Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
Sun
200 papers
Bibliometric analysis and data visualization on drug delivery systems for infectious keratitis.
Ouyang S, Yang G, Yang Y … +3 more , Yang Y, Liu H, Deng Z
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42171727 · Publisher ↗
PURPOSE: This study aimed to conduct a bibliometric analysis of the research literature on drug delivery systems (DDS) for infectious keratitis from 2006 to 2025, presenting research trends, current hotspots, and collabo...
PURPOSE: This study aimed to conduct a bibliometric analysis of the research literature on drug delivery systems (DDS) for infectious keratitis from 2006 to 2025, presenting research trends, current hotspots, and collaboration patterns through visual maps. METHODS: A systematic retrieval strategy was established to search and extract data from the Web of Science Core Collection database for studies on therapeutic DDS for keratitis between January 1, 2006, and December 31, 2025. GraphPad Prism, CiteSpace, AND VOSviewer were used to perform visualization analysis and evaluate the trends. RESULTS: (1) Over the 20-year period from 2006 to 2025, the number of publications and citations on DDS for infectious keratitis has continued to increase, rising from an initial annual output of less than 10 to over 50 papers in recent years. (2) A total of 60 countries and regions worldwide participated in these publications, with China ranking first with a total of 137 papers. Cairo University emerged as the most productive institution, with 29 papers. Soumyajit Majumdar contributed the most, with 11 papers in total. In terms of academic impact, China had the highest total citation count( 3,169), whereas the USA showed the highest betweenness centrality. (3) The"International Journal of Pharmaceutics" was the leading journal in this field, with the highest number of co-citations (360). (4) Co-occurrence and clustering analysis of high-frequency keywords revealed several major themes centered on drug delivery, nanoparticles, fungal keratitis, drug formulation, and sustained release. High-frequency keyword and clustering analyses highlighted sustained interest in nanoparticles, hydrogels, liposomes, in situ gels and 3D printing related delivery strategies. CONCLUSION: This bibliometric study covers two decades of research on the development and application of advanced DDS in the treatment of infectious keratitis. The field has attracted increasing global research attention, with China leading in publication output and the USA exerting greater academic influence. The current focus has shifted from traditional formulations to smart nanocarrier strategies. To achieve success, interdisciplinary collaboration is required to overcome the challenges of safety, production scalability, and clinical translation.
AI-driven multimodal retinal imaging for early detection and risk stratification of vascular and neurodegenerative diseases.
Agrawal L, Agrawal PK, Agrawal SS … +4 more , Sonune MS, Kadu RK, Kulkarni MB, Bhaiyya M
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42171726 · Publisher ↗
Systemic vascular and neurodegenerative disorders are important causes of disability and death worldwide, mainly because of the late stage of diagnosis and the high cost of current screening tools. Artificial intelligenc...
Systemic vascular and neurodegenerative disorders are important causes of disability and death worldwide, mainly because of the late stage of diagnosis and the high cost of current screening tools. Artificial intelligence (AI) and multimodal retinal imaging offer a non-invasive and viable approach for early risk stratification and longitudinal monitoring. This review highlights how changes in the retinal vasculature and nerve layers are markers of underlying pathophysiologies related to cardiovascular, metabolic, and neurological disorders. It gives an account of the critical retinal imaging modalities, such as fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and more recently developed metabolic-sensitive imaging modalities, and how current AI approaches, such as deep learning, self-supervised learning, and multimodal fusion, can be leveraged for better risk stratification and decision support. Evidence from hypertension, stroke, coronary artery disease, diabetic complications, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and cognitive impairment shows the potential for the retina to serve as a scalable biomarker for systemic health. However, there are still hurdles to be cleared, such as multicenter validation, prospective clinical trials, data fusion, and regulatory frameworks. In conclusion, AI-assisted retinal analysis may make way for early screening, better prevention, and more accessible precision healthcare.
Synthetic data-driven diabetic retinopathy diagnosis with explainable AI: a clinically interpretable framework.
