Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
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200 papers
Visual and refractive outcomes of retinopathy of prematurity in school-age patients.
Tseng YH, Wang WY, Wu PL … +6 more , Kang EY, Chen KJ, Wang NK, Hwang YS, Lai CC, Wu WC
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42363983 · Publisher ↗
PURPOSE: To evaluate visual and refractive outcomes in school-aged patients with a history of prematurity and retinopathy of prematurity (ROP) with or without treatment. METHODS: This is a retrospective cross-sectional s...
PURPOSE: To evaluate visual and refractive outcomes in school-aged patients with a history of prematurity and retinopathy of prematurity (ROP) with or without treatment. METHODS: This is a retrospective cross-sectional study. Participants were categorized into five groups: full-term, preterm without ROP, ROP without treatment, intravitreal injection of anti-vascular endothelial growth factor (IVI)-treated ROP, and laser indirect ophthalmoscopy (LIO)-treated ROP. Patients underwent comprehensive ophthalmic examinations, including cycloplegic refraction and optical biometry. Comparisons were stratified into two age cohorts: 5 ≤ AGE < 10 and 10 ≤ AGE ≤ 13. Refractive errors, axial length (AL), anterior chamber depth (ACD), corneal parameters, and lens thickness were measured and compared between the groups. RESULTS: A total of 310 patients were enrolled in the study. Significant intergroup differences in AL, ACD, white-to-white distance, and best-corrected visual acuity (BCVA) were observed across both age cohorts (all p < 0.05). In the older age cohort, post-hoc analysis revealed that LIO-treated eyes had significantly shorter AL (22.73 ± 1.51 mm vs. 24.39 ± 0.89 mm, p = 0.0057), shallower ACD (3.31 ± 0.46 mm vs. 3.78 ± 0.22 mm), smaller corneal diameter (11.53 ± 0.35 mm vs. 12.29 ± 0.42 mm, p = 0.0018), and steeper corneal curvature (46.23 ± 1.53 D vs. 42.95 ± 1.37 D, p = 0.0002) compared with full-term controls. When directly compared with IVI-treated eyes in the older cohort, LIO-treated eyes had significantly thinner corneas (p = 0.04) and steeper corneal curvature (p = 0.005). IVI-treated eyes exhibited biometric and refractive profiles similar to those of untreated ROP. CONCLUSION: ROP and its treatment have long-term effects on ocular development and refraction. Laser-treated patients exhibited significantly higher myopia and astigmatism, shorter axial length, shallower anterior chambers, and smaller corneal diameters, particularly in older age groups. In contrast, IVI-treated eyes had a biometry closer to that of untreated ROP.
Longitudinal and cross-sectional study of retinal and choroidal changes in primary aldosteronism.
Xiao R, Shen S, Zhang M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42360468 · Publisher ↗
PURPOSE: To investigate the structural and vascular changes of central and peripheral retina/choroid in patients with primary aldosteronism (PA) using ultra-widefield (24 × 20 mm²) swept source optical coherence tomograp...
PURPOSE: To investigate the structural and vascular changes of central and peripheral retina/choroid in patients with primary aldosteronism (PA) using ultra-widefield (24 × 20 mm²) swept source optical coherence tomography angiography (SS-OCTA), and explore the relationship between systemic factors and ocular indicators. METHODS: This is a prospective study with both cross-sectional and longitudinal self-controlled comparisons. A total of 61 PA patients (122 eyes) due to unilateral adrenal adenoma and 59 healthy individuals (118 eyes) were recruited. The parameters assessed included retinal/choroidal thickness (RT, ChT), choroidal vascular index (CVI), choroid vessel/stromal volume per unit area (CVV/a, CSV/a), and deep capillary plexus vessel density (DCPVD). SS-OCTA images were divided into 3 × 3 grid, with the grid center defined as central area and the rest as peripheral area. And receiver operating characteristics curves were generated to determine the discriminative power of choroidal parameters. RESULTS: Compared to healthy controls, PA patients exhibited increased RT, ChT, CVI, CSV/a, CVV/a and DCPVD (P < 0.05). After adrenalectomy, the decline in aldosterone levels was accompanied by the recovery of choroidal parameters (P < 0.05). After controlling confounding factors, SFCT and mean peripheral ChT were related to aldosterone and serum potassium, while central and mean peripheral CVI metrics were correlated with serum potassium. The AUC values of choroidal parameters were greater in the combination of peripheral subfields than the central area alone. CONCLUSIONS: PA patients demonstrated abnormal retinal/choroidal thickness and choroidal volume. Choroidal parameters were positively correlated with endogenous aldosterone levels, underscoring the pivotal role of aldosterone in ocular health.
Long-term analysis of fibrosis in neovascular age-related macular degeneration: A 7-year follow-up.
