Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
Sun
200 papers
Navigating the fragmented learning journey: early-career ophthalmologists' experiences of learning in residency.
Ong AY, Sanadgol N, Lewis F … +5 more , Solhdjou NS, Engelmann J, Keane PA, Sevgi M, Merle DA
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42257699 · Publisher ↗
PURPOSE: Early ophthalmology training requires rapid development of clinical skills in high-pressure environments. However, the disconnect between formal curricula and residents' lived experiences remains under-researche...
PURPOSE: Early ophthalmology training requires rapid development of clinical skills in high-pressure environments. However, the disconnect between formal curricula and residents' lived experiences remains under-researched. This study aims to identify modifiable educational and structural barriers, and to understand ophthalmology residents' requirements for tools to support learning and non-surgical skill acquisition. METHODS: Qualitative study involving semi-structured one-to-one interviews with 27 ophthalmology residents in the UK and Germany. Interviews explored the lived experiences of non-surgical skill acquisition during early training, as well as perceived gaps and priorities for improvement. Transcripts were analysed using reflexive thematic analysis. RESULTS: Six key themes were identified. The learning journey was felt to be fragmented, and learning needs occasionally fell secondary to clinical service demands. Experiences also varied across hospitals and regions. Essential clinical skills (e.g. fundoscopy, imaging interpretation) were frequently learned in emergency settings or busy clinic environments with limited structured supervision and feedback, and available resources for learning were described as "fragmented" and "variable in quality". Participants cited inconsistent feedback and poor work-life balance as significant sources of emotional burden. Consequently, many relied on self-organised peer networks to compensate for gaps in formal support. Participants expressed a desire for mentorship as well as a technology-enabled integrated learning environment to address some of these gaps. CONCLUSION: Careful consideration is needed to bridge the gap between formal curricula and real-world experiences, particularly as contemporary training experiences appear to rely heavily on improvisation and self-motivation rather than structured training. Formal integration of non-surgical skills training and mentorship into the clinical workflow may help reduce uncertainty and variability in training outcomes.
Effects of cataract surgery on eyes with neovascular age-related macular degeneration undergoing anti-vascular endothelial growth factor therapy under a treat-and-extend regimen.
Hosokawa MM, Ouchi C, Matoba R … +7 more , Hayashi J, Morita T, Kindo H, Masuda Y, Akatsuka R, Tsuji A, Morizane Y
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42247159 · Publisher ↗
PURPOSE: To evaluate the effects of cataract surgery on eyes with neovascular age-related macular degeneration (nAMD) undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy under a treat-and-extend (TAE)...
PURPOSE: To evaluate the effects of cataract surgery on eyes with neovascular age-related macular degeneration (nAMD) undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy under a treat-and-extend (TAE) regimen. METHODS: This retrospective observational study included eyes with nAMD receiving anti-VEGF therapy under a TAE regimen and undergoing cataract surgery, with anti-VEGF therapy continued for ≥ 6 months before and after surgery. Best-corrected visual acuity (BCVA), retinal exudation, central retinal thickness (CRT), and subfoveal choroidal thickness (SFCT) were evaluated at the preoperative baseline and at 1 and 6 months after surgery. Anti-VEGF treatment intervals at the preoperative baseline and at 6 months after surgery were compared, and the number of injections during the 6 months before and after surgery was assessed. Factors associated with treatment-interval shortening at 6 months were analyzed using multivariate logistic regression. RESULTS: A total of 85 eyes from 82 patients were included. Median BCVA significantly improved from 0.52 logMAR at baseline to 0.10 at 1 month and 0.05 at 6 months (P < 0.001 for both). At 6 months, 53 eyes (62.4%) showed improved BCVA and 32 eyes (37.6%) remained stable; no eyes demonstrated visual deterioration. The proportion of eyes with retinal exudation was 21.2% at baseline, 29.4% at 1 month, and 32.9% at 6 months, with no significant differences. CRT increased significantly at 6 months compared with baseline (P = 0.004), and SFCT increased significantly at both 1 and 6 months compared with baseline (P < 0.001 for both). Although neither the median anti-VEGF treatment interval nor the median number of injections significantly changed before and after surgery, individually, 31.8% of eyes required shorter treatment intervals and 42.4% achieved longer treatment intervals at 6 months. Greater CRT at the preoperative baseline was a significant factor associated with treatment-interval shortening. CONCLUSIONS: Cataract surgery in eyes with nAMD receiving anti-VEGF therapy under a TAE regimen appears beneficial for maintaining or improving visual acuity at 6 months despite the presence of postoperative retinal and choroidal anatomical changes. Changes in anti-VEGF treatment intervals varied among individuals, and greater preoperative CRT may serve as a useful indicator for predicting treatment-interval shortening. KEY MESSAGES: WHAT IS KNOWN : Cataract surgery in eyes with neovascular age-related macular degeneration (nAMD) treated under pro re nata (PRN) or mixedregimens has been associated with significant improvements in mean or median visual acuity; however, some individual eyes haveshown postoperative visual deterioration. The effects of cataract surgery on retinal and choroidal morphology and disease activity in nAMD remain controversial. WHAT IS NEW: In eyes with nAMD undergoing continuous anti-vascular endothelial growth factor (anti-VEGF) therapy under a treat-and-extend(TAE) regimen, cataract surgery significantly improved median visual acuity at 6 months, with no eyes showing postoperativevisual deterioration. Although central retinal thickness (CRT) and subfoveal choroidal thickness increased after surgery, these anatomical changes didnot lead to visual functional decline under continued TAE management. Changes in anti-VEGF treatment intervals varied among individuals, and greater preoperative CRT was associated with the needfor treatment-interval shortening at 6 months after cataract surgery.
