Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
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200 papers
OVD-assisted press injection in gasless surgery for sectorial inverted internal limiting membrane flap stabilization.
Li H, Zhou Y, Chen X … +2 more , Liang M, Li X
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42307764 · Publisher ↗
PURPOSE: To describe and evaluate an ophthalmic viscosurgical device (OVD)-assisted press injection technique for stabilizing a sectorial inverted internal limiting membrane (ILM) flap in full-thickness macular hole (MH)...
PURPOSE: To describe and evaluate an ophthalmic viscosurgical device (OVD)-assisted press injection technique for stabilizing a sectorial inverted internal limiting membrane (ILM) flap in full-thickness macular hole (MH) surgery without perfluorocarbon liquid or endotamponade. METHODS: Twenty-eight eyes (28 patients) with full-thickness MH underwent 27-gauge pars plana vitrectomy with a superior sectorial inverted ILM flap. An OVD was first placed over the MH before indocyanine green (ICG) staining to minimize direct dye exposure to the fovea. After ILM flap creation, gentle OVD press injection was performed to flatten and secure the inverted flap over the hole. Postoperative outcomes included best-corrected visual acuity (BCVA), macular hole closure on optical coherence tomography (OCT), and surgical complications. RESULTS: All surgeries were completed successfully using the OVD-assisted press injection technique. Anatomical closure of the macular hole was achieved in all eyes (100%). OCT demonstrated stable ILM flap coverage throughout follow-up. Mean BCVA improved significantly from 0.92 ± 0.29 log MAR preoperatively to 0.60 ± 0.29 log MAR at 3 months postoperatively (P < 0.001). No retinal detachment, MH reopening, or clinical evidence of ICG-related toxicity occurred. Intraocular pressure remained stable; transient hypotony occurred in two eyes and resolved within 1 week. CONCLUSION: OVD-assisted press injection provides reliable mechanical stabilization of the inverted flap and enables macular hole closure without the need for perfluorocarbon liquids or endotamponade. CLINICAL TRIAL NUMBER: Not applicable.
Predictors of retinal detachment and visual outcome in acute retinal necrosis: a 14-year retrospective cohort.
Tabatabaei SA, Soleimani M, Ghochani G … +14 more , Daneshvar K, Mahdizad Z, Ghasemi S, Mehrabi Bahar M, Mohammadi N, Esmaeili K, Riazi-Esfahani H, Aminizade M, Karimi M, Baharvand A, Valizadeh A, Sanchez J, Mirzaei A, Ebrahimiadib N
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42307763 · Publisher ↗
PURPOSE: To identify predictors of retinal detachment (RD) and final visual outcome in acute retinal necrosis (ARN). METHOD: This retrospective cohort study included ARN patients who were treated at a tertiary center bet...
PURPOSE: To identify predictors of retinal detachment (RD) and final visual outcome in acute retinal necrosis (ARN). METHOD: This retrospective cohort study included ARN patients who were treated at a tertiary center between 2009 and 2022. The incidence and risk factors of RD and predictors of final vision loss (< 20/200) were analyzed. RESULT: 156 ARN patients (58.3% male, mean age: 47.74 ± 15.49 years) were included in our study. RD occurred in 51 eyes (32.7%), at a median of 8.0 weeks from ARN onset. Extensive retinitis (four vs. one quadrant involvement) independently predicted RD (adjusted OR 3.45, p = 0.042). Poor final visual outcome (< 20/200) occurred in 79% of eyes. Worse baseline visual acuity was the strongest predictor of poor final vision (adjusted OR 5.58, p = 0.003). In contrast, presence of retinal hemorrhages at presentation (adjusted OR 0.185, p = 0.011) were associated with better final visual outcomes. CONCLUSION: In ARN, severe initial disease, characterized by panretinal necrosis and poor presenting acuity, predisposes to RD and profound vision loss. Most detachments occur within two months of onset, highlighting the need for vigilant early monitoring. Baseline visual acuity is a powerful prognostic indicator, whereas adjunctive treatments (prophylactic laser, intravitreal antivirals) did not independently improve outcomes. To our knowledge, this is the largest cohort of ARN patients reported from the Middle East and one of the few studies globally to incorporate time-to-event analysis and ROC-based visual prognostication. These findings provide region-specific data that refine global risk models for ARN. These findings can guide risk stratification and management decisions in ARN.
Age-related changes in the orbital pulley array of older Japanese adults with acquired exotropia.
Kono R, Hamasaki I, Kishimoto F … +3 more , Shibata K, Morisawa S, Morizane Y
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42307762 · Publisher ↗
PURPOSE: To evaluate age-related changes in the orbital pulley array using magnetic resonance imaging (MRI) in older Japanese adults with acquired exotropia (XT) compared with young healthy participants (YHP). METHODS: I...