Vasireddi HK, Gedela RT, Dasari SK … +1 more , Devarapalli RK
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42171725 · Publisher ↗
PURPOSE: Diabetic Retinopathy (DR), a serious complication of Diabetes and leading cause of blindness, demands accurate and early diagnosis. Current diagnostic challenges results from two major limitations: (i) lack of e...
PURPOSE: Diabetic Retinopathy (DR), a serious complication of Diabetes and leading cause of blindness, demands accurate and early diagnosis. Current diagnostic challenges results from two major limitations: (i) lack of expertly annotated clinical datasets due to privacy and cost factors, and (ii) the nature of deep learning models that limits clinical adoption. This study presents a novel solution combining synthetic data generation with explainable machine learning approach to overcome these challenges. METHODS: In the proposed work, synthetic retinal fundus images were generated to simulate the Diabetic Retinopathy (DR) severity grading, enabling the generation of a balanced dataset with 1200 instances. Handcrafted features were retrieved using a pre-processing pipeline consisting of (Hue Saturation Value) HSV color space transformation, GLCM (Gray Level Co-occurrence Matrix) based texture analysis, and lesion specific quantification, ensuring clinically relevant feature representation. A Random Forest (RF) classifier optimized with Out of Bag (OOB) validation is implemented for DR severity grading. Shapley Additive Explanations (SHAP) based Explainability is integrated alongside the classifier to include interpretations of feature importance and decision making patterns. RESULTS: The proposed framework achieved an accuracy of 94% on synthetic data, outperforming several established deep learning models such as ResNet-50, VGG16 + DenseNet, EfficientNet-B0. Swarm plot analyses revealed that predictions were consistently aligned with better confidence values, and SHAP explanations highlighted the clinically interpretable features such as exudates, validating the reliability of the classifier. CONCLUSION: Incorporating the synthetic data with ground truth data through domain adaptation techniques could reduce the performance gaps and improve the transferability in clinical settings.
Sonography versus anterior segment OCT for imaging bleb morphology after glaucoma drainage device surgery.
Schipper P, Aretz B, Bourauel L … +6 more , Deubel C, Petrak M, Holz FG, Liegl R, Mercieca K, Liegl C
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42159690 · Publisher ↗
PURPOSE: The PAUL Glaucoma Implant (PGI) is increasingly used in the surgical management of complex glaucoma, but detailed evaluation of its subconjunctival bleb morphology remains challenging due to its posterior locati...
PURPOSE: The PAUL Glaucoma Implant (PGI) is increasingly used in the surgical management of complex glaucoma, but detailed evaluation of its subconjunctival bleb morphology remains challenging due to its posterior location. While ultrasonography has long been used for bleb imaging, anterior segment optical coherence tomography (AS-OCT) offers higher-resolution imaging of anterior structures. This study aimed to directly compare ultrasonography and AS-OCT in assessing bleb morphology following PGI implantation. METHODS: In this prospective observational study, 20 patients (21 eyes) with PGI underwent postoperative assessment with both AS-OCT and B-scan ultrasonography. Bleb configuration (single- vs. double-layered), bleb height, and spatial extension were evaluated and compared between modalities. RESULTS: Mean age was 64.0 years (SD = 16.6); 80% were male. Sonography identified double-layered blebs in 95.2% of eyes, compared to 47.7% with AS-OCT, which failed to fully visualize bleb layers in 38.1% of eyes. Sonography consistently measured greater bleb heights and lengths than AS-OCT (total bleb height 3.76 ± 1.39 mm vs. 1.77 ± 0.71 mm, p < 0.001; maximum bleb length 17.24 ± 3.17 mm vs. 2.85 ± 1.03 mm, p < 0.001). CONCLUSIONS: Sonography provided more comprehensive visualization of PGI blebs, particularly in detecting double-layered configurations, total height and measuring full posterior extension, whereas AS-OCT offered detailed anterior segment assessment including the tube entry site and patch graft. Both modalities yield complementary information, and their combined use may enhance postoperative monitoring and early detection of bleb dysfunction.
Associations between quadrant retinal layer thickness and pupillary light reflex in axial myopia.