Comparative efficacy and safety of tofacitinib versus adalimumab in patients with Behçet's uveitis: a real-world retrospective study.
Shu Q, Ding X, Lei B … +3 more , Gu R, Li T, Zhou M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42247158 · Publisher ↗
BACKGROUND: To conduct a comparative analysis of the efficacy and safety profiles of Tofacitinib (Tofa) and Adalimumab (ADA) in individuals diagnosed with refractory Behçet's uveitis. METHODS: A retrospective analysis wa...
BACKGROUND: To conduct a comparative analysis of the efficacy and safety profiles of Tofacitinib (Tofa) and Adalimumab (ADA) in individuals diagnosed with refractory Behçet's uveitis. METHODS: A retrospective analysis was conducted on the medical records of 64 patients who received Tofa (n = 30) or ADA (n = 34) in routine clinical practice. Treatment allocation was not randomized. The analysis focused on drug response rate, central macular thickness, ocular inflammation parameters, and best-corrected visual acuity at 3, 6, 12, and 24 months after treatment initiation. RESULTS: A total of 23 patients in the Tofa group (76.6%) and 24 patients in the ADA group (70.5%) achieved remission. Both groups exhibited improvements in mean best-corrected visual acuity (BCVA, Snellen chart, from baseline 0.33 ± 0.31 to 0.54 ± 0.27 in the ADA group, and from baseline 0.31 ± 0.27 to 0.57 ± 0.31 in the Tofa group), central macular thickness (CMT, from baseline 354.53 ± 101 μm to 199.71 ± 57 μm in the ADA group and from baseline 366.77 ± 120 μm to 203.67 ± 71 μm in the Tofa group), anterior chamber cell counts, and vitreous haze. No statistically significant differences were observed between the two groups in these overall outcomes. In an exploratory subgroup analysis, Tofa showed a lower response rate in patients with central occlusive retinal vasculitis, with 1/7 patients responding, whereas 6/8 patients responded in the ADA group (P = 0.041). CONCLUSIONS: Both ADA and Tofa demonstrated favorable efficacy in treating refractory Behçet's uveitis in this retrospective real-world study. The observed differences according to vasculitis phenotype should be interpreted cautiously and require confirmation in larger prospective studies.
Chromovitrectomy: current evidence, emerging technologies, and practical applications in vitreoretinal surgery.
Giannuzzi F, Hu L, Cusato M … +6 more , Carlà MM, Crincoli E, Maragno F, Cestrone V, De Vico U, Rizzo S
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42247157 · Publisher ↗
Chromovitrectomy has revolutionized vitreoretinal surgery by enabling the visualization of nearly transparent intraocular structures. This review evaluates the clinical utility of key vital dyes, such as brilliant blue G...
Chromovitrectomy has revolutionized vitreoretinal surgery by enabling the visualization of nearly transparent intraocular structures. This review evaluates the clinical utility of key vital dyes, such as brilliant blue G, trypan blue, indocyanine green, and triamcinolone acetonide, focusing on their physicochemical properties, staining affinities, and safety profiles. Recent advancements in dye formulation, including high-density and multi-component preparations, have improved tissue selectivity and surgical handling. These pharmacological innovations are now complemented by digital visualization technologies, such as 3D heads-up displays and customizable spectral filtering, which enhance contrast perception and ergonomics. We further discuss specialized surgical strategies for identifying occult retinal breaks and sequential staining techniques, while addressing critical concerns regarding phototoxicity and macular protection. As the field moves toward integrating intraoperative OCT and artificial intelligence, chromovitrectomy remains a dynamic cornerstone of posterior segment surgery. Understanding the synergy between novel biocompatible agents and digital platforms is essential for optimizing surgical precision and patient outcomes.
Silicone oil tamponade in vitreoretinal surgery and future perspective: a narrative review.
Mariotti C, Muzi A, Gregori G … +9 more , Gagliardi OM, Iannetta D, Mogetta V, Quarta A, Ruggeri ML, Mangoni L, Rizzo C, Mastropasqua R, Lupidi M
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42247156 · Publisher ↗
PURPOSE: Silicone oil (SO) represents an essential ocular tamponade in complex vitreoretinal surgery, due to its transparency, chemical inertness, and long-term stability. This review aims to describe the current role of...
PURPOSE: Silicone oil (SO) represents an essential ocular tamponade in complex vitreoretinal surgery, due to its transparency, chemical inertness, and long-term stability. This review aims to describe the current role of SO in vitreoretinal surgery, highlighting its indications, physicochemical characteristics, and the spectrum of associated complications. Special attention is given to the timing of removal and the balance between efficacy and safety. METHODS: We performed a narrative review of PubMed, Scopus and Google Scholar, focusing on indications, physicochemical determinants, complications and removal strategies of SO. The literature search was conducted up to January 2026. Inclusion was limited to English-language clinical and translational studies. RESULTS: Silicone oil provides a reliable long-term internal tamponade and contributes to favorable anatomical outcomes in eyes at high risk of recurrent retinal detachment. However, complications such as emulsification, ocular hypertension, corneal decompensation, cataract formation, and unexplained visual loss remain significant concerns. The risk of these adverse events increases with the duration of tamponade, underscoring the need for timely removal. Many centers plan removal around 3-6 months, tailored to retinal stability, IOP, and anterior SO migration. In selected cases with particularly severe or recurrent pathology, extended tamponade can still offer functional benefits and preserve useful vision. CONCLUSION: Silicone oil continues to play a central role in complex vitreoretinal surgery. Careful patient selection, appropriate choice of oil formulation, meticulous surgical technique, and vigilant follow-up are critical to optimizing outcomes. Future directions should focus on the development of improved SO formulations and surgical strategies to enhance safety, minimize complications, and expand therapeutic indications.