PURPOSE: To evaluate age-related changes in the orbital pulley array using magnetic resonance imaging (MRI) in older Japanese adults with acquired exotropia (XT) compared with young healthy participants (YHP). METHODS: In this retrospective cross-sectional case series, MRI images of 30 eyes from fifteen patients (age ≥ 60 years) with distance XT and no high myopia were compared with those of 14 eyes from seven YHP. Rectus muscle (RM) pulley positions relative to the globe center were assessed. The lateral rectus muscle-superior rectus (LR-SR) band was evaluated for rupture. RESULTS: Mean age of patients with XT was 73.7 ± 5.5 years. Compared with YHP, patients with XT showed significant inferior displacement of the lateral rectus (LR) pulley (-3.6 ± 1.2 mm vs. - 2.0 ± 1.1 mm, p < 0.01) and temporal displacement of the superior rectus (SR) pulley (-0.4 ± 1.2 mm vs. - 1.6 ± 0.8 mm, p < 0.01). No significant differences were observed in medial rectus or inferior rectus pulley positions. Inferior LR pulley displacement correlated with inferior SR pulley displacement (r = 0.41, p = 0.03), whereas no significant relationship was observed between LR pulley position and MR or IR pulley position. Rupture of the LR-SR band was observed in 24 orbits (80.0%). CONCLUSION: Older Japanese adults with XT exhibit localized pulley displacement and LR-SR band rupture. These structural changes differ from the global sagging observed in sagging eye syndrome and may contribute to the pathogenesis of acquired exotropia in older adults.
Gene therapy in patients with choroideremia: a meta-analysis of clinical trials.
Redruello-Guerrero P, Ridruejo-Ortega B, González-Barros D … +7 more , Silva-Schultz S, Stalmashka T, Molinero-Sicilia L, Benites-Narcizo G, Rivera-Izquierdo M, Usategui-Martín R, Pastor-Idoate S
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42307761 · Publisher ↗
PURPOSE: To systematically review the published literature on clinical trials of gene therapy in patients with choroideremia (CHM gene mutation). METHODS: A comprehensive search was conducted in Medline, Cochrane Central...
PURPOSE: To systematically review the published literature on clinical trials of gene therapy in patients with choroideremia (CHM gene mutation). METHODS: A comprehensive search was conducted in Medline, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov up to April 2026, and was limited to studies published in English or Spanish. Clinical trials evaluating the efficacy of gene therapy in patients with a confirmed molecular diagnosis were included. Methodological quality was assessed using the Revised Cochrane Risk-of-Bias Tool for Randomised Trials and ROBINS-I. A random-effects meta-analysis was performed to compare best-corrected visual acuity (BCVA) in treated versus untreated eyes by standardised mean differences (SMD). Heterogeneity was assessed using the I² statistic and the Q test. RESULTS: Eight intervention arms from seven clinical trials (377 eyes) assessed the effects of gene therapy on BCVA, showing a small, non-significant improvement (SMD 0.34; 95% CI: -0.52 to 1.19; p = 0.38) with high heterogeneity (I²=89.6%, p < 0.01). Exploratory subgroup analyses by dose suggested differences across dose groups, but these findings should be interpreted cautiously because of the limited number of studies and high heterogeneity. Seven clinical trials (351 eyes) found no significant effect on retinal sensitivity, though lower doses showed more consistent positive trends. Three trials (276 eyes) reported no significant change in foveal thickness overall, with high variability and dose-related differences. No publication bias was detected (Egger's test: p = 0.54). CONCLUSION: Some individual studies showed significant visual improvements with gene therapy in choroideremia, but the overall pooled effect was modest and not conclusive. High heterogeneity reflects varied study designs and criteria. More rigorous, standardized trials are needed to confirm gene therapy's efficacy.
Prognostic factors for therapeutic keratoplasty in Acanthamoeba keratitis: a retrospective study.
Marques-Couto P, Ferreira AM, Gama E Castro A … +8 more , da Silva AC, Cunha AM, Cardoso PN, Monteiro T, Torrão L, Rocha-Sousa A, Pinheiro-Costa J, Vilares-Morgado R
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42301488 · Publisher ↗
PURPOSE: Acanthamoeba keratitis (AK) is a rare but vision-threatening infection that often requires prolonged medical therapy. However, a significant proportion of patients still require surgical treatment. The purpose o...
PURPOSE: Acanthamoeba keratitis (AK) is a rare but vision-threatening infection that often requires prolonged medical therapy. However, a significant proportion of patients still require surgical treatment. The purpose of this study was to identify clinical predictors for the need of therapeutic keratoplasty (TK) in patients with AK. METHODS: This was a single-center, retrospective longitudinal study including 51 eyes from 46 patients with AK diagnosed by real-time polymerase chain reaction between March 2010 and October 2022. The primary outcome was the need for TK. Eyes were divided into two groups (TK versus non-TK) and compared regarding demographic features, initial clinical presentation, and anti-Acanthamoeba treatment. Univariable and multivariable analyses were performed using generalized estimating equations (GEE) logistic regression to account for within-patient correlation (two eyes from the same subject). RESULTS: Fifty-one eyes of 46 patients (71.7% female; mean age 35.3 ± 13.9 years) were included, with a mean follow-up of 39 ± 30.2 months. All cases were associated with contact lens wear. The median time from symptom onset to diagnosis was 22 days. Fifteen eyes (29.4%) required TK. In univariable GEE analysis, older age at diagnosis (OR 1.09; 95% CI 1.03-1.16; p = 0.005) and longer symptom duration (OR 1.03; 95% CI 1.01-1.05; p = 0.011) were associated with TK. Presenting BCVA was significantly worse in eyes requiring TK than in non-TK eyes in the full cohort, but could not be reliably estimated in GEE regression because of quasi-complete separation. In the multivariable GEE model, older age at diagnosis (OR 1.09; 95% CI 1.02-1.17; p = 0.015) and longer symptom duration (OR 1.03; 95% CI 1.003-1.05; p = 0.028) remained independent predictors. CONCLUSION: In this cohort of PCR-confirmed AK, nearly one-third of eyes required TK. Older age at diagnosis and longer symptom duration were independently associated with TK, while worse presenting BCVA likely remained a clinically relevant marker of disease severity. These findings highlight the importance of early diagnosis, prompt treatment, and close monitoring of high-risk patients.
