By targeting the source of pigment dispersion, lens extraction may halt the disease process, making this a very promising strategy.
Detection of microaneurysms causing macular edema associated with branch retinal vein occlusion using optical coherence tomography and optical coherence tomography angiography and the effect of focal photocoagulation.
Hasegawa T, Kakehashi M, Kawai M … +1 more , Maruko I
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41824024 · Publisher ↗
PURPOSE: To determine the efficacy of focal photocoagulation for microaneurysms causing macular edema associated with branch retinal vein occlusion. We also compared the efficacy of treatment with fluorescein angiography...
PURPOSE: To determine the efficacy of focal photocoagulation for microaneurysms causing macular edema associated with branch retinal vein occlusion. We also compared the efficacy of treatment with fluorescein angiography (FA) as a method of targeting microaneurysms with the use of optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: This retrospective study included 45 eyes with macular edema caused by microaneurysms. All eyes received focal photocoagulation for microaneurysms, with FA used to detect microaneurysms in 19 eyes and OCT/OCTA in 26 eyes, depending on the treatment time. Eyes with only focal leakage on FA and eyes with edema relatively confined to the microaneurysm area on OCT/OCTA were included in this study. Eyes without macular edema in the fovea after 12 months of focal photocoagulation alone were classified as responsive. Eyes with residual edema or with additional anti-VEGF therapy during the study were classified as unresponsive. RESULTS: Ten eyes (52.6%) in the FA group and 12 eyes (46.2%) in the OCT/OCTA group were responsive (P = 0.6676). In responsive eyes, both FA and OCT/OCTA groups had significantly improved visual acuity at 12 months. In unresponsive eyes, visual acuity improved significantly in the FA group but not in the OCT/OCTA group. CONCLUSION: The combination of OCT and OCTA can be used to identify edema-causing microaneurysms without the use of FA. However, compared to FA, OCT and OCTA alone may not clearly distinguish between cases in which focal photocoagulation is indicated and those in which it is not.
Longitudinal change in anterior chamber depth and its determinants: a median 4.9-year follow-up of 2,247 Japanese adults.
Inooka T, Tomita R, Kominami T … +6 more , Fujikawa S, Kojima T, Ueno S, Ito Y, Nishiguchi KM, Yuki K
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41817721 · Publisher ↗
PURPOSE: To quantify anterior chamber depth (ACD) changes and identify associated determinants in individuals with good-corrected visual acuity. METHODS: In a retrospective single‑centre cohort, participants attending a...
PURPOSE: To quantify anterior chamber depth (ACD) changes and identify associated determinants in individuals with good-corrected visual acuity. METHODS: In a retrospective single‑centre cohort, participants attending a combined health and eye screening programme underwent same‑day biometry, anthropometry and routine haematology. For each participant, the annual ACD change (mm/year) was estimated as the individual-linear regression slope. The cross-sectional age–ACD relationship was characterised with restricted cubic splines and a single-knot piecewise model. Associations between annual ACD change and baseline characteristics were evaluated using ordinal logistic regression across quartiles of the slopes. RESULTS: A total of 2,247 participants (median age at baseline visit 52.7 years) with 10,869 visits over a median follow-up of 4.9 years were analysed. The median annual ACD change was − 1.11 × 10⁻² mm/year (interquartile range − 2.04 × 10⁻² to − 0.24 × 10⁻²). The piecewise model identified a knot at 51.3 years, with estimated ACD narrowing of − 1.52 × 10⁻² mm/year at ages ≤ 51.3 and − 0.91 × 10⁻² mm/year at > 51.3 (both P < 0.001). Ordinal models showed that younger age and shorter body height were associated with faster ACD narrowing (both P < 0.05). CONCLUSION: ACD narrowing progressed more steeply until approximately 51 years of age, with a trend toward relatively faster narrowing in shorter individuals. These findings suggest that structural predisposition to angle-closure is largely established by early middle age and support targeted monitoring and preventive strategies in middle-aged, shorter adults.
Management of incontinentia pigmenti retinopathy.
Tseng RMWW, Yonekawa Y, Zafar S … +2 more , Fenner B, Tsai ASH
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41817720 · Publisher ↗
Incontinentia Pigmenti (IP) is a rare genetic condition caused by mutations in the NEMO/IKBKG gene and is characterised by multisystem involvement, including retinal pathology. Although ocular manifestations have traditi...
Incontinentia Pigmenti (IP) is a rare genetic condition caused by mutations in the NEMO/IKBKG gene and is characterised by multisystem involvement, including retinal pathology. Although ocular manifestations have traditionally been considered a minor diagnostic criteria, they are increasingly recognised for their potential to cause vision-threatening complications that require prompt intervention. Among these, retinal involvement is the most frequently reported ocular manifestation in IP thus far. In 2019, a revised classification system for IP-related retinopathy was proposed, and along with that, diagnostic evaluation such as the use of multimodal imaging and therapeutic approaches such as the use of anti-VEGF injections have also been expanding. Despite these advancements, the literature remains fragmented. Given the rarity of the condition, synthesis of current evidence may better inform management strategies. This review consolidates existing case series and reports on both medical and surgical management of IP-related retinopathy, aiming to inform clinical practice and highlight areas in need of further research.
Hormonal factors in the pathophysiology of central serous chorioretinopathy - a systematic review and meta-analysis.
Skulimowski B, Liberski S, Gotz-Więckowska A … +1 more , Nijakowski K
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41817719 · Publisher ↗
PURPOSE: Central serous chorioretinopathy (CSC) is a relatively prevalent retinopathy, characterized by the accumulation of subretinal fluid and an often-unpredictable clinical course. Hormonal dysregulation, particularl...
PURPOSE: Central serous chorioretinopathy (CSC) is a relatively prevalent retinopathy, characterized by the accumulation of subretinal fluid and an often-unpredictable clinical course. Hormonal dysregulation, particularly of the hypothalamic–pituitary–adrenal (HPA) axis and sex hormones, has been proposed as a pathogenic factor. The aim of this study was to systematically review and quantitatively synthesize the current evidence regarding endogenous hormonal alterations in patients with CSC. METHODS: A systematic search of MEDLINE, Scopus, Web of Science, and Embase was conducted up to March 2025, in accordance with the PRISMA guidelines. Eligible studies included adult CSC patients with a clinically confirmed diagnosis and matched controls, who reported hormonal measurements in body fluids. The quality of included studies was assessed with the NHLBI tool. A meta-analysis was conducted for cortisol, testosterone, and oestradiol levels. The study protocol was prospectively registered in PROSPERO (CRD420251002790). RESULTS: Twenty-one studies involving 1,139 CSC patients from 17 countries were included. Meta-analysis of serum concentrations of the most frequently studied hormones in male patients revealed elevated morning cortisol (SMD = 0.56, 95% CI: 0.30–0.81) and evening cortisol (SMD = 0.48, 95% CI: 0.17–0.79) in CSC patients compared with controls; for cortisol, only studies reporting sampling time were pooled. Serum testosterone and oestradiol did not differ overall, although exploratory acute–chronic subgroup analyses, based on few studies, suggested transient elevations in acute CSC. Findings on mineralocorticoids were mixed; some studies suggested a role for local cortisol metabolism and potential mineralocorticoid receptor signalling. Norepinephrine and serotonin results were limited and synthesized narratively. CONCLUSION: CSC is associated with systemic hormonal alterations, particularly hyperactivity of the HPA axis and transient changes in sex hormones. These results support the hypothesis that CSC represents a stress-related endocrine disorder. Longitudinal studies with standardized hormonal assessment are warranted to establish causality and evaluate therapeutic implications.
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