Levofloxacin/ketorolac combination versus levofloxacin alone for topically treating moderate-severe acute bacterial conjunctivitis: a randomized controlled trial.
Bandello F, Ledbedev OI, Alessio G … +17 more , Avitabile T, Castellino N, Covello G, Figus M, Lisitsyn A, Lo Giudice G, Malygin A, Nagomova Z, Nicolini N, Pioppo A, Puzo P, Romano D, Rossetti L, Yavorky AE, Ciprandi G, Seleznev A, Malyugin B
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42247155 · Publisher ↗
BACKGROUND: This study aimed to obtain the first evidence-based microbiological confirmation of the efficacy and an assessment of the local tolerability of a combination of an ocular antibiotic and a non-steroidal anti-i...
BACKGROUND: This study aimed to obtain the first evidence-based microbiological confirmation of the efficacy and an assessment of the local tolerability of a combination of an ocular antibiotic and a non-steroidal anti-inflammatory drug in treating moderate-to-severe acute bacterial conjunctivitis (ABC). METHODS: This was a phase II, randomized, parallel-group, masked-assessor, multicentre study to assess the non-inferiority of levofloxacin plus ketorolac eye drops versus levofloxacin eye drops alone in microbiological eradication (protocol number: LEVOKETO_02-2020). Treatment lasted 5 days. Non-inferiority was demonstrated if the lower bound of the two-sided 95% confidence interval (CI) of the difference was > -0.15. The study randomized 252 patients enrolled in 20 centers (Italy and Russia). The primary endpoint was the proportion of patients with microbiological eradication of levofloxacin-susceptible bacteria. Secondary endpoints included microbiological and clinical outcomes. This study is registered with EudraCT number 2020-005263-31. RESULTS: At the final visit, 100% of patients in the test arm had eradicated levofloxacin-susceptible pathogens, versus 92.59% in the control arm (difference = 0.0741; 95% CI: 0.0042-0.1439). In the Per Protocol population, the levofloxacin-ketorolac eye drops combination proved to be superior (P < 0.0001) to levofloxacin eye drops alone in bacterial eradication during treatment of ABC with moderate-to-severe signs in adults despite being administered with a simplified dosing regimen. Local tolerability was similar between arms (p = 0.7666). CONCLUSIONS: The levofloxacin-ketorolac combination was effective in bacterial eradication and well-tolerated in adults with moderate-to-severe ABC. These results suggest a possible positive levofloxacin-ketorolac interaction warranting further investigation in a phase III study.
Predictors of visual outcomes after vitrectomy for submacular hemorrhage due to polypoidal choroidal vasculopathy.
Chihara Y, Kimura S, Doi S … +6 more , Hosokawa MM, Shiode Y, Matoba R, Morita T, Akatsuka R, Morizane Y
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42240673 · Publisher ↗
PURPOSE: To evaluate visual outcomes after vitrectomy-based displacement of submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV) using swept-source optical coherence tomography (SS-OCT), and t...
PURPOSE: To evaluate visual outcomes after vitrectomy-based displacement of submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV) using swept-source optical coherence tomography (SS-OCT), and to identify preoperative factors associated with favorable postoperative best-corrected visual acuity (BCVA). METHODS: This retrospective study included 43 eyes with SMH secondary to PCV that underwent vitrectomy with subretinal tissue plasminogen activator injection and air/gas tamponade. All eyes were followed for at least 6 months. SS-OCT was used to assess continuity of external limiting membrane (ELM) and ellipsoid zone, central retinal thickness (CRT), the presence or absence of pigment epithelial detachment (PED), SMH height and diameter, and contrast-to-noise ratio, as a parameter reflecting the degree of SMH solidification. Correlation and multiple regression analyses were performed to evaluate associations between preoperative parameters and final BCVA. RESULTS: Mean SMH height decreased from 654.6 ± 307.5 μm preoperatively to 29.1 ± 73.7 μm at 1 month (P < 0.001). BCVA significantly improved from 0.97 ± 0.56 at baseline to 0.64 ± 0.51 at 1 month and 0.55 ± 0.58 at the final visit (both P ≤ 0.004). Preoperative ELM continuity, better baseline BCVA, lower SMH height, the absence of foveal PED, and lower CRT were significantly associated with a more favorable final BCVA (all P < 0.05). Multiple regression analyses identified preoperative ELM continuity and baseline BCVA as independent predictors of good final BCVA (P < 0.001, P < 0.05, respectively). CONCLUSION: In SMH secondary to PCV, vitrectomy-based SMH displacement achieved effective and sustained visual improvement. Preoperative ELM continuity and better visual acuity were strongly predictive of a favorable postoperative BCVA.
Classification of hypotony maculopathy based on optical coherence tomography findings and risk factors for visual outcomes.
Kanzaki Y, Fujiwara M, Fujiwara R … +11 more , Okamoto S, Mitsui N, Shiode Y, Hosokawa MM, Matoba R, Morita T, Hayashi J, Masuda Y, Akatsuka R, Tsuji A, Morizane Y
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42234015 · Publisher ↗
PURPOSE: To classify hypotony maculopathy (HM) using optical coherence tomography (OCT) findings and to investigate the associations among morphological types, clinical factors, and visual outcomes. METHODS: We retrospec...