Honjo J, Mukai R, Itagaki K … +8 more , Kato Y, Tsuchiya Y, Shioya T, Tanaka K, Norikawa K, Kato Y, Kasai A, Sekiryu T
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42360467 · Publisher ↗
PURPOSE: We investigated the 7-year incidence rate of macular fibrosis and its related factors in Japanese patients with neovascular age-related macular degeneration (nAMD) receiving anti-vascular endothelial growth fact...
PURPOSE: We investigated the 7-year incidence rate of macular fibrosis and its related factors in Japanese patients with neovascular age-related macular degeneration (nAMD) receiving anti-vascular endothelial growth factor therapy. METHODS: This retrospective study involved 301 eyes of 301 treatment-naïve Japanese patients. Macular fibrosis was diagnosed using color fundus photography and spectral-domain optical coherence tomography. We compared clinical parameters between eyes with and without fibrosis. Fibrosis incidence, lesion morphology, and visual outcomes were assessed across nAMD subtypes. A multivariable logistic regression analysis was performed to identify independent factors associated with fibrosis development. RESULTS: Fibrosis development was observed in 73 eyes (24.3%). Fibrosis incidence was significantly higher in type 2 macular neovascularization (MNV; 42.1%) than in type 1 MNV (18.1%) and polypoidal choroidal vasculopathy (20.6%). The fibrosis group had significantly worse baseline logarithm of the minimum angle of resolution visual acuity, greater central macular thickness (CMT), and higher incidences of intraretinal fluid (IRF), subretinal hyperreflective material, and retinal hemorrhage than the non-fibrosis group. The most common fibrosis subtype was mixed-type fibrosis, with subretinal fibrosis being more prevalent in type 2 MNV than in type 1 MNV. Visual acuity significantly improved in the non-fibrosis group but not in the fibrosis group. Final visual acuity did not significantly differ across nAMD subtypes in the fibrosis group. In multivariable analysis, worse baseline visual acuity, greater CMT, retinal hemorrhage, IRF, and nAMD subtype were independently associated with fibrosis development. CONCLUSION: Macular fibrosis occurred across all nAMD subtypes and was associated with poor visual outcomes. Worse baseline visual acuity, greater CMT, retinal hemorrhage, IRF, and nAMD subtype were independently associated with fibrosis development. Thus, baseline disease severity and active exudative lesion characteristics may contribute to fibrotic progression in nAMD.
DMEK, DSAEK, and repeat PKP for endothelial failure after PKP: systematic review and meta-analysis with a graphical synthesis of clinical decision factors.
Beschi G, Youssef Y, Lozza F … +3 more , Ferrara M, Romano V, Rocha G
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42360466 · Publisher ↗
PURPOSE: To compare outcomes of Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and repeat penetrating keratoplasty (re-PKP) performed for endothelial fai...
PURPOSE: To compare outcomes of Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and repeat penetrating keratoplasty (re-PKP) performed for endothelial failure after penetrating keratoplasty (PKP), and to summarize the clinical factors that appear to influence procedure selection. METHODS: A review and meta-analysis was conducted using a preregistered protocol. Studies reporting outcomes of DMEK, DSAEK, or re-PKP for post-PKP endothelial failure were included. A systematic search was conducted in MEDLINE (via PubMed), Embase, and the Cochrane Library from inception. Pooled proportions were calculated for graft failure, rejection, and detachment. Eligible studies included original clinical studies of adult eyes with endothelial failure after prior PKP undergoing DMEK, DSAEK, or re-PKP, with at least five post-PKP eyes in a relevant treatment arm and reporting at least one outcome of interest. Visual acuity (VA) was synthesized as weighted means with bootstrap confidence intervals at predefined timepoints (preoperative, 3-5 months, 6 months, 12-13 months). Clinical decision factors were summarized descriptively and graphically. Risk of bias was assessed using the Joanna Briggs Institute checklist for case series and ROBINS-I V2 for comparative non-randomized studies. RESULTS: Thirty-two studies met inclusion criteria, consisting predominantly of retrospective case series, with a smaller number of prospective or comparative observational studies. Pooled failure rates were 0.22 for DMEK, 0.19 for DSAEK, and 0.29 for re-PKP. Rejection was lowest after DMEK (0.07) and higher after DSAEK (0.14) and re-PKP (0.15). Detachment occurred more frequently after DMEK (0.37) than DSAEK (0.18). All three procedures improved VA relative to baseline. DMEK showed numerically greater and more sustained improvement through 12-13 months, whereas DSAEK and re-PKP improved early and then stabilized; however, these findings are descriptive and should be interpreted with caution given differences in baseline visual acuity and follow-up across studies. Several clinical factors-including the initial PKP indication, pre-existing glaucoma, and prior glaucoma surgery-were variably associated with procedure choice, but reporting was inconsistent. CONCLUSIONS: DMEK, DSAEK, and re-PKP all improve vision after endothelial failure of a prior PKP but differ in complication profiles and in the trajectory of visual recovery. DMEK showed numerically greater visual acuity improvement and the lowest pooled rejection proportion, albeit with a higher pooled detachment proportion. Current evidence is limited by incomplete reporting of preoperative and graft-related variables, the predominance of retrospective non-randomized studies, and variable risk of bias across included studies, constraining the ability to derive a consistent decision framework.