Cao J, Ma Y, Bao Y … +7 more , Yu Y, Ding X, Hu J, Wang Z, Ye Y, Zhou X, Zhao J
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42154061 · Publisher ↗
PURPOSE: To evaluate the impact of various factors, including sex, retinal thickness, and axial length (AL), on pupillary light reflex (PLR) in young individuals with axial myopia. METHODS: Sixty-two patients (50% male)...
PURPOSE: To evaluate the impact of various factors, including sex, retinal thickness, and axial length (AL), on pupillary light reflex (PLR) in young individuals with axial myopia. METHODS: Sixty-two patients (50% male) were recruited for this study. AL and anterior chamber metrics were measured. Ocular fundus images for quadrant retinal layer segmentation were obtained automatically using swept-source optical coherence tomography. PLR metrics, including constriction and dilation metrics (ratio, time, and velocity), were derived using the pupillometry technique. RESULTS: Male participants showed a weaker peak pupillary constriction ratio compared with females (32.99 ± 4.85% versus 36.15 ± 5.21%, P = 0.0143). The constriction period metrics (peak ratio, time, mean velocity, and maximum velocity) showed no correlation with the AL. The maximum constriction velocity was positively affected by the ganglion cell-inner plexiform layers (GCIPL) and the entire retinal thickness in most outer annular regions (all P < 0.05). In male participants only, the peak pupil constriction ratio was affected by similar outer annular regions in the GCIPL and entire retinal thickness (all P < 0.05). The accelerated pupillary dilation time were affected by both higher AL (β=-0.256 s/mm, P = 0.038) and thicker macular retinal nerve fiber layer (mRNFL) thickness, especially in inner nasal, and outer nasal region (both P < 0.05). CONCLUSION: Axial elongation exerts no significant impact on the constriction procedure but accelerates post-illumination dilation. Reduced outer annular GCIPL thickness is associated with attenuated pupillary constriction velocity, whereas thinning of the mRNFL in the nasal direction correlates with prolonged dilation latency.
Ocular clinical characteristics and surgical outcomes of patients with stickler syndrome.
Yang Y, Gao X, Zhang X … +15 more , Xiao H, Lu Z, Liu M, Liu H, Zhang W, Yin J, Wu M, Guo S, Wang M, Yang Y, Ma H, Zhang X, Feng H, Peng J, Zhao P
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42149213 · Publisher ↗
PURPOSE: Stickler syndrome represents a group of rare, inherited genetic disorders and is the leading cause of inherited retinal detachment (RD). This study aimed to examine the ocular clinical characteristics and compar...
PURPOSE: Stickler syndrome represents a group of rare, inherited genetic disorders and is the leading cause of inherited retinal detachment (RD). This study aimed to examine the ocular clinical characteristics and compare the surgical outcomes of Stickler syndrome. METHODS: This single-center, retrospective study included 86 patients diagnosed with Stickler syndrome (58 genetically confirmed) between 2012 and 2024. Patients with RD underwent one of two surgical procedures, and their anatomical and functional outcomes were compared. Patients without RD underwent ora serrata and peripheral retinal screening, with 360° prophylactic laser therapy applied to high-risk eyes exhibiting pathology. RESULTS: The pars plana vitrectomy (PPV) group exhibited more severe baseline clinical characteristics than the scleral buckle (SB) group. After surgery, the two groups showed no statistically significant differences in any outcomes except anatomical success rate and best-corrected visual acuity (BCVA). Preoperative BCVA, the presence of cataract, RD extent and status, proliferative vitreoretinopathy (PVR) grade, and silicone oil tamponade were significantly associated with worse postoperative BCVA. Patients at high risk of RD underwent ora serrata and peripheral retina screening, and 36 eyes received prophylactic laser treatment. Preoperative retinal breaks and ora serrata dialysis were independent risk factors for post-laser RD. CONCLUSION: Stickler syndrome is a progressive disorder associated with a high risk of RD. Early diagnosis and regular surveillance are crucial for initiating timely intervention. Further research is needed to understand the pathogenesis of Stickler syndrome better, develop more effective prophylactic and surgical strategies, and improve outcomes for affected individuals.