PURPOSE: To classify hypotony maculopathy (HM) using optical coherence tomography (OCT) findings and to investigate the associations among morphological types, clinical factors, and visual outcomes. METHODS: We retrospectively reviewed 60 eyes that developed HM after trabeculectomy. HM was classified according to the distribution and configuration of chorioretinal undulations on OCT B-scans. Between-group comparisons were performed, and factors associated with the morphological classification and logMAR best-corrected visual acuity (BCVA) at 3 months after HM onset (3-month BCVA) were determined. RESULTS: HM was classified into three OCT-based types by categorizing chorioretinal undulations as folds (U-shaped troughs) or spikes (V-shaped troughs): Type 1, folds only on vertical scans; Type 2, folds on both vertical and horizontal scans; Type 3, folds on both scans, with spikes. Axial length in Type 3 was significantly longer than that in Type 2 (P = 0.034). Subfoveal choroidal thickness was significantly thinner in Type 3 than in Types 1 and 2 (both P < 0.001). Minimum intraocular pressure (IOP) was significantly higher in Type 1 than in Types 2 and 3 (P < 0.001 and P = 0.003, respectively), with no difference between Types 2 and 3. In multivariable analysis using Type 1 as the reference group, minimum IOP was significantly associated with Type 2 (P = 0.001). For Type 3, both minimum IOP (P = 0.03) and subfoveal choroidal thickness (P = 0.02) showed significant associations. The 3-month BCVA was significantly worse in Type 3 than in Types 1 and 2 (P < 0.001 and P = 0.007, respectively). Chorioretinal spikes and preoperative BCVA were significantly associated with 3-month BCVA (both P < 0.001). Exploratory receiver operating characteristic analysis assessed the discriminative ability of subfoveal choroidal thickness for the presence of chorioretinal spikes (AUC = 0.876). A thickness of 195.0 μm was identified as a candidate cutoff value (sensitivity 92.3% and specificity 72.3%). CONCLUSIONS: In HM following TLE, chorioretinal spikes and preoperative BCVA are significantly associated with the 3-month BCVA. In HM, a thin subfoveal choroid (< 195.0 μm), may be associated with chorioretinal spikes, suggesting the need for careful postoperative IOP and OCT monitoring.
Factors correlated to different patterns of regression of retinoblastoma defined by optical coherence tomography.
Abdel Dayem HMKMH, Abdel Aziz NAS, Ziko OAO … +2 more , Said AMA, Mohamed NS
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42223578 · Publisher ↗
PURPOSE: To investigate factors correlated to retinoblastoma regression patterns defined by optical coherence tomography (OCT). METHODS: This exploratory cross-sectional study included 33 eyes of 31 cured retinoblastoma...
PURPOSE: To investigate factors correlated to retinoblastoma regression patterns defined by optical coherence tomography (OCT). METHODS: This exploratory cross-sectional study included 33 eyes of 31 cured retinoblastoma patients having 37 regressed tumors using spectral domain OCT. Three reviewers classified OCT patterns, and inter-rater reliability was assessed using Fleiss' kappa. Associations between patterns and demographic and clinical factors were analyzed. RESULTS: Mean follow-up was 117.2 (± 57.3) months. Inter-rater agreement for pattern assignment was substantial (κ = 0.774). Pattern B was most common (45.9%; 95% CI, 29.4%-63.1%), followed by pattern A (29.7%; 95% CI,15.8%-46.9%) and C (24.3%; 95% CI,11.7%-41.2%). Age was significantly associated with OCT pattern distribution. In patients ≤ 10 years, pattern B predominated (70%), in those > 10 years, pattern A was most frequent (47.1%), then pattern C (35.3%). Pattern C showed greater posterior tumor margin-disc distance than patterns A and B. Initial tumor height differed significantly across patterns, with pattern B showing greater height than pattern C. OCT patterns were significantly associated with clinical regression types. Type I regression predominantly showed pattern B (81.8%) and less frequently pattern A (18.2%). Type II showed equal distribution between patterns A and B. Type III corresponded exclusively to pattern B. Type IV was distributed across patterns A (36.4%), B (22.7%), and C (40.9%). All pattern C tumors were observed with type IV regression. No significant associations were observed with gender, laterality, tumor base diameter, treatment intensity, regression size, or follow-up duration. CONCLUSION: Tumor anteroposterior location and initial height showed associations with OCT regression patterns.
Lens power and associated factors affect ocular response to highly aspherical lenslets (HAL) in myopic children.
Gao M, Li S, Wang W … +3 more , Wu B, Zhang Y, Xiong F
Graefes Arch Clin Exp Ophthalmol · 2026 Jun · PMID 42223577 · Publisher ↗
PURPOSE: To characterize associations between ocular biometrics and lens power (LP), identify nonlinear inflection points, and evaluate their role in modulating the myopia control efficacy of highly aspherical lenslets (...
PURPOSE: To characterize associations between ocular biometrics and lens power (LP), identify nonlinear inflection points, and evaluate their role in modulating the myopia control efficacy of highly aspherical lenslets (HAL). METHODS: This retrospective study included two cohorts. The cross-sectional cohort (n = 559, mild-to-moderate myopia) was analyzed using Pearson/Spearman correlation and Generalized Additive Mixed Models (GAMMs) to explore associations and nonlinear relationships.The 12-month HAL follow-up cohort (n = 62 children) was evaluated using repeated-measures ANOVA and ANCOVA. Subgroup analyses stratified by myopia progression speed (based on annual spherical equivalent (SE) change and axial length (AL) growth) were performed using chi-square and Mann-Whitney U tests. RESULTS: GAMMs identified critical inflection points: AL = 24.0 mm, AL/CR = 3.15, and lens thickness (LT) = 3.3 mm. LP decreased more rapidly in subgroups with AL ≤ 24 mm, AL/CR < 3.15, or LT > 3.3 mm(P < 0.05). HAL wearers with AL ≤ 24 mm, AL/CR < 3.15, or LT > 3.3 mm showed faster LP reduction. The slow-progression group exhibited significantly greater annual LP reduction than the rapid-progression group (-0.28 ± 0.44 D vs. -0.03 ± 0.42 D, P = 0.02). Stage-specific analysis showed HAL's strongest regulatory effect on SE and LP occurred during the 3-6 month interval. CONCLUSIONS: We identified nonlinear relationships and critical inflection points between ocular biometrics (AL = 24.0 mm, AL/CR = 3.15, LT = 3.3 mm) and LP. Gender was significantly associated with LP, and AL/CR was superior to AL alone for evaluating lens compensation. AL > 24 mm and AL/CR ≥ 3.15 indicate exhausted lens compensation and rapid myopia progression. HAL provides effective myopia control, and these inflection-based thresholds enable clinical risk stratification and personalized intervention with improved precision and efficacy.