Incidence and progression of ptosis after glaucoma surgery during one year of follow-up.
Okuzumi N, Mori S, Katakami K … +4 more , Iwaki Y, Sakamoto M, Yamada-Nakanishi Y, Nakamura M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42347993 · Publisher ↗
PURPOSE: This study evaluated the incidence and progression of ptosis during the first year after glaucoma surgery. METHOD: This prospective study included patients who underwent initial glaucoma surgery between October...
PURPOSE: This study evaluated the incidence and progression of ptosis during the first year after glaucoma surgery. METHOD: This prospective study included patients who underwent initial glaucoma surgery between October 2023 and December 2024. Procedures included microhook ab interno trabeculotomy (µTLO), Preserflo MicroShunt (PMS), trabeculectomy, and Ahmed glaucoma valve (AGV). Margin reflex distance 1 (MRD-1) and MRD-2 were measured preoperatively and at 1, 3, 6, 9 and 12 months using standardised photographs. Ptosis was defined as a decrease in MRD-1 of ≥ 1 mm from baseline. Logistic regression was used to identify factors associated with ptosis. Eyes with absolute MRD-1 ≤ 1 mm were also evaluated at each time point. RESULT: A total of 167 patients were included: 28 underwent µTLO, 102 PMS, 28 trabeculectomy and 8 AGV implantation. Mean (SD) MRD-1 decreased from 2.5 (1.2) mm preoperatively to 2.1 (1.3) mm at one year. Ptosis occurred in 54 eyes (32.3%). MRD-1 decreased significantly from 1 month through 1 year, whereas MRD-2 showed only a transient decrease at 1 month. No significant MRD-1 reduction occurred after µTLO, whereas significant decreases were observed after filtration surgery. AGV implantation and higher preoperative MRD-1 were associated with ptosis. Eyes with MRD-1 ≤ 1 mm increased over time in the PMS and AGV groups but not after µTLO or trabeculectomy. CONCLUSION: Ptosis occurred in about one-third of eyes after glaucoma surgery and progressed up to one year. Filtration surgery was associated with a higher risk of postoperative ptosis.
Iridology: Biological plausibility, clinical evidence, and implications for ophthalmic practice : A position paper of the Associazione Pazienti Malattie Oculari (APMO).
Iuliano L, Veritti D, Lanzetta P
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42347992 · Publisher ↗
Iridology is an alternative diagnostic practice that claims to identify systemic diseases and organ dysfunction through visual inspection of iris features, including pigmentation patterns, crypts, furrows, and discolorat...
Iridology is an alternative diagnostic practice that claims to identify systemic diseases and organ dysfunction through visual inspection of iris features, including pigmentation patterns, crypts, furrows, and discolorations. Despite its continued presence within complementary and alternative medicine, iridology has not been incorporated into mainstream medical practice. This review critically examines iridology from an ophthalmologic perspective, addressing its historical origins and epistemological foundations, proposed mechanisms, biological plausibility, and clinical evidence. A systematic appraisal of the available literature, including the most recent government-commissioned evidence evaluation, demonstrates a consistent lack of diagnostic accuracy, reproducibility, and pathophysiological rationale. The ethical and clinical implications of iridology use are discussed, with particular attention to the risk of delayed diagnosis and patient misinformation. Based on the totality of evidence, iridology cannot be supported as a diagnostic or screening tool in ophthalmology or general medicine.
Identification and management of different types of bacillary layer detachment in eyes with rhegmatogenous retinal detachment.
Affatato M, Rapino G, Muni RH … +6 more , Melo IM, Cucciniello P, Castelluzzo AM, Rossi T, Ziccardi L, dell'Omo R
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42347991 · Publisher ↗
PURPOSE: To describe the preoperative and postoperative features of eyes with fovea-off rhegmatogenous retinal detachment (RRD) and different types of bacillary layer detachment (BALAD), which consists of an intraretinal...