Do steroids improve outcomes of idiopathic sixth nerve palsy in children?
Sternfeld A, Goren L, Ehrenberg M … +3 more , Pesoa Y, Elbaz U, Dotan G
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42142158 · Publisher ↗
PURPOSE: To analyze the effect of systemic steroid treatment in children with benign acquired isolated sixth nerve palsy (BAISNP) regarding healing, recurrence risk and late sequelae. METHODS: A retrospective cohort desi...
PURPOSE: To analyze the effect of systemic steroid treatment in children with benign acquired isolated sixth nerve palsy (BAISNP) regarding healing, recurrence risk and late sequelae. METHODS: A retrospective cohort design was used. The clinical database of a single medical center was reviewed for all children with BAISNP between 2016 and 2024. Data were collected as follows: demographics, age at initial presentation, complete eye and neurological examinations at presentation and every follow-up visit, neuroimaging and LP findings, treatments at presentation or for residual ocular misalignment, recovery periods and recurrences. Systemic steroids (1 mg/kg/day oral prednisolone for 10 days) were recommended by certain physicians, to whom some patients were randomly assigned. RESULTS: Twenty-seven children were included in the study. Mean age at presentation was 2.6 ± 2.2 years with a follow-up of 2.0 ± 2.3 years. BAISNP completely resolved after 3.2 ± 3.1 months in all children. Nine children (33%) had a recurrence that resolved after 1.8 ± 0.7 months. Residual comitant esotropia (RCE) exceeding 10 prism diopters persisted in six children (22%) despite resolution of the abduction weakness. Three of them underwent surgery and none regained stereopsis. Fifteen children (56%) received systemic steroids upon presentation. Steroid treatment affected neither time to resolution nor recurrence rate. However, fewer children treated with steroids developed RCE (6% vs. 45%, p = 0.026). A multivariable analysis for RCE development found that only steroids had a statistically significant impact (β=-0.58, p = 0.006). CONCLUSIONS: Systemic steroids reduce the rates of RCE when administered during an acute episode of BAISNP.
Living tissues and dead objects in the eye: The first description of ocular immune privilege by J.C. van Dooremaal in Albrecht Von Graefe's Archiv für Ophthalmologie in 1873.
Jager MJ, Bosch JJ, Mensink HW … +4 more , Dooremaal FHV, Roest FC, Kivelä TT, Cursiefen C
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42142157 · Publisher ↗
BACKGROUND: Immune privilege of the eye is considered to contribute significantly to the excellent survival of transplants in the anterior and posterior segment of the eye. While Sir Peter Medawar proved the existence of...
BACKGROUND: Immune privilege of the eye is considered to contribute significantly to the excellent survival of transplants in the anterior and posterior segment of the eye. While Sir Peter Medawar proved the existence of this phenomenon scientifically, a prior study by Dr. J.C. van Dooremaal already suggested the existence of ocular immune privilege and was published in this journal in 1873. METHODS: The original 1873 German paper by J.C. van Dooremaal in Albrecht von Graefe's Archiv für Ophthalmologie was translated into English and commented on by immunologist Dr. J. Wayne Streilein and other eye specialists. Family of Dr. van Dooremaal supplied information about the author himself. RESULTS: Dr. van Dooremaal was a military doctor when he was confronted with a severe epidemic of trachoma while serving at the Government Institution of Benevolence in the Netherlands (now a UNESCO heritage site). While finding a solution to fight the epidemic, he became familiar with the eye clinic of professor F.C. Donders in Utrecht. He subsequently trained as an ophthalmologist, and worked on a thesis on implantation of foreign tissues in the anterior chamber of different animals. He observed that a piece of skin of a white mouse placed in the eye of a dog survived amazingly long and was integrated into the tissues of the anterior chamber instead of rejected. According to Dr. J. Wayne Streilein, this was the first experimental demonstration of ocular immune privilege. CONCLUSION: The 1873 paper by Dr. J.C. van Dooremaal can be regarded as the first description of ocular immune privilege, and as Dr. J. Wayne Streilein wrote in 2001: Dr. van Dooremaal is the FATHER of immune privilege - although he could not call it that since immunology had not yet been discovered.