Evaluation of anti-VEGF response in diabetic macular edema patients with baseline DRIL: a multicenter real-world study (BOSPHORUS-DME Study Group Report No.16).
Karataş ME, Çakır A, Arıcı M … +20 more , Korkmaz A, Ermiş S, Hayat ŞÇ, Karapapak M, Özal E, Özal SA, Karabaş VL, Tokuç EÖ, Erdoğan M, Koçak İ, Sayın N, Öztürk M, Demir ST, Uçak T, Karataş G, Yıldız D, Demirayak B, Onur İU, Hepokur M, Özkaya A
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42287320 · Publisher ↗
PURPOSE: To evaluate the functional and anatomical outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve diabetic macular edema (DME) eyes exhibiting disorganization of t...
PURPOSE: To evaluate the functional and anatomical outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve diabetic macular edema (DME) eyes exhibiting disorganization of the retinal inner layers (DRIL) at baseline, and to examine associations between DRIL and systemic or imaging biomarkers in a large multicenter real-world cohort. METHODS: This multicenter retrospective cohort study included 221 eyes with baseline DRIL among 1321 treatment-naïve DME eyes followed at eight tertiary centers in Türkiye. All eyes initially received a bevacizumab loading dose, followed by a pro re nata (PRN) regimen with bevacizumab, aflibercept, or ranibizumab according to clinical response. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and DRIL status were assessed using spectral-domain OCT at baseline and at months 3, 6, and 12. RESULTS: Mean BCVA and CMT improved significantly at 12 months across all treatment groups (p < 0.001). In univariate analyses, eyes switched to aflibercept showed superior functional (0.58 logMAR) and anatomical (370.7 μm) outcomes compared with bevacizumab and ranibizumab (p = 0.039 and p = 0.001, respectively). However, in multivariable regression analyses adjusting for baseline characteristics and treatment intensity, anti-VEGF agent type was not independently associated with outcomes. Baseline DRIL was negatively correlated with BCVA and CMT improvement and positively correlated with systemic lipid parameters (p < 0.01). CONCLUSION: In this large real-world multicenter study, anti-VEGF therapy provided meaningful anatomical and functional improvements in DRIL-positive DME eyes. Although aflibercept appeared superior in univariate analyses, this difference was not sustained after adjustment, indicating that baseline characteristics rather than treatment selection may be the primary determinants of outcome. Unlike prior studies that focused primarily on corticosteroids, this study provides one of the largest datasets evaluating anti-VEGF efficacy in DRIL-positive eyes. Findings underscore DRIL as a strong prognostic OCT biomarker with potential to guide individualized treatment planning and optimize therapeutic outcomes in DME.
Optical coherence tomography angiography in cerebral small vessel disease: a review.
Yi H, Lian X
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42283732 · Publisher ↗
Cerebral small vessel disease (CSVD) is a progressive microvascular condition affecting the entire brain, often leading to cognitive impairment and vascular dementia. Optical coherence tomography angiography (OCTA) is an...
Cerebral small vessel disease (CSVD) is a progressive microvascular condition affecting the entire brain, often leading to cognitive impairment and vascular dementia. Optical coherence tomography angiography (OCTA) is an emerging non-invasive technique primarily used for assessing retinal vascularization, with potential applications in both ophthalmology and the diagnosis of CSVD. This review outlines the fundamental principles and applications of OCTA, discusses ongoing research on imaging characteristics of different cerebral small vessel disorders using OCTA, and consolidates the current findings in this field.The association between OCTA and different types of cerebral small vessel diseases has been initially confirmed in small-scale studies. Nevertheless, there is a need to standardize OCTA imaging and analysis techniques and validate existing results through large-sample, multicenter studies.
Axial length-based reference values for corneal sensitivity in a pediatric population.
Onal I, Aydin B, Akbas YB … +5 more , Aydin FO, Nurozler Tabakci B, Avci E, Duran Guler S, Kepez Yildiz B
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42283731 · Publisher ↗
PURPOSE: To investigate the relationship between axial length (AL) and corneal sensitivity (CS) in healthy pediatric eyes and to establish preliminary corneal sensitivity reference values across different AL groups. METH...
PURPOSE: To investigate the relationship between axial length (AL) and corneal sensitivity (CS) in healthy pediatric eyes and to establish preliminary corneal sensitivity reference values across different AL groups. METHODS: This prospective, cross-sectional study included 353 children aged 5-18 years. AL was categorized into four groups: ≤22 mm, 22.01-23.99 mm, 24.0-25.99 mm, and ≥ 26 mm. CS was assessed in five corneal quadrants (central, superior, inferior, nasal, temporal) using a Cochet-Bonnet esthesiometer. Subgroup analyses were performed according to age groups. Non-parametric statistical analyses were applied to compare sensitivity values among AL groups. RESULTS: CS differed significantly across AL groups in all measured quadrants (overall p-values: central p = 0.005; superior p = 0.009; inferior p < 0.001; nasal p < 0.001; temporal p < 0.001). In eyes with AL≥26 mm, corneal sensitivity was significantly reduced in all quadrants compared with the AL≤22 mm group (all p ≤ 0.002). However, not all pairwise comparisons reached statistical significance, particularly those involving the 22.01-23.99 mm and 24.0-25.99 mm groups. Spearman correlation demonstrated a weak negative association between AL and CS across all quadrants (r = - 0.125 to - 0.212, p = 0.019 to < 0.001). In the primary adjusted model including age, sex, and CCT, AL remained independently associated with lower corneal sensitivity across all corneal quadrants. CONCLUSION: In pediatric eyes, CS differed across AL groups and was lower in eyes with AL≥26 mm. This association remained evident after adjustment for age, sex, and CCT; however, given the uneven distribution of age-stratified subgroups, these findings should be interpreted with caution. These results provide preliminary reference data for pediatric corneal sensitivity and suggest that axial elongation may be associated with alterations in corneal sensory function.