PURPOSE: To describe the preoperative and postoperative features of eyes with fovea-off rhegmatogenous retinal detachment (RRD) and different types of bacillary layer detachment (BALAD), which consists of an intraretinal split within the photoreceptor inner segment myoid zone or formation of a inner lamellar defect at the fovea visible on spectral-domain optical coherence tomography (OCT). METHODS: Retrospective cohort study of patients with primary RRD and BALAD who underwent pars plana vitrectomy (PPV). OCT, multicolor images, and logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuities (BCVAs) were obtained preoperatively and at 1, 3, 6, and 12 months after the operation. Three types of BALAD were identified preoperatively on the basis of OCT: cavity, transition and lamellar hole. RESULTS: Among the 42 eyes included, 23 were classified as cavity, 6 as transition and 13 as lamellar hole BALAD. All types showed a sharp red round area at the fovea on multicolor images. After standard PPV, additional internal limiting membrane (ILM) peeling was carried out in none eyes with cavity BALAD, in 2 eyes with transition BALAD and in all BALAD-lamellar hole eyes. Post-operatively, no eyes showed evidence of full-thickness macular hole (FTMH). At 12 months post-operatively, external limiting membrane (ELM) and ellipsoid zone (EZ) appeared continuous in 69% (29/42) eyes (24 cavity/transition and 5 BALAD lamellar-hole, P = 0.006) and 54.8% (23/42) eyes (20 cavity/transition and 3 BALAD lamellar-hole, P = 0.004), respectively. Accordingly, BCVA was worse in the eyes with BALAD-lamellar hole than in those with cavity/transition BALAD (0.6 ± 0.4 vs. 0.3 ± 0.2; P = 0.01). CONCLUSION: Multicolor imaging is useful to identify BALAD. Cavity and transition BALAD are likely to not progress to FTMH after retinal reattachment. ILM peeling and cover flap prevented FTMH formation in eyes with BALAD-lamellar hole in this cohort. 12 months postoperatively, restoration rates of integrity of ELM and EZ bands and BCVA scores remained lower in eyes with BALAD-lamellar hole in comparison to those with cavity/transition BALAD.
Review of emerging imaging findings to reveal a broader spectrum of lesions in AMD.
Borrelli E, Neri G, Berni A … +8 more , Olivieri C, Chhablani J, Corradetti G, Dolz-Marco R, Reiter GS, Zur D, Bandello F, Reibaldi M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42347990 · Publisher ↗
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in developed countries, with prevalence expected to reach nearly 288 million by 2040. Accurate classification of AMD is critical for...
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in developed countries, with prevalence expected to reach nearly 288 million by 2040. Accurate classification of AMD is critical for patient care and clinical research, guiding prognosis, therapeutic strategies, and the design of clinical trials. A widely adopted framework, the Beckman classification, stratifies AMD based primarily on color fundus photography (CFP) findings, defining stages from early to late disease. While simple and clinically applicable, such systems do not account for several key phenotypes revealed by advances in multimodal imaging. Such novel phenotypes include reticular pseudodrusen (RPD), acquired vitelliform lesions (AVL), non-exudative macular neovascularization (MNV), incomplete retinal pigment epithelium and outer retina atrophy (iRORA), and non-neovascular exudative fluid. Recent imaging modalities-including optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA)-have uncovered features with important prognostic implications that are currently misclassified with respect to AMD. For example, eyes with RPD or AVL in the absence of drusen are currently misclassified as "early AMD" or excluded altogether, despite their high risk of progression. Similarly, the ambiguous status of non-exudative MNV, which carries both protective and harmful potential, highlights the need for greater granularity. The Classification of Atrophy Meetings (CAM) group has also introduced refined OCT-based definitions such as iRORA and cRORA, underscoring early degenerative changes that precede geographic atrophy. Moreover, novel entities like non-neovascular intraretinal or subretinal fluid challenge the assumption that exudation is synonymous with neovascular AMD. This review synthesizes recent evidence highlighting the limitations of current classification systems in light of these advances. Furthermore, we emphasize that intermediate AMD, currently treated as a uniform category, actually encompasses highly heterogeneous phenotypes with distinct risks and trajectories. A more nuanced, imaging-integrated classification system is urgently needed to improve disease staging, identify high-risk eyes, and ensure appropriate patient selection for emerging therapies. Such a framework would not only better reflect the complex natural history of AMD but also facilitate the regulatory shift toward continuous, quantitative endpoints in clinical trials.
Unveiling dry eye disease prior to cataract surgery: A multicenter clinical study.
Di Zazzo A, Barabino S, Rolando M … +5 more , Aragona P, Orfeo V, Mencucci R, Giannaccare G, Italian Ocular Surface Associates (IOSA) Study Group
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42347989 · Publisher ↗
PURPOSE: To assess preoperative ocular surface findings in consecutive cataract surgery candidates without a prior dry eye diagnosis using a standardized battery of device-based and conventional tests, and to explore ass...