Effects of relative humidity on intraocular pressure using a time-series analysis.
Yoshida Y, Fujino Y, Michihata N … +4 more , Akagi A, Koizumi N, Okumura N, Tanito M
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42142156 · Publisher ↗
PURPOSE: This study aimed to investigate the association between ambient humidity and intraocular pressure (IOP), including potential nonlinear relationships and delayed effects of humidity on IOP. METHODS: A time-series...
PURPOSE: This study aimed to investigate the association between ambient humidity and intraocular pressure (IOP), including potential nonlinear relationships and delayed effects of humidity on IOP. METHODS: A time-series analysis was conducted using outpatient data collected at Shimane University Hospital between 2018 and 2023. Meteorological data on the days of IOP measurements were obtained from the Japan Meteorological Agency using data from the nearest weather station in Izumo City. Nonlinear relationships between humidity and IOP were evaluated using generalized additive models (GAMs), and delayed cumulative effects of humidity on IOP were assessed using distributed lag nonlinear models (DLNMs). RESULTS: The dataset included 1,269 observation days and 33,979 IOP measurements, comprising 8,756 measurements over 921 days in the non-glaucoma group and 25,173 measurements over 1,182 days in the glaucoma group. In GAM, nonlinear associations between humidity and IOP were not significant in any group. In the glaucoma group, cumulative exposure to relative humidity of 61-69% and 78-89% over lag 0-6 days, as well as 79-88.5% over lag 0-13 days, was significantly associated with reduced IOP. In contrast, cumulative exposure to very high humidity (97-98%) over lag 0-6 days was significantly associated with increased IOP. No significant cumulative lag effects were observed in the non-glaucoma group. CONCLUSION: These findings suggest that short- to middle-term exposure to ambient humidity over the preceding 1-2 weeks may influence IOP in patients with glaucoma.
Long-term outcomes and factors associated with visual recovery after small-gauge vitrectomy for infectious endophthalmitis: a 10-year experience at a single tertiary center in Taiwan.
Hsiao CH, Chen HJ, Chang CJ … +3 more , Feng SC, Cheng YS, Lo WJ
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42133000 · Publisher ↗
PURPOSE: To evaluate long-term visual outcomes and prognostic factors after small-gauge pars plana vitrectomy (PPV) for exogenous endophthalmitis. METHODS: Single-center, retrospective cohort of 45 eyes (45 patients) und...
PURPOSE: To evaluate long-term visual outcomes and prognostic factors after small-gauge pars plana vitrectomy (PPV) for exogenous endophthalmitis. METHODS: Single-center, retrospective cohort of 45 eyes (45 patients) undergoing PPV for exogenous endophthalmitis (June 2014-September 2024). Demographics, etiology, microbiology, surgical parameters, and outcomes were reviewed. Best-corrected visual acuity (BCVA) was recorded preoperatively and at final follow-up. Associations with final BCVA were explored using univariate tests. RESULTS: Median BCVA improved from hand motion (~ 20/4000; logMAR 2.30) to approximately 20/1200 (logMAR 1.78; p = 0.004). Overall, 51.1% improved and 24.4% achieved ≥ 20/40. Factors associated with worse final BCVA included poorer initial BCVA (p = 0.002), culture positivity (p = 0.037), and intraoperative retinal detachment (p = 0.009). Favorable factors were 27-gauge PPV (p = 0.044) and post-cataract etiology (p = 0.006). CONCLUSION: Small-gauge PPV, including 27-gauge, was associated with meaningful visual improvement in exogenous endophthalmitis. Final visual outcomes appeared to be influenced by baseline vision, microbial virulence, and the presence of retinal detachment. However, given the highly heterogeneous nature of this cohort, these findings should be interpreted with caution and may warrant further validation. Our findings provide contemporary data complementing the Endophthalmitis Vitrectomy Study and reflect outcomes achievable with modern techniques.