Retinal and optic nerve measures after initiation of empagliflozin plus metformin versus metformin alone in early type 2 diabetes: a prospective observational comparative study.
Argon BD, Çakır A, Çakır SD … +3 more , Safalı F, Elçioğlu MN, Adaş M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42283730 · Publisher ↗
PURPOSE: To explore whether empagliflozin added to metformin is associated with short-term changes in optical coherence tomography (OCT) and visual evoked potential (VEP) parameters in adults with newly diagnosed early t...
PURPOSE: To explore whether empagliflozin added to metformin is associated with short-term changes in optical coherence tomography (OCT) and visual evoked potential (VEP) parameters in adults with newly diagnosed early type 2 diabetes mellitus (T2DM). METHODS: In this prospective observational comparative study, adults with newly diagnosed T2DM received metformin alone (M) or empagliflozin plus metformin (EM) according to routine clinical care. Outcomes were macular ganglion cell complex (GCC) and peripapillary retinal nerve fibre layer (RNFL) thickness measured by OCT, and pattern-reversal VEP parameters. Confounding by indication was addressed using propensity-score overlap weighting. Six-month change was analysed using baseline-adjusted overlap-weighted regression with HC3 robust standard errors. Secondary endpoints were controlled using the Benjamini-Hochberg false discovery rate. An additional exploratory repeated-measures mixed-effects analysis incorporating baseline, 3-month, and 6-month data was also performed. Only right eyes were included. RESULTS: Eighty participants were analysed (40 per group). Overlap weighting achieved excellent covariate balance (maximum weighted absolute standardized mean difference, 0.017). At 6 months, mean GCC change favoured EM over M (β = +3.33 μm; 95% CI, 2.90 to 3.76; p < 0.001). Secondary outcomes also favoured EM, including shorter VEP P100 latency (β = -10.06 ms; 95% CI, - 12.07 to - 8.05; q < 0.001) and greater VEP N75-P100 amplitude (β = +4.17 µV; 95% CI, 3.21 to 5.14; q < 0.001), with directionally consistent findings across RNFL and GCC sectoral measures. CONCLUSION: In this exploratory prospective observational study, empagliflozin added to metformin was associated with short-term OCT and VEP changes compatible with a potential neuroprotective signal in early T2DM. Findings require confirmation in longer-term randomised or robust quasi-experimental studies.
Subclinical corneal endothelial alterations in Familial Mediterranean Fever patients during clinical remission.
Sumer F, Cure O, Kizilkaya B … +1 more , Subasi S
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42274786 · Publisher ↗
PURPOSE: Although ocular involvement in Familial Mediterranean Fever (FMF) has been described, the corneal endothelium has not been systematically evaluated in these patients. This study aimed to compare corneal endothel...
PURPOSE: Although ocular involvement in Familial Mediterranean Fever (FMF) has been described, the corneal endothelium has not been systematically evaluated in these patients. This study aimed to compare corneal endothelial and anterior segment parameters between FMF patients in clinical remission and healthy controls, and to explore whether these parameters differ according to MEFV M694V genotype. METHODS: In this prospective, observational case-control study, 90 genetically confirmed FMF patients in clinical remission and 60 age- and sex-matched healthy controls were evaluated. Only the right eye of each participant was analyzed. Corneal endothelial parameters were assessed by non-contact specular microscopy, and corneal structural parameters by Scheimpflug-based tomography. Measured parameters included endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation of cell area (CV), and percentage of hexagonal cells (HEX). MEFV mutation analysis was performed by Sanger sequencing. RESULTS: Compared with controls, FMF patients showed a lower ECD (median 2154.5 vs. 2348 cells/mm, p < 0.001; approximately 8.2% lower), a higher CCT (556.5 vs. 543 μm, p < 0.001), a higher CV (42 vs. 39.5, p = 0.003), and a lower HEX (44.5% vs. 48%, p < 0.001). Intraocular pressure was modestly higher (18 vs. 15 mmHg, p < 0.001) and the iridocorneal angle was narrower (42° vs. 47°, p < 0.001) in the FMF group, with both groups remaining within normal physiological ranges. Within the FMF group, patients homozygous for M694V (n = 14) showed a higher mean CCT (540.93 ± 39.14 vs. 510.93 ± 36.21 μm, p = 0.020) and a lower median ECD (2071 vs. 2218.5 cells/mm, p = 0.006) than heterozygotes (n = 29). In an exploratory multivariable logistic regression within this subgroup, CCT and ECD were jointly associated with M694V homozygous versus heterozygous status (correct classification 69.8%). CONCLUSION: FMF patients in clinical remission show measurable differences in corneal endothelial parameters compared with healthy controls, and these differences appear more pronounced in M694V homozygous patients. Because the study is cross-sectional, it is not possible to conclude that these parameters reflect ongoing disease activity; prospective, longitudinal studies are needed to determine whether corneal endothelial assessment has a role in the ophthalmologic follow-up of patients with FMF.