PURPOSE: To assess preoperative ocular surface findings in consecutive cataract surgery candidates without a prior dry eye diagnosis using a standardized battery of device-based and conventional tests, and to explore associations with age-, sex-, and menopausal status-related factors. METHODS: A multicenter prospective clinical study was conducted across 12 centers, enrolling consecutive cataract patients scheduled for phacoemulsification surgery with intraocular lens implantation. Patients were studied preoperatively using a combination of non-invasive tests and traditional diagnostic tools. Test results were classified as physiological or non-physiological based on established cut-off values. RESULTS: A total of 1,482 patients were enrolled. Despite no preoperative diagnosis of dry eye, 20% of patients exhibited severe ocular surface symptoms via the SANDE questionnaire. Preoperatively, pathological findings were noted in 75.9% for abnormal blinking, 67.6% for reduced TF-BUT, 66.9% for meibomian gland dysfunction, and 43% for eye redness. Older patients and post-menopausal women were found to be at higher risk for ocular surface abnormalities. Logistic regression analysis revealed significant associations between preoperative abnormalities and postoperative risks. CONCLUSION: Preoperative evaluation of cataract patients revealed that a substantial proportion exhibited signs of ocular surface disease, despite not reporting ocular discomfort. This highlights the importance of integrating ocular surface evaluation into routine preoperative assessment and considering targeted preoperative optimization, particularly in high-risk populations.
Tablet-based multi-stimulus perimetry for glaucoma screening.
Tanabe F, Matsumoto C, Nomoto H … +3 more , Ishibashi M, Kusaka S, Iwase A
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42340412 · Publisher ↗
PURPOSE: To evaluate the Multi-Stimulus Vision Tester for a single eye (MVT-s), a tablet-based perimetry tool for detecting glaucomatous visual field (VF) defects. PARTICIPANTS: Forty-two eyes of 42 patients with glaucom...
PURPOSE: To evaluate the Multi-Stimulus Vision Tester for a single eye (MVT-s), a tablet-based perimetry tool for detecting glaucomatous visual field (VF) defects. PARTICIPANTS: Forty-two eyes of 42 patients with glaucoma were classified into three stages on the basis of the mean deviation (MD) measured by the imo perimeter: early (12 eyes), moderate (19 eyes), and advanced (11 eyes), with an overall median MD of MD of - 8.5 dB (IQR, - 13.2 to - 5.2). Additionally, 39 eyes of 39 visually normal individuals were included as controls. METHODS: All participants underwent testing with the MVT-s and standard automated perimetry using the imo perimeter. The MVT-s used a multipoint stimulation paradigm with flickering stimuli, presenting up to three test points simultaneously. Participants recorded their responses by directly touching the stimulus locations on the screen. The MVT-s test was performed three times on the same day for each participant. We evaluated the relationship between the number of abnormal points detected by the MVT-s and MD obtained with the imo, diagnostic accuracy using sensitivity, specificity, and receiver operating characteristic curve analysis, short-term test-retest reproducibility using the intraclass correlation coefficient (ICC), and examination time. RESULTS: Abnormal points increased with disease severity (median 7.5, 17.0, and 22.0 in early, moderate, and advanced glaucoma; p < 0.001) and correlated with MD (ρ = - 0.84). Discrimination was high (AUC 0.93). Using cutoffs of ≥ 3/ ≥ 4/ ≥ 5 abnormal points, sensitivities were 92.9/92.9/90.5% and specificities were 79.5/82.1/84.6%. Test-retest reproducibility was good, with ICCs of 0.95 overall, 0.82 in normal eyes, and 0.93 in glaucomatous eyes. CONCLUSION: The MVT-s demonstrated high diagnostic accuracy and reproducibility for detecting glaucomatous VF defects, with a relatively short examination time, suggesting its potential as a practical screening and complementary assessment tool in glaucoma care.
Pachy-reticular pseudodrusen associated with pachyvitelliform maculopathy.
Romano E, Capuano V, Fragiotta S … +6 more , Parravano M, Beretta F, Sacconi R, Lambiase A, Souied EH, Querques G
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42340411 · Publisher ↗
PURPOSE: To characterize the phenotype of pachy-reticular pseudodrusen (pachy-RPD) associated with pachyvitelliform maculopathy (PVM). METHODS: A retrospective, case-control study of patients over 50 with pachy-RPD (chor...
PURPOSE: To characterize the phenotype of pachy-reticular pseudodrusen (pachy-RPD) associated with pachyvitelliform maculopathy (PVM). METHODS: A retrospective, case-control study of patients over 50 with pachy-RPD (choroidal thickness > 250 μm) associated with PVM. Acquired vitelliform lesions (AVL) without other comorbidities were included as controls. Medical records and multimodal imaging from two tertiary centers were analyzed, including structural optical coherence tomography (OCT), fundus autofluorescence, OCT angiography (OCTA), and dye-based angiography. RESULTS: Twenty-five eyes of 17 patients (mean age 74 ± 11 years) fulfilled the inclusion criteria. Best-corrected visual acuity was 20/64 (range 20/32 to 20/250). Most of the lesions were unilateral (59%) with foveal involvement. Pachy-RPD/PVM eyes had smaller lesions, lower central macular thickness (p = 0.04), lesion height (p = 0.008), and lesion width (p < 0.001) compared to AVL eyes. Despite this, pachy-RPD/PVM eyes presented more frequent external limiting membrane discontinuities (56% vs. 27%, p = 0.03) and hypertransmission (68%) compared to AVL eyes (8%, p < 0.001). Six out of 25 eyes (24%) of PVM cases showed late-stage complications in the fellow eye, including type 1 macular neovascularization (4 eyes) and macular atrophy (2 eyes). These eyes exhibited thinning of the outer retina (306 ± 32 μm vs. 277 ± 13 μm, p = 0.007) and macular cube (9.1 ± 1.0 mm³ vs. 8.1 ± 0.4 mm³, p = 0.01). CONCLUSION: Pachy-RPD and PVM represent a phenotypic variant within the heterogenous spectrum of vitelliform lesions. The present study highlights distinct imaging and morphological features of pachy-RPD/PVM compared to AVL, revealing a stronger association between choroidal status, outer retina involvement, and hypertransmission.