Twelve-month outcomes after open bleb revision for Preserflo microshunt bleb failure in refractory glaucoma patients.
Darmon J, Bastelica P, Huard M … +10 more , Lagrené K, Blumen-Ohana E, Brasnu E, Rousseau A, Hamard P, Nordmann JP, Brouk Z, Buffault J, Baudouin C, Labbé A
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42213135 · Publisher ↗
PURPOSE: To evaluate the 12-month efficacy and safety of open bleb revision (OBR) for Preserflo MicroShunt (PMS) (Santen, Osaka, Japan) bleb failure. PATIENTS AND METHODS: All consecutive patients who underwent PMS OBR f...
PURPOSE: To evaluate the 12-month efficacy and safety of open bleb revision (OBR) for Preserflo MicroShunt (PMS) (Santen, Osaka, Japan) bleb failure. PATIENTS AND METHODS: All consecutive patients who underwent PMS OBR for primary bleb failure between April 2019 and July 2024 at the Hôpital National des Quinze-Vingts (Paris, France) were retrospectively included. The primary endpoint was assessed at 6 and 12 months as surgical success, defined as an intraocular pressure (IOP) ≤ 21 mmHg with a ≥ 20% reduction in IOP using the same or fewer hypotensive treatments, with no additional glaucoma surgery, no chronic hypotony, and no loss of light perception. All complications during follow-up were analyzed. RESULTS: A total of 87 patients who underwent PMS OBR for primary bleb failure were evaluated. Most patients presented with severe, refractory, glaucoma, as the mean number of glaucoma surgical procedures prior to the first PMS implant was 1.9 ± 1.4. 97% of patients had previously undergone major bleb-forming glaucoma surgery. The mean preoperative IOP was 30.2 mmHg with 1.8 ± 1.5 hypotensive treatments. OBR was performed after a median interval of 157 days. Success rate was 40.7% at 6 months, and dropped to 20.9% at 12 months. The mean IOP decreased to 20.2 ± 7.6 mmHg at 12 months, representing a significant decrease of 9.8 ± 9.3 mmHg (33%), with 1.7 ± 1.5 hypotensive treatments (p = 0.82). Transient postoperative hypotony was observed in 3 patients (3.5%). No serious complications were reported during follow-up, in particular no chronic hypotony. CONCLUSION: Following OBR for PMS bleb failure, approximately 40% of patients achieved surgical success at 6 months, compared with 20% at 12 months. However, a significant reduction in intraocular pressure was maintained at 12 months, without a statistically significant reduction in medication burden.
Clinical course of non-exudative macular neovascularisations in sustained unilateral neovascular age-related macular degeneration.
Cinque F, Brink SCAT, Shahabi M … +5 more , de Breuk A, Heesterbeek TJ, Klaver CCW, Hoyng CB, Lechanteur YTE
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42213134 · Publisher ↗
PURPOSE: To assess the risk of conversion of non-exudative macular neovascularisations (NEMNV) in relation to disease history in sustained unilateral neovascular age-related macular degeneration (AMD). METHODS: This expl...
PURPOSE: To assess the risk of conversion of non-exudative macular neovascularisations (NEMNV) in relation to disease history in sustained unilateral neovascular age-related macular degeneration (AMD). METHODS: This exploratory case-only cohort study included six-monthly visits. Fellow-eye NEMNV were identified using fluorescein and indocyanine green angiography. Patients were stratified by time since first-eye exudation: < 5 years (G1) or ≥ 5 years (G2). The primary outcome was the cumulative annual conversion rate of NEMNV, expressed as conversion rate ratios (CRR) with 95% confidence intervals (CI). Secondary outcomes were independent grading of foveal involvement, core vessel, central core vessel, round shape, sharp borders, and lesion growth. RESULTS: A total of 134 patients (65.7% female) were included. Mean age at baseline was 74.2 years (SD 8.0). Median time since first-eye exudation was 2.9 years (IQR 1.0-6.3). Patients in G2 had an earlier age at first-eye exudation (66.0 [9.1] years) than G1 (72.7 [7.8]; P < .001). Seven NEMNV lesions were identified (G1:2, G2:5). Cumulative conversion rates were 22.1% overall, 14.3% in G1, and 27.1% in G2. CRR were 2.3 (95% CI 0.6-6.2), 1.3 (95% CI 0.0 - 7.8), and 4.0 (95% CI 0.7 - 16.8). All but one NEMNV showed growth. CONCLUSION: In this limited sample, most NEMNV show growth time regardless of conversion to exudative AMD and appear at a higher risk of conversion. The rate of conversion varies with the age of onset of first-eye exudation. Evaluating potential predictive signs of conversion may benefit from incorporating disease history with vascular features.
Endophthalmitis rates following intravitreal injection of aflibercept using a prefilled syringe - a multicenter study.
David D, Zur D, Biran A … +13 more , Braudo S, Brosh K, Moisseiev E, Shulman S, Barak Y, Ehrlich R, Fried S, Peled A, Hauser D, Jaouni T, Pras E, Hayat H, Katz G
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42213133 · Publisher ↗
PURPOSE: To evaluate endophthalmitis rates following intravitreal injection of aflibercept, comparing between vial preparation and prefilled syringe use. METHODS: We retrospectively collected data from ten ophthalmology...