Retinal and choroidal optical coherence tomography findings in gestational diabetes mellitus: a systematic review and meta-analysis.
KamaliZonouzi S, Semnani F, Mahiny D … +1 more , Arevalo JF
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270918 · Publisher ↗
PURPOSE: Gestational diabetes mellitus (GDM) may induce subtle retinal microvascular alterations even in the absence of clinical diabetic retinopathy. This study represents the first systematic review and meta-analysis t...
PURPOSE: Gestational diabetes mellitus (GDM) may induce subtle retinal microvascular alterations even in the absence of clinical diabetic retinopathy. This study represents the first systematic review and meta-analysis to comprehensively evaluate retinal and choroidal structural and microvascular alterations in women with GDM. METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science up to September 2025 identified cross-sectional studies comparing OCT or OCTA parameters between women with GDM and healthy pregnant (HP) or healthy non-pregnant (HNP) controls. Pooled standardized mean differences (SMDs) were calculated using random-effects models with Knapp-Hartung adjustment. RESULTS: Twelve studies encompassing 2,798 eyes from 1,997 women were included. Compared with HP controls, eyes with GDM exhibited a small but statistically significant reduction in mean and parafoveal superficial capillary plexus vessel density (SMD = -0.07 and - 0.13, respectively; both p < 0.05) and thinning of the inferior peripapillary retinal nerve fiber layer (SMD = -0.25; p = 0.003), all with zero heterogeneity (I² = 0%). No significant differences were observed in central macular thickness, foveal avascular zone area, deep plexus density, or subfoveal choroidal thickness. CONCLUSIONS: This systematic synthesis demonstrates that GDM is associated with early, subclinical neurovascular alterations, particularly reduced superficial capillary density and inferior retinal nerve fiber layer thinning, while overall retinal and choroidal structures remain preserved. These findings introduce OCTA as a potential sensitive biomarker for detecting early microvascular compromise in GDM and emphasize the need for longitudinal studies to determine their reversibility postpartum.
Comparative effectiveness of accelerated and standard corneal cross-linking in pediatrics: a systematic review and meta-analysis.
Al-Shammari YM, Aljassar F, Al-Shammari SM … +1 more , Alrewais AA
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270917 · Publisher ↗
PURPOSE: We aim to evaluate the efficacy and safety of accelerated corneal collagen cross-linking (CXL) compared with standard CXL in pediatric keratoconus. METHODS: We conducted comprehensive search of PubMed, Scopus, E...
PURPOSE: We aim to evaluate the efficacy and safety of accelerated corneal collagen cross-linking (CXL) compared with standard CXL in pediatric keratoconus. METHODS: We conducted comprehensive search of PubMed, Scopus, Embase and Web of Science until September 2025. Studies comparing accelerated (9 mW/cm² × 10 min or 18 mW/cm² × 5 min) with standard (3 mW/cm² × 30 min) epithelium-off CXL in patients < 18 years were included. Primary outcomes were spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and maximum keratometry (K-max). Data was pooled using a random-effects model and risk of bias was assessed with ROB-2 and NOS. RESULTS: Eight studies were included involving 571 eyes and 464 patients. No significant differences were found between accelerated and standard CXL in mean SE (MD = - 0.02, P = 0.84), UCVA (MD = - 0.06, P = 0.08) BCVA (MD = - 0.02, P = 0.47) or K-max (MD = 0.28, P = 0.72). Heterogeneity was low for SE, UCVA and BCVA but high for K-max. Sensitivity analyses confirmed robustness of results. CONCLUSIONS: Accelerated CXL provides visual and topographic outcomes equivalent to standard CXL while offering significantly shorter procedure times. These findings suggest that accelerated epithelium-off CXL may be a feasible short- to mid-term alternative in selected pediatric patients, but long-term safety and durability require further confirmation.
Lens capsular accumulation of advanced glycation end products in eyes with intraocular lens dislocation.
Komatsu K, Toma A, Masuda Y … +8 more , Iida M, Ichihara K, Iwauchi A, Kubota H, Nakazawa Y, Yamamoto N, Shimoda M, Nakano T
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270916 · Publisher ↗
PURPOSE: Late in-the-bag intraocular lens (IOL) dislocation after cataract surgery has been associated with degenerative changes of the lens capsule, but the relationship between capsular degeneration and accumulation of...