Comment to: Hashiya N, Maruko I, Maruko R et al. Increased intraocular pressure immediately after aflibercept 8 mg intravitreal injection for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol (2026) 264:1611-1617. doi:10.1007/s00417-026-07117-3.
Sarao V, Veritti D, Lanzetta P
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42324407 · Publisher ↗
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Vascular remodeling of macular neovascularization following switch to intravitreal faricimab in neovascular AMD.
Serra R, Français C, Boulet JF … +6 more , Pinna A, Philippakis E, Zambrowski O, Mathis T, Kodjikian L, Coscas F
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42324406 · Publisher ↗
PURPOSE: To describe qualitative optical coherence tomography angiography (OCTA) changes in age-related macular degeneration (AMD) macular neovascularization (MNV) treated with faricimab. METHODS: This was a retrospectiv...
PURPOSE: To describe qualitative optical coherence tomography angiography (OCTA) changes in age-related macular degeneration (AMD) macular neovascularization (MNV) treated with faricimab. METHODS: This was a retrospective study including 30 eyes with active AMD-related Type 1 MNV, resistant to traditional anti-vascular endothelial growth factor (VEGF) agents, receiving intravitreal faricimab. Complete ophthalmological evaluation, consisting of best corrected visual acuity (BCVA), traditional multimodal imaging, and OCTA scans, was performed at baseline and at the last examination. OCTA high-flow networks corresponding to MNV were qualitatively and quantitatively analyzed to assess morphological changes. Furthermore, the correlation between MNV OCTA pattern and presence/absence of exudation signs on spectral domain OCT (SD-OCT) was evaluated. RESULTS: On baseline OCTA, 11/30 eyes showed a sea fan pattern, 13/30 a medusa pattern, and the remaining 6/30 an indistinct pattern. At the last follow-up, in 12/30 eyes, the MNV pattern remained unchanged. In these 12 cases, SD-OCT revealed the exudative signs in 11/12 eyes (one with intra-retinal fluid, ten with sub-retinal fluid) at the final evaluation. In the remaining 18/30, MNV pattern changed to a dead tree type with no exudation signs at the last follow-up in 17/18 eyes. The mean interval of intravitreal injection was significantly extended from 4 to 7.2±2.3 weeks (p < 0.0001) with BCVA stabilization. At the last follow-up the dead tree OCTA pattern resulted to be significantly related to the absence of exudation sings (p < 0.0001). CONCLUSION: Our study reveals that the initial MNV pattern frequently moves toward a dead tree pattern after switching from traditional anti-VEGF agents to faricimab therapy.
Development of a conceptual, HOV-inspired spatial weighting model for quantifying geographic atrophy severity.
Chujo S, Quarta A, Abbasgholizadeh R … +11 more , Chung YC, Kwak H, Soylu C, Alhelaly M, Rattu R, Huang J, Corradetti G, Velaga S, Nittala MG, Uji A, Sadda SR
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42322415 · Publisher ↗
PURPOSE: To develop a Hill of Vision (HOV)-inspired severity score for geographic atrophy (GA) and evaluate its ability to capture spatial characteristics of disease progression, including lesion location and proximity t...
PURPOSE: To develop a Hill of Vision (HOV)-inspired severity score for geographic atrophy (GA) and evaluate its ability to capture spatial characteristics of disease progression, including lesion location and proximity to the foveal center, compared with the conventional lesion area (ΔArea) metric. METHODS: This retrospective analysis included 103 untreated fellow eyes from the MAHALO study with fundus autofluorescence images available at all visits. GA lesions were delineated and binarized to generate mask images. A Gaussian weighting function based on the distance from the foveal center was applied to each lesion pixel to model the spatial distribution of retinal functional resolution, yielding a volumetric "severity score," that was kept unitless for the purpose of this exercise. For eyes with multifocal GA, total severity was defined as the sum of all lesion values. The correlation between ΔArea and ΔSeverity (0-18 months) was assessed using Pearson's coefficient. Lesion expansion direction was visualized using Euclidean distance maps. RESULTS: Mean changes in ΔArea and ΔSeverity over 18 months were 1.02 ± 1.11 mm² and 5811 ± 4584, respectively. A weak but significant correlation was observed (r = 0.36, p < 0.01). Cases with peripheral enlargement showed modest severity increases, whereas parafoveal expansion caused steep severity rises despite relatively minimal area growth. Expansion maps revealed that the direction and expansion to the fovea strongly influenced severity progression. CONCLUSIONS: The HOV-inspired severity score provides a spatially weighted framework for assessing GA progression and may complement conventional structural metrics by incorporating lesion location relative to the fovea.