A large comprehensive comparison of large language models on ophthalmology board exams.
Galindo AM, Saadi R, Kerman T … +4 more , Schwartzman D, Pasternak D, Kinori M, Loewenstein A
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42132999 · Publisher ↗
PURPOSE: A comprehensive performance evaluation of seven state-of-the-art large language models (LLMs) compared to human resident benchmarks on ophthalmology board exam questions. Furthermore, this study aims to define c...
PURPOSE: A comprehensive performance evaluation of seven state-of-the-art large language models (LLMs) compared to human resident benchmarks on ophthalmology board exam questions. Furthermore, this study aims to define current model strengths and limitations while validating an assessment tool for clinicians to evaluate model-generated outputs. METHODS: Seven LLMs were assessed: ChatGPT-5, ChatGPT-4, Gemini 2.5 Pro, Gemini 2.5 Flash, Claude Sonnet 4.5, Grok-4-Fast-Reasoning, and Perplexity Sonar Pro. A dataset of 1,037 Israeli ophthalmology board questions (2020-2025) was manually categorized by question type (logical vs. informative), image modality, and 12 subspecialties. Models were evaluated for accuracy compared with resident performance, response latency, question difficulty, and self-assessed confidence. RESULTS: Performance varied substantially across models. Gemini 2.5 Pro achieved the highest accuracy, followed by ChatGPT-5, both outperforming residents. Accuracy declined significantly with increasing question difficulty (Very Hard vs. Easy: aOR 0.28, 95% CI,0.16-0.46; aP < 0.001), mirroring resident trends. Questions containing images were significantly more challenging for all models. Logical reasoning questions were significantly more challenging for LLMs than informative ones (aOR 0.66, aP = 0.019). Confidence calibration varied widely, with ChatGPT-5 showing superior discrimination (AUC = 0.827). CONCLUSIONS: LLMs' performance on ophthalmology board questions varied across models. Gemini 2.5 Pro achieved the highest performance, surpassing the mean resident score. However, the majority of LLMs exhibit significant error rates and poor calibration of self-assessed confidence. To safely integrate LLMs into the clinical workflow, continuous evaluation is essential to guide ophthalmologists on LLMs' characteristics and clinical limitations.
Machine learning for risk stratification of postoperative corneal edema in East Asian cataract patients: a model for precision ophthalmology.
Lu S, Zhou M, Zhang X … +7 more , Huang P, Pan S, Ba L, Wang J, Zhou X, Wen K, Sun J
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42126536 · Publisher ↗
PURPOSE: To develop and validate machine learning (ML) models for predicting early postoperative corneal edema (CE) after phacoemulsification in patients with normal preoperative corneal endothelium. METHODS: A retrospec...
PURPOSE: To develop and validate machine learning (ML) models for predicting early postoperative corneal edema (CE) after phacoemulsification in patients with normal preoperative corneal endothelium. METHODS: A retrospective cohort study analyzed data from 1128 eyes undergoing uncomplicated phacoemulsification at Tianjin Medical University Eye Hospital (May 2024-May 2025). CE was diagnosed on postoperative day 1 based on central corneal thickness increase > 50 μm, central stromal opacification, and blurred iris texture. Lasso regression preliminarily screened 26 clinical features to 9 key variables. Eleven ML models and a logistic regression model were developed. A hybrid Recursive Feature Elimination and Exhaustive Search strategy identified optimal feature subsets. Model performance is evaluated using metrics such as Area Under the Curve (AUC), accuracy, sensitivity, specificity, and Brier Score. RESULTS: Key predictors consistently identified included cumulative dissipated energy (CDE), age, and lens nucleus hardness. The optimized Support Vector Machine (SVM) model demonstrated superior performance during internal validation (AUC = 0.92, accuracy = 91.56%) and maintained strong generalizability on the independent test set (AUC = 0.89, accuracy = 84.50%). Other models like GradientBoost and PLS-DA also showed good performance post-optimization. The traditional LR model underperformed (optimized AUC = 0.81). CONCLUSIONS: ML models, particularly SVM, effectively predict postoperative CE risk in cataract patients with normal corneal endothelium. CDE, age, and nucleus hardness are critical predictors. The SVM model provides a robust, preoperative tool for predicting individual risk of postoperative CE. By identifying high-risk patients, it has the potential to guide surgical technique selection, optimize patient counseling, and streamline postoperative care pathways, thereby enhancing overall surgical quality and patient satisfaction.