PURPOSE: Late in-the-bag intraocular lens (IOL) dislocation after cataract surgery has been associated with degenerative changes of the lens capsule, but the relationship between capsular degeneration and accumulation of advanced glycation end products (AGEs) remains unclear. We compared AGE accumulation in anterior lens capsules from eyes with IOL dislocation and cataract controls to clarify its clinicopathological significance. METHODS: This single-centre retrospective observational study included 11 eyes that underwent surgery for IOL dislocation (6 dead bag syndrome [DBS], 5 capsular bag dislocation [CBD]) and 11 eyes that underwent routine cataract surgery between 2022 and 2025. AGE immunofluorescence of excised anterior capsules was quantified as the AGE-positive area (µm). AGE-positive areas were compared between the IOL dislocation and cataract groups and between DBS and CBD. RESULTS: Patients with IOL dislocation were younger than cataract controls (53.1 ± 11.3 vs. 70.1 ± 12.1 years, p = 0.007). The AGE-positive area of the lens capsule was significantly higher in the IOL dislocation group than in the cataract group (59.7 ± 21.0 µm vs. 33.3 ± 23.9 µm, p = 0.010). Within the IOL dislocation group, DBS showed greater AGE accumulation than CBD (71.6 ± 17.3 µm vs. 45.5 ± 16.4 µm, p = 0.030). In all specimens, AGE staining was detected on the anterior-chamber side of the capsule and in residual lens epithelial cells. CONCLUSIONS: Eyes with IOL dislocation, particularly DBS, exhibited marked accumulation of AGEs in the anterior lens capsule. These findings suggest that AGE accumulation is associated with degenerative changes of the lens capsule and may contribute to superficial capsular peeling and deep intralamellar splitting in late in-the-bag IOL dislocation.
Objective structured assessment of posterior capsular rupture management.
Martin GC, Tanoubi I, Manassero A … +6 more , Aubineau A, Chapron T, Guindolet D, Huaulmé A, Jannin P, Mouriaux F
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270915 · Publisher ↗
PURPOSE: Posterior capsular rupture (PCR) management requires specific technical skills. Simulation-based training may support skill acquisition but requires validated, procedure-specific assessment tools. This study aim...
PURPOSE: Posterior capsular rupture (PCR) management requires specific technical skills. Simulation-based training may support skill acquisition but requires validated, procedure-specific assessment tools. This study aimed to develop and validate a structured scale for assessing technical performance during PCR management. METHODS: The Objective Structured Assessment of Posterior Capsular Rupture (OSA-PCR) was developed using a Delphi consensus process involving 20 cataract surgeons. Validation was subsequently conducted in a prospective simulation-based study including 12 residents and surgeons, who performed two standardized PCR scenarios on a virtual-reality simulator, separated by structured instructor-guided training. The 24 recorded performances were independently evaluated by four experts. Psychometric evaluation of the OSA-PCR included reliability, internal consistency, construct validity, and responsiveness, with correlation to simulator scores. RESULTS: The final OSA-PCR comprised 19 items, all achieving 100% consensus in the third Delphi round. Interrater reliability was excellent (ICC[2,1] = 0.95; 95% CI, 0.89-0.98; ICC[2,4] = 0.90; 95% CI, 0.77-0.96), as was intrarater reliability (ICC[3,1] = 0.98). Internal consistency was high (Cronbach α = 0.93; McDonald ω = 0.94). OSA-PCR scores showed strong correlation with EyeSi Surgical scores (r = 0.90; 95% CI, 0.77-0.96) while providing greater discrimination among lower-performing cases. Scores improved significantly after training (median 63.5 vs. 96.6; P = 0.0005) but did not differ significantly across experience levels (P = 0.71). CONCLUSION: The OSA-PCR is a valid, reliable, and responsive instrument for assessing technical performance during simulated PCR management. It enables structured, procedure-specific evaluation and may support competency-based training and assessment in cataract surgery education.
Factors impacting the assessment of geographic atrophy on ultra‑widefield fundus autofluorescence imaging.
Abbasgholizadeh R, Quarta A, Alhelaly M … +10 more , Soylu C, Habibi A, Rattu R, Au A, Corradetti G, Chung YC, Chujo S, Huang J, Ip MS, Sadda SR
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270914 · Publisher ↗
PURPOSE: To determine how often geographic atrophy (GA) lesions cannot be reliably delineated on ultrawidefield (UWF) green-light fundus autofluorescence (GAF) and to identify factors associated with poor lesion demarcat...
PURPOSE: To determine how often geographic atrophy (GA) lesions cannot be reliably delineated on ultrawidefield (UWF) green-light fundus autofluorescence (GAF) and to identify factors associated with poor lesion demarcation. METHODS: Retrospective cross-sectional study. 88 patients (138 eyes) with GA due to non-exudative age-related macular degeneration (AMD). Consecutive retina clinic subjects with GA secondary to AMD and UWF-GAF, UWF pseudocolor, and OCT imaging at the same visit were included in this study. Eyes with AMD due to other causes, evidence of exudative AMD, or images with overall poor quality were excluded. Two independent masked graders classified the UWF-GAF images as gradable (clearly delineated GA borders amenable to measurement) or ungradable (indistinct borders), and discrepancies were adjudicated by the senior investigator. Choroidal thickness (CT) was measured on central horizontal B-scan at the foveal center and at points 1.5 mm nasal and temporal to the center. MAIN OUTCOME MEASURES: Frequency of ungradable UWF-GAF images and choroidal thickness measurements at the foveal, nasal, and temporal locations. RESULTS: UWF-GAF images were deemed ungradable for GA size in 7/138 eyes (5.1%; 95% CI, 2.5-10.1). Inter-reader agreement for gradability was excellent (κ = 0.867; p < 0.001). Ungradable eyes demonstrated a markedly thinner choroid at all measurement locations including the foveal center (74.71 ± 37.04 μm vs. 177.41 ± 91.16 μm; p = 0.0002), nasal (58.14 ± 14.73 μm vs. 132.70 ± 88.28 μm ; p = 0.0013), and temporal (85.29 ± 34.54 μm vs. 177.40 ± 87.07 μm; p = 0.018) points. CONCLUSION: In retina practices that routinely obtain Optos UWF-GAF imaging, approximately 5% of GA lesions may not be measurable on UWF GAF imaging, with a very thin choroid being a common feature among such cases. Green fluorescence from the unmasked sclera is the likely explanation for this phenomenon, though such GA lesions lend themselves to reliable quantification using the companion UWF pseudocolor image. These findings have implications for the monitoring of GA lesions in clinical practice in the era of GA therapeutics.