Response to letter to the editor: modified flapless surgical technique for sutureless scleral fixation of FIL SSF intraocular lens.
Iannetta D, de Smet MD
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42322414 · Publisher ↗
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Evaluation of retinochoroidal changes after implantable collamer lens implantation: insights from UWF-SS-OCTA and AI-based 3D modeling.
Wang X, Wang J, Song D … +2 more , Wumaier A, Han W
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42319431 · Publisher ↗
PURPOSE: To evaluate the long-term changes in retinochoroidal structure and perfusion status in highly myopic eyes following ICL V4c implantation, using ultra-widefield swept-source optical coherence tomography angiograp...
PURPOSE: To evaluate the long-term changes in retinochoroidal structure and perfusion status in highly myopic eyes following ICL V4c implantation, using ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) combined with a three-dimensional modelling algorithm. DESIGN: Prospective cohort study. SUBJECTS: Sixty-six highly myopic patients (132 eyes) underwent ICL V4c implantation surgery and completed one year of follow-up. METHODS: Retinal and choroidal parameters, including retinal thickness (RT), capillary plexus density, foveal avascular zone (FAZ), retinal curvature, choroidal thickness (CT), and three-dimensional choroidal vascularity index (3D-CVI), were measured preoperatively and at multiple postoperative time points using UWF-SS-OCTA integrated with advanced 3D analytic techniques. Repeated measures mixed-effects models were applied to compare the pre- and postoperative parameters and test the correlations between parameters. RESULTS: The surgical outcomes are satisfactory with a stable safety profile and no major complications. RT and retinal vascular density exhibited transient changes in one month postoperatively, and gradually recovered (p < 0.05). Choroidal parameters, including CT and 3D-CVI, demonstrated a progressive and sustained postoperative increase across the 1-year follow-up, with the most pronounced changes observed in the foveal and perifoveal zones (p < 0.001). Factors of surgical duration and axial length showed significant correlation to the retinochoroidal responses (p < 0.05). CONCLUSION: Our analysis based on UWF-SS-OCTA demonstrated that ICL implantation can cause the recoverable changes of retinal structure and perfusion status, and the sustained remodeling of choroidal vascular conditions one year postoperatively in high myopia. TRIAL REGISTRATION NUMBER: ChiCTR2500108664, registered at the Chinese Medical Research Registry.
Tea tree oil action on human corneal epithelial cells biological activity.
Paduch R, Matysik-Woźniak A, Jünemann AG … +1 more , Rejdak R
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42319430 · Publisher ↗
PURPOSE: In ophthalmology, tea tree oil is used as an anti-infective and wound-healing compound. It is also effective in combating parasitic eyelid infections. Unfortunately, it has been linked to corneal epithelial defe...
PURPOSE: In ophthalmology, tea tree oil is used as an anti-infective and wound-healing compound. It is also effective in combating parasitic eyelid infections. Unfortunately, it has been linked to corneal epithelial defects when it contacts the ocular surface. METHODS AND RESULTS: It was shown that concentrations of TTO exceeding 0.01% may have adverse effects on corneal epithelial cells, reducing cell viability. The IC50 (MTT assay) was 0.055% and the IC50 (NR uptake assay) was 0.1%. Cell death occurred primarily through apoptosis. Flow cytometry revealed that TTO increased the release of reactive oxygen species (ROS) threefold by the tested cells at TTO concentrations of 0.01%. However, TTO reduced ROS levels in cells previously preincubated with phorbol ester (PMA). TTO concentrations below 0.01% did not affect the level of nitric oxide (NO) released by cells. TTO concentrations (up to 0.01%) increased the number of cells in the sub-G1 and triggered an 5-6% increase in the G1 and 15% decrease in the G2 phase. Moreover, these concentrations increased the level of IL-1β twofold and IL-6 2.5-fold compared to the untreated control measured by ELISA. CONCLUSIONS: We detected that the threshold concentration of TTO that can be considered safe for human corneal epithelial cells is 0.01% in in vitro tests. Higher concentrations were toxic to corneal epithelial cells, leading to their morphological and metabolic changes.
Sectoral analysis of macular inner retinal layers and diagnostic performance in early pseudoexfoliation glaucoma.
Azimi A, Vahidifard MJ, Mohsenian Sisakht MH … +2 more , Ezzatabadi Pour H, Tabatabaei SM
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42313165 · Publisher ↗
PURPOSE: To compare the sectoral inner macular layers thicknesses among eyes with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), and healthy controls. METHODS: This cross-sectional study included 27...