PURPOSE: To evaluate endophthalmitis rates following intravitreal injection of aflibercept, comparing between vial preparation and prefilled syringe use. METHODS: We retrospectively collected data from ten ophthalmology departments in Israel. The number of intravitreal anti-VEGF injections administered in years 2022 and 2023 was recorded. Endophthalmitis rates in 2022 (vial use) and in 2023 (prefilled syringe use) were compared. Clinical details of endophthalmitis cases were reviewed. RESULTS: In 2022, out of 119,904 intravitreal injections, 31,991 (27%) were aflibercept injections prepared from vials. In 2023, out of 128,306 intravitreal injections, 35,589 (28%) were aflibercept injections from prefilled syringes. Endophthalmitis rates were similar between vial preparation (1:1991) and prefilled syringe (1:2372) (p = 0.63). Notably, aflibercept injections exhibited significantly higher endophthalmitis rates compared to bevacizumab and ranibizumab combined, in both years (1:1999 vs. 1:5494 in 2022, and 1:2373 vs. 1:7132 in 2023, respectively; p < 0.01 for both). CONCLUSION: Despite the transit to prefilled aflibercept syringes, endophthalmitis rates following aflibercept injection did not decrease. Post-injection endophthalmitis rates were significantly higher with aflibercept compared to bevacizumab and ranibizumab, with both vial and prefilled syringe.
First-in-human implantation of a self-adjustable glaucoma drainage device (eyeValve): safety and performance in blind eyes.
Rafiei S, Gerber JM, Bigler S … +6 more , Villamarin A, Stergiopulos C, Ndoye C, Ngom EM, Mermoud A, Stergiopulos N
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42213132 · Publisher ↗
PURPOSE: To evaluate the implantability, safety, and intraocular pressure (IOP)-regulating performance of a novel miniaturized passive self-adjustable glaucoma drainage device (eyeValve) in a first-in-human (FIH) feasibi...
PURPOSE: To evaluate the implantability, safety, and intraocular pressure (IOP)-regulating performance of a novel miniaturized passive self-adjustable glaucoma drainage device (eyeValve) in a first-in-human (FIH) feasibility study. METHODS: Prospective single-arm pilot study in six blind eyes with end-stage glaucoma and uncontrolled IOP. The eyeValve was implanted in a partial-thickness intrascleral pocket and connected to a distal silicone plate (eyePlate) for orbital drainage. No mitomycin C was used. Follow-up was performed at Day 1, Day 7, Day 28, Day 120, and Month 9. Eyes with transient iris-related tube occlusion were analyzed separately. RESULTS: Implantation was successful in all eyes. Mean IOP decreased from 30.1 ± 10.6 mmHg to 15.0 ± 7.4 mmHg (Day 1), 12.0 ± 2.0 mmHg (Day 7), 14.8 ± 2.1 mmHg (Day 28), 12.3 ± 2.5 mmHg (Day 120), and 14.3 ± 1.7 mmHg (Month 9), corresponding to an overall reduction of ~ 53%. IOP remained within the physiological range (6-18 mmHg). No hypotony, overdrainage, or sustained postoperative IOP elevation suggestive of bleb encapsulation was observed. Two eyes showed transient iris-related tube occlusion. Among eyes not affected by iris-related tube obstruction, 50% maintained IOP control without glaucoma medication during follow-up. CONCLUSIONS: The eyeValve demonstrated feasibility, safety, and sustained IOP control up to 9 months without hypotony or hypertensive-phase behavior, supporting autonomous pressure regulation. Larger studies are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07480603 (retrospectively registered on 17.03.2026).
Who safeguards science? - The crisis of information overload and research quality.
Sakamoto T, Sadda SR, Joussen A
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42207291 · Publisher ↗
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Semaglutide and risk of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) in type 2 diabetes mellitus: A systematic review and meta-analysis.
Lampsas S, Agapitou C, Oikonomou E … +5 more , Siasos G, Theodossiadis P, Tsivgoulis G, Lambadiari V, Chatziralli I
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42201355 · Publisher ↗
BACKGROUND: The use of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) has expanded dramatically worldwide, with semaglutide being one of the most widely utilized agents. Nonarteritic anterior ischemic optic neuropa...
BACKGROUND: The use of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) has expanded dramatically worldwide, with semaglutide being one of the most widely utilized agents. Nonarteritic anterior ischemic optic neuropathy (NAION) has been associated with GLP-1RAs use from emerging pharmacovigilance data. This systematic review and meta-analysis sought to evaluate the risk of NAION in patients with type 2 diabetes mellitus (T2DM). METHODS: A literature search was made up to September 2025 (PROSPERO: CRD420251155026). Results were synthesized following the PRISMA guidelines and are presented as pooled Hazard Ratios (HR) with 95% confidence intervals (CI). RESULTS: Twelve studies were included; eight retrospective cohorts (14,255,247 participants) were meta-analyzed, with a mean age of 59.3 ± 15.9 years and 32.7% males. Patients with T2DM using semaglutide compared to non-GLP-1RAs showed an increased risk of NAION at 1-year follow-up with a pooled HR of 3.36 (95% CI: 1.44-7.84; p < 0.001; I = 97%). At 2-year follow-up, the pooled HR was 2.37 (95% CI: 1.46-3.85; p < 0.001; I² = 0%). The 3-year risk after the sensitivity analysis showed a pooled HR of 2.37 (95% CI: 1.45-3.87, p < 0.001; I² = 28%), and the 5-year pooled HR was 2.37 (95% CI: 0.62-3.92; p < 0.001; I² = 0%). CONCLUSION: This meta-analysis indicates a significant association between semaglutide use and NAION in patients with T2DM compared to non-GLP-1RAs, with this association remaining significant even after 5-years of semaglutide use.