FECD-like histopathological features of descemet's membrane in bullous keratopathy associated with primary angle closure.
Igarashi A, Nishihata S, Fujiwara K … +7 more , Shimizu T, Higashise N, Tanaka S, Yamagami S, Koizumi N, Okumura N, Hayashi T
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42270913 · Publisher ↗
PURPOSE: To investigate the histopathological features of Descemet's membrane (DM) in eyes with bullous keratopathy associated with primary angle closure (PAC), with or without a history of argon laser iridotomy. METHODS...
PURPOSE: To investigate the histopathological features of Descemet's membrane (DM) in eyes with bullous keratopathy associated with primary angle closure (PAC), with or without a history of argon laser iridotomy. METHODS: This multicenter, retrospective, observational study included eyes that underwent endothelial keratoplasty for corneal endothelial failure. Eyes with clinically diagnosed Fuchs endothelial corneal dystrophy (FECD) were excluded. DM specimens excised from eyes with PAC-associated endothelial failure were flat-mounted and examined using phase-contrast microscopy. The presence and spatial distribution of corneal guttae-like changes were evaluated and compared with those of reference specimens from FECD. RESULTS: In total, 13 eyes with PAC-associated endothelial failure were included in this study. Guttae-like changes were identified on the excised DM in 9 of the 13 eyes. Of these, four eyes exhibited an atypical peripheral-predominant distribution of guttae-like changes with relative sparing of the central DM, differing from the typical central-predominant pattern observed in FECD. Additionally, guttae-like changes identified in the affected eyes were not consistently accompanied by corresponding guttae in the fellow eyes. CONCLUSION: These findings demonstrate that excised Descemet's membranes from some eyes with endothelial failure associated with primary angle closure exhibit guttae or guttae-like changes, sometimes with an atypical distribution. These observations raise the possibility of heterogeneous underlying endothelial vulnerability and should be interpreted as hypothesis-generating.
Faricimab: current evidence for the treatment of retinal vein occlusion.
Vitiello L, Giannaccare G, Borrelli E … +8 more , Coco G, Chiosi F, Lixi F, Troisi M, Gagliardi V, D'Aniello E, Pellegrino A, Iovino C
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42265442 · Publisher ↗
PURPOSE: To provide an updated and critical overview of the available clinical evidence on the use of faricimab for the treatment of macular edema secondary to retinal vein occlusion (RVO), with particular focus on effic...
PURPOSE: To provide an updated and critical overview of the available clinical evidence on the use of faricimab for the treatment of macular edema secondary to retinal vein occlusion (RVO), with particular focus on efficacy, durability of response, and clinical applicability in both trial and real-world settings. METHODS: A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Scopus databases. Pivotal phase III randomized clinical trials and real-world studies evaluating intravitreal faricimab in patients with branch, central, or hemiretinal vein occlusion were included. Both treatment-naïve and previously treated eyes were considered. Evidence was qualitatively synthesized with attention to visual and anatomical outcomes, treatment durability, and safety. RESULTS: Data from the BALATON and COMINO phase III trials demonstrated that faricimab achieved visual and anatomical outcomes comparable to aflibercept 2.0 mg during fixed monthly dosing, with maintenance of efficacy up to 72 weeks under treat-and-extend regimens. A clinically meaningful proportion of patients achieved extended treatment intervals, suggesting potential reduction in treatment burden. Real-world studies largely confirmed consistent anatomical efficacy across different RVO subtypes and clinical scenarios. However, functional improvement was more heterogeneous, particularly in chronic or therapy-resistant cases, where anatomical and visual outcomes were frequently dissociated, likely reflecting irreversible retinal ischemia or structural damage. Across studies, faricimab showed a generally favorable safety profile. CONCLUSION: Available evidence supports faricimab as an effective and well-tolerated therapeutic option for RVO-related macular edema, especially when initiated early in the disease course. However, although extended dosing intervals were achieved in a proportion of patients, superiority in durability compared with other anti-VEGF agents has not yet been demonstrated. Further prospective, comparative, and long-term real-world studies are needed to better define patient selection criteria and the optimal positioning of faricimab within current RVO treatment algorithms.
Sub-retinal pigment epithelium features as predictors for limited interval extension of faricimab in treatment-naïve neovascular age-related macular degeneration.
Kataoka K, Watanabe Y, Kumagai M … +3 more , Ko R, Yamamoto A, Okada AA
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42262543 · Publisher ↗
PURPOSE: To explore subtypes of macular neovascularization (MNV) and anatomical features predictive for limited interval extension of faricimab injections in treatment-naïve neovascular age-related macular degeneration (...