PURPOSE: To compare the sectoral inner macular layers thicknesses among eyes with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), and healthy controls. METHODS: This cross-sectional study included 27 eyes from 14 patients with early pseudoexfoliation glaucoma, 39 eyes from 29 patients with pseudoexfoliation syndrome, and 37 eyes from 19 healthy controls. All eyes underwent spectral-domain optical coherence tomography (SD-OCT) of the macula using the Glaucoma Module Premium Edition of Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). The sectoral thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (INL) were measured. Differences in sectoral thicknesses of the RNFL, GCL, and IPL between groups were evaluated using generalized estimating equations. The diagnostic performance of single and composite macular layers in detecting PXG was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: There were no significant differences in age or sex between groups (p > 0.05). We observed significant differences in ganglion cell and inner plexiform layer thicknesses in sectors 2-5 between the groups (p < 0.05). Both PXG and PXS eyes showed significant sectoral thinning of the GCL and IPL compared to controls. The ganglion cell complex (GCC) provided the highest AUC for discriminating between PXG eyes, particularly in sector 4. CONCLUSIONS: Early PXG preferentially affects the inner macular layers, particularly the IPL, with sectoral vulnerability. Composite macular layers, such as the GCC, demonstrated modest discriminatory ability and may have adjunctive value in the detection of early glaucoma.
Comparative visual outcomes of inverted ILM flap "covering" versus "stuffed" techniques for macular hole surgery.
Aizawa N, Kunikata H, Nakazawa T
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42313164 · Publisher ↗
PURPOSE: To compare the functional and anatomical outcomes of the inverted internal limiting membrane (ILM) flap covering and stuffed techniques in primary macular hole (MH) surgery. METHODS: This retrospective case seri...
PURPOSE: To compare the functional and anatomical outcomes of the inverted internal limiting membrane (ILM) flap covering and stuffed techniques in primary macular hole (MH) surgery. METHODS: This retrospective case series included 57 eyes that underwent inverted ILM flap surgery by a single surgeon (covering, n = 33; stuffed, n = 24). Best-corrected visual acuity (BCVA) and optical coherence tomography findings, including restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ), were assessed preoperatively and at 1 and 6 months postoperatively. RESULTS: There were no significant differences in preoperative characteristics or MH closure rates between groups. BCVA improved significantly in both groups postoperatively; however, BCVA was significantly better in the covering group at 1 month (P = 0.005) and 6 months (P = 0.001). Restoration of the ELM and EZ was more frequent in the covering group at 1 month (ELM, P < 0.001; EZ, P = 0.002) and 6 months (ELM, P < 0.001; EZ, P = 0.001). CONCLUSION: Although both techniques achieved comparable anatomical closure, the covering method provided superior visual and outer retinal recovery for a wide range of macular holes, including medium-to-large cases. These findings suggest that the covering technique may be preferable as a standard approach for primary MH surgery.
Enhanced S-cone syndrome in a family: first long-term (12-year) follow-up and literature review.
Pignatto S, Martin AA, Gavric AU … +3 more , Meglič A, Redolfi De Zan E, Lanzetta P
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42313163 · Publisher ↗
PURPOSE: To describe the long-term clinical course of Enhanced S-cone Syndrome (ESCS) in three siblings carrying the same NR2E3 variant, and to report therapeutic outcomes of choroidal neovascularization (CNV) and cystic...
PURPOSE: To describe the long-term clinical course of Enhanced S-cone Syndrome (ESCS) in three siblings carrying the same NR2E3 variant, and to report therapeutic outcomes of choroidal neovascularization (CNV) and cystic macular changes during a 12-year follow-up from early childhood. METHODS: This is a retrospective observational family case with literature review. Three siblings were examined periodically over 12 years beginning in early childhood. Clinical evaluation included best corrected visual acuity (BCVA), cycloplegic refraction, multimodal imaging. CNV was treated with intravitreal ranibizumab, while cystic macular changes were managed with topical carbonic anhydrase inhibitors (CAIs). RESULTS: The three siblings shared a homozygous splice site variant (c.119-2 A > C) in the NR2E3 gene and ERG showed ESCS pathognomonic features. In the eldest brother, acute onset esotropia secondary to visual impairment caused by CNV represented the first clinical manifestation. Following the onset of night blindness between ages 11 and 14, the older brother and sister developed macular cystic changes; however, topical CAIs were ineffective. Notably, they maintained stable visual acuity over a 12-year observation period. CONCLUSION: This family report underscores the clinical variability in ESCS and suggests that the visual acuity of young patients with ESCS remains stable, even in the presence of macular schisis. CNV was successfully treated with two intravitreal injections of ranibizumab, whilst topical CAIs proved ineffective for treating cystic patterns. Additional long-term studies are required to better understand the natural history of ESCS and improve therapeutic strategies.
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