Canaloplasty via an ab-interno approach in primary open-angle glaucoma: Results from a large case series.
Khaimi MA
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42189209 · Publisher ↗
PURPOSE: To evaluate the effectiveness and safety of ab-interno canaloplasty using the iTrack microcatheter in patients with primary open-angle glaucoma (POAG). METHODS: This retrospective, single-center case series incl...
PURPOSE: To evaluate the effectiveness and safety of ab-interno canaloplasty using the iTrack microcatheter in patients with primary open-angle glaucoma (POAG). METHODS: This retrospective, single-center case series included eyes with POAG treated with iTrack ab-interno canaloplasty (Nova Eye Medical, USA), performed either as a standalone procedure or combined with phacoemulsification, with a minimum follow-up of 12 months. Primary outcomes were changes in IOP and number of glaucoma medications. Secondary outcomes included visual acuity (VA), visual field (VF) mean deviation (MD), complications, need for additional glaucoma surgery, and surgical success (as defined by American Academy of Ophthalmology [AAO] criteria). Subgroup analyses were conducted based on disease severity, baseline IOP (≤ 18 mmHg vs. > 18 mmHg), and preoperative medication use (0-4). RESULTS: Both standalone (n = 167) and combined (n = 364) procedures achieved significant reductions in IOP and medication use (p < 0.001). At the last follow-up (mean: 20.4 ± 7.7 months), mean IOP was reduced by 3.29 ± 6.0 mmHg in the combined group (from 17.5 ± 5.8 to 14.2 ± 3.8 mmHg) and by 4.50 ± 6.1 mmHg in the standalone group (from 20.2 ± 6.0 to 15.7 ± 4.3 mmHg), with the standalone group showing a significantly greater absolute IOP reduction (p = 0.025). Medication burden was reduced by 1.05 ± 1.06 medications in the combined group and by 0.84 ± 1.15 in the standalone group (p = 0.032). Subgroup analyses confirmed significant IOP and/or medication reductions across all strata, with greater relative benefits in eyes with uncontrolled baseline IOP (> 18 mmHg). Surgical success was 64% in combined and 47% in standalone procedures; success was 75% and 46% in eyes with uncontrolled and controlled baseline IOP. Intraoperative complications were infrequent (1.6%), and 13.1% of eyes required additional glaucoma surgery during follow-up. CONCLUSIONS: Ab-interno canaloplasty using the iTrack microcatheter, whether as a standalone procedure or combined with phacoemulsification, resulted in sustained reductions in IOP and medication use, with a low rate of complications. These outcomes were consistent across varying levels of disease severity and baseline IOP, with the most pronounced benefits observed in eyes with elevated preoperative IOP.
Loss of DNA-PK complex in recurrent pterygium suggests a role for defective double-strand break repair.
Lupacchini L, Marenco M, Rosina M … +5 more , Mallone F, Mollinari C, Pernazza A, Lambiase A, Merlo D
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42189208 · Publisher ↗
PURPOSE: Pterygium is a common ocular surface disorder strongly associated with ultraviolet (UV) radiation exposure and oxidative stress. Double-strand breaks (DSBs) are among the most deleterious forms of DNA damage, an...
PURPOSE: Pterygium is a common ocular surface disorder strongly associated with ultraviolet (UV) radiation exposure and oxidative stress. Double-strand breaks (DSBs) are among the most deleterious forms of DNA damage, and their repair mainly relies on the non-homologous end joining (NHEJ) pathway, in which the DNA-dependent protein kinase (DNA-PK) complex plays a central role. This study investigated the expression of the DNA-PK complex components-DNA-PKcs, Ku70, and Ku86-in pterygium compared with healthy conjunctiva. METHODS: Conjunctival tissues were obtained from six patients undergoing surgical excision of recurrent pterygium and 6 age- and sex-matched controls undergoing ocular surgery without surface disease. Protein and transcript expression of DNA-PKcs, Ku70, and Ku86 were assessed by immunofluorescence, Western blotting, and real-time PCR. RESULTS: Immunofluorescence revealed markedly reduced DNA-PKcs immunoreactivity in the epithelium of pterygium conjunctiva compared with marked staining in controls. Western blot analysis demonstrated a significant decrease of DNA-PKcs protein, paralleled by a ~ 13-fold reduction of its mRNA. Similarly, Ku70 and Ku86 protein levels were dramatically reduced (by ~ 93.5% and ~ 92.0%, respectively) in pterygium compared with controls. CONCLUSIONS: This study provides the first evidence of profound down-regulation of the DNA-PK complex in pterygium. The loss of DNA-PKcs and its regulatory subunits Ku70 and Ku86 suggests impaired DSB repair capacity, potentially driven by chronic UV-induced oxidative stress. These alterations may contribute to pterygium pathogenesis and recurrence, highlighting DNA-PK complex proteins as potential biomarkers of disease susceptibility and progression.
Baseline OCT biomarkers associated with visual prognosis in cystoid macular edema secondary to noninfectious uveitis.
Bodur MF, Koçak N, Eser-Ozturk H … +1 more , Sullu Y
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42183910 · Publisher ↗
PURPOSE: To evaluate the relationship between baseline optical coherence tomography (OCT) biomarkers and both baseline and post-treatment best-corrected visual acuity (BCVA) in eyes with cystoid macular edema (CME) secon...