PURPOSE: To explore subtypes of macular neovascularization (MNV) and anatomical features predictive for limited interval extension of faricimab injections in treatment-naïve neovascular age-related macular degeneration (nAMD). METHODS: This retrospective study evaluated 82 eyes of 78 patients initiating treatment with faricimab using a treat-and-extend regimen. Age and best-corrected visual acuity (BCVA) were extracted from medical records. Optical coherence tomography parameters including central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and maximum pigment epithelial detachment (PED) height were measured. RESULTS: At one year, 63 eyes (76.8%) continued faricimab treatment, while 19 eyes (23.2%) discontinued due to inability to maintain ≥ 8-week intervals. Discontinued eyes exhibited significantly greater baseline maximum PED height (P = 0.012). Eyes achieving intervals ≥ 12 weeks (extended group, n = 40) were compared with those not achieving this criterion (non-extended group, n = 42). Post hoc residual analysis revealed that type 1 MNV without polypoidal lesions was significantly overrepresented in the non-extended group (P = 0.033). Multivariable logistic regression analysis confirmed that greater baseline maximum PED height was the only independent predictor of limited interval extension (odds ratio, 0.965 per 10-µm increase; 95% confidence interval, 0.935-0.995; P = 0.021). Other baseline factors, including age, BCVA, CRT, and SFCT, showed no significant association. CONCLUSION: Sub-RPE features at baseline, specifically type 1 MNV without polypoidal lesions and greater PED height, are significant predictors of limited treatment interval extension in treatment-naïve nAMD eyes receiving faricimab. Recognizing these features prior to treatment initiation may guide clinical decision-making regarding injection frequency.
Five-year real-world outcomes and patterns of MNV-related atrophy after anti-VEGF therapy in eyes with pathologic myopia.
Sayanagi K, Shunto T, Fujimoto S … +5 more , Hara C, Fukushima Y, Sato S, Maeno T, Nishida K
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42257701 · Publisher ↗
PURPOSE: We investigated the long-term visual and structural outcomes in eyes with myopic macular neovascularization (MNV) treated with anti-vascular endothelial growth factor (VEGF) therapy and focused on developmental...
PURPOSE: We investigated the long-term visual and structural outcomes in eyes with myopic macular neovascularization (MNV) treated with anti-vascular endothelial growth factor (VEGF) therapy and focused on developmental patterns and associated factors of MNV-related atrophy. METHODS: This retrospective, observational study included 39 eyes with treatment-naïve myopic MNV who received intravitreal ranibizumab or aflibercept and were followed for at least 5 years. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT) were measured longitudinally. Color fundus photography classified the atrophy as perilesional and foveal. Factors associated with atrophy and final BCVA were analyzed. RESULTS: Over 5 years, the mean BCVA significantly improved from baseline and remained significantly better at all time points (P < 0.05); the CRT and CCT decreased significantly from baseline (P < 0.05). MNV-related atrophy developed in 59% of eyes and foveal atrophy in 38%. Three atrophic types were identified: perilesional (74%), patchy atrophy expansion (22%), and atrophy following subretinal hemorrhage (4%). Perilesional atrophy developed in older patients. Eyes with perilesional or foveal atrophy had worse baseline BCVA, thicker baseline CRT, larger greatest linear dimension, more frequent Meta-Analysis for Pathologic Myopia category 3, subfoveal MNV, and more injections than without atrophy, although none remained significant in multivariate analysis. Multivariate analysis showed foveal atrophy to be the strongest determinant of poorer BCVA. CONCLUSION: Anti-VEGF therapy was associated with favorable long-term visual outcomes in myopic MNV. However, MNV-related atrophy, particularly foveal atrophy, was associated with visual decline. The presence of multiple atrophic patterns may suggest heterogeneous underlying mechanisms.
Orbital manifestations of inflammatory bowel disease - a systematic review.
Zhang C, Ang T, Almater A … +1 more , Selva D
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42257700 · Publisher ↗
BACKGROUND: Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in 25-40% of patients; however, orbital involvement is rare and underreported. Only case reports and series have been documented in th...
BACKGROUND: Extra-intestinal manifestations of inflammatory bowel disease (IBD) occur in 25-40% of patients; however, orbital involvement is rare and underreported. Only case reports and series have been documented in the literature with no consensus on diagnosis or management. AIM: This systematic review aims to compile and analyse the published literature on orbital manifestations of IBD, focusing on clinical presentation, imaging, management and outcomes. METHODS: A systematic search of PubMed, Embase, and Web of Science was performed from database inception to April 2025. Data were collected and risk of bias was assessed using the JBI Critical Appraisal Checklist for Case Reports/Case Series. RESULTS: 41 studies reporting 48 patients were included. Mean age at orbital presentation was 31 years (range 2-63 years) with a female predominance (3:1). Orbital inflammation preceded IBD diagnosis in 19 patients. Crohn's disease was most frequently associated (n = 40). The most common clinical features were periorbital pain, swelling and ophthalmoplegia, with orbital myositis (n = 32) and dacryoadenitis (n = 15) being the predominant manifestations. 30 of 48 cases (63%) presented with bilateral disease, in contrast to the 8-20% bilateral rate typically reported for non-specific orbital inflammation (NSOI). Imaging most often demonstrated extraocular muscle enlargement. The majority of patients received systemic corticosteroids, often in combination with immunomodulators or biologics with most achieving remission. Recurrence occurred in 22 patients, and two experienced permanent vision loss. CONCLUSION: Orbital IBD is a rare but clinically significant entity, and may precede intestinal symptoms, sometimes representing the first sign of underlying IBD. Clinicians should maintain vigilance for orbital involvement in IBD, and standardised prospective reporting is needed to better characterise these manifestations and optimise patient outcomes.
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