PURPOSE: To evaluate the relationship between baseline optical coherence tomography (OCT) biomarkers and both baseline and post-treatment best-corrected visual acuity (BCVA) in eyes with cystoid macular edema (CME) secondary to noninfectious uveitis. METHODS: This retrospective study included 84 eyes from 66 patients with uveitic CME showing anatomical resolution after treatment. Baseline OCT parameters, including central foveal thickness (CFT), subretinal fluid (SRF) height, total intraretinal cyst (IRC) volume, hyperreflective foci (HRF) count, and integrity of the ellipsoid zone (EZ), external limiting membrane (ELM), and disorganization of retinal inner layers (DRIL), were analyzed. Univariate and multivariate linear regression analyses were used to identify predictors of baseline and final BCVA. RESULTS: In univariate analysis, baseline BCVA was significantly associated with CFT (p < 0.001), DRIL presence (p = 0.021), and SRF height (p = 0.002). In multivariate analysis, CFT (p = 0.038) and SRF height (p = 0.049) remained independent predictors. For final BCVA, univariate associations were found with EZ (p = 0.007) and ELM disruption (p = 0.007), total IRC volume (p = 0.010), and baseline CFT (p < 0.001), whereas only baseline CFT (p = 0.006) persisted as an independent predictor. CONCLUSION: Increased baseline CFT was significantly associated with poorer visual acuity both at baseline and after treatment, emerging as the strongest independent predictor of visual outcome. In univariate analysis, SRF height, EZ and ELM disruption, DRIL presence, and higher total IRC volume showed associations with BCVA; however, these relationships were not retained in the multivariate model and therefore were not independent predictors after adjusting for covariates.
Repeatability of corneal diameter measured by Sirius versus IOLMaster 700 in myopic eyes: combined with consistency and relationship of sulcus-to-sulcus.
Xu X, Yu P, Wu S … +3 more , Wang L, Li Q, Peng D
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42176225 · Publisher ↗
PURPOSE: To assess the repeatability of measuring the corneal diameter (white-to-white, WTW) using Sirius and IOLMaster 700 in myopic eyes, to evaluate their consistency and relationship with sulcus-to-sulcus (STS) and a...
PURPOSE: To assess the repeatability of measuring the corneal diameter (white-to-white, WTW) using Sirius and IOLMaster 700 in myopic eyes, to evaluate their consistency and relationship with sulcus-to-sulcus (STS) and angle-to-angle (ATA). METHODS: This retrospective study enrolled 58 volunteers with myopia (116 eyes). Each subject was evaluated using Sirius, IOLMaster 700 and ultrasound biomicroscope (UBM) for parameters which included WTW, STS, and ATA. STS referred to horizontal STS (STS) and vertical STS (STS), ATA contained horizontal ATA (ATA) and vertical ATA (ATA). The intra-device and intra-operator repeatability was assessed using the within-subject SD (Sw), precision, intrasession test-retest variability (repeatability), coefficient of variation (CoV), intraclass correlation coefficient (ICC) and Cronbach's coefficient Alpha (CoA). Bland-Altman plots were used to analyze the agreement between WTW and STS/ATA at different meridians. The correlation among ocular parameters was assessed by Spearman correlation analysis. The ocular parameters with normal distribution were used to analyze the multiple linear regressions of STS at different meridians. Curve fitting was used to analyze the relationship between STS and WTW at different meridians, separately. Akaike information criterion (AIC), Bayesian information criterion (BIC) and adjusted coefficient of determination (adjusted R) were used to assess Goodness of fit (GOF). RESULTS: Three repeated measurements of WTW by Sirius and IOLMaster 700 showed no statistically significant discrepancies between the data (F = 0.306; 2.469, P > 0.05), and the difference between the data of paired t-tests of the mean values of WTW measured by each instrument was statistically significant (t= -2.894, P < 0.01). The Sw, precision, repeatability, CoV, ICC, CoA values for WTW measured by Sirius and IOLMaster 700 were (0.027, 0.054, 0.076, 0.232%, 0.981, 0.993) and (0.079, 0.155, 0.219, 0.666%, 0.980, 0.993), respectively. This trial demonstrated by Bland-Altman plots that the 95% LoA (Limits of agreement) for concordance between WTW measured by Sirius (WTW), WTW measured by IOLMaster 700 (WTW), STS, STS, ATA and ATA were beyond clinically acceptable limits. WTW and WTW had a moderate negative correlation with Kf (r=-0.39;-0.45, P<0.01) and Ks (r=-0.38;-0.39, P<0.01). Inversely, WTW and WTW had a weak to moderate positive correlation with ACD(r = 0.33, P<0.01; r = 0.20, P<0.05), AL(r = 0.25; 0.35, P<0.01), STS(P<0.01) and ATA(P<0.01) at different meridians, WTW had a high positive correlation with WTW (r = 0.76, P<0.01). Similarly ATA had a high positive correlation with ATA (r = 0.76, P<0.01). Through multiple linear regression analysis, the prediction equation of STS was STS7.098- 0.357xSE+0.281xACD-0.201 xKf+0.307xWTW, the prediction equation of STS was STS7.710-0.289xIOP-0.336xSE+0.359xACD-0.203xKf+0.263xWTW, the Adj. R were 0.391 and 0.423, respectively. The linear equation between STS and STS was STS2.765+0.804xSTS, and the Adj. R was 0.486. The curve fitting suggested that the optimal curve model between WTW and STS was Logistic (AIC=-161.622, BIC=-148.399 and Adj. R=0.226), the optimal curve model between WTW and STS was also Logistic (AIC=-153.969, BIC=-140.747 and Adj. R=0.174), the curve fit between WTW and STS was poor, the optimal curve model between STS and STS was Extreme (AIC=-180.337, BIC=-167.115 and Adj. R=0.501). CONCLUSION: The repeatability of WTW measured by Sirius and IOLMaster 700 was satisfactory. The WTW measured by IOLMaster 700 was bigger than the WTW measured by Sirius. The parameters of WTW, WTW, STS, STS, ATA and ATA were inconsistent with each other, they were not clinically interchangeable. Using WTW and WTW to predict STS may be more appropriate for categorical studies. It was recommended to use vertical corneal diameter to study STS.
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