Parental knowledge-attitude-practice profiles in childhood myopia: a comprehensive evaluation integrated with clinical findings.
Parca O, Akyol T, Bahar A … +2 more , Seker-Un E, Abadanoglu ZN
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42118248 · Publisher ↗
PURPOSE: Childhood myopia is increasing globally, yet limited evidence exists on how parental knowledge, attitudes, and practices (KAP) relate to children's myopia status. This study aimed to evaluate parental KAP regard...
PURPOSE: Childhood myopia is increasing globally, yet limited evidence exists on how parental knowledge, attitudes, and practices (KAP) relate to children's myopia status. This study aimed to evaluate parental KAP regarding childhood myopia and examine their associations with refractive outcomes. METHODS: This cross-sectional study included parents of myopic children aged 6-18 years presenting to an ophthalmology clinic between July and November 2025. A structured KAP questionnaire assessed parental knowledge of risk factors and control methods, attitudes toward myopia severity and management, and daily preventive practices. KAP scores were analyzed as continuous variables. Annual myopia progression was categorized according to refractive change (< - 0.50 D, 0.50-1.00 D, > 1.00 D). RESULTS: A total of 303 parents were enrolled. The mean knowledge, attitude, and practice scores were 4.68 ± 2.44, 8.12 ± 3.37, and 3.59 ± 1.52, respectively. Higher educational level, urban residence, and a family history of myopia were consistently associated with higher KAP scores. Parental KAP also varied by the child's myopia severity: parents of children with high myopia demonstrated markedly higher knowledge and attitude scores than those of children with mild or moderate myopia. Correlation analysis showed a moderate positive association between knowledge and attitude scores (r = 0.360, p < 0.001). Annual myopia progression was negatively correlated with knowledge (r = - 0.263, p < 0.001), attitude (r = - 0.127, p = 0.027), and practice scores (r = - 0.123, p = 0.033), indicating that children of parents with higher KAP scores tended to show less refractive progression. CONCLUSIONS: Parental KAP profiles were associated with clinically relevant patterns of refractive progression in childhood myopia. Despite generally positive attitudes, substantial gaps persisted in parental knowledge and daily implementation of protective practices. Strengthening parental education and improving access to evidence-based interventions may support better behavioral engagement in myopia management.
Early macular choroidal hemodynamic changes after faricimab loading in treatment-naïve diabetic macular edema.
Tanaka K, Fujioka N, Nunose M … +6 more , Imai S, Moriyama S, Takenaka R, Yagi F, Hori Y, Hashimoto R
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42118247 · Publisher ↗
PURPOSE: To investigate the early macular choroidal hemodynamic changes induced by faricimab loading in treatment-naïve diabetic macular edema (DME) and to determine potential systemic crossover effects by comparing fari...
PURPOSE: To investigate the early macular choroidal hemodynamic changes induced by faricimab loading in treatment-naïve diabetic macular edema (DME) and to determine potential systemic crossover effects by comparing faricimab-injected eyes with the contralateral non-injected eyes. METHODS: This retrospective, single-center cohort study analyzed data of a total of 92 eyes from 46 treatment-naïve patients with DME. All patients received three consecutive monthly intravitreal faricimab injections in the study eye. The primary outcome was the longitudinal change in macular choroidal blood flow (CBF) in injected and contralateral non-injected eyes, together with changes in central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT). Macular CBF was quantified as mean blur rate (MBR) using laser speckle flowgraphy. Data were analyzed using a linear mixed-effects model. RESULTS: In the 46 injected eyes, faricimab treatment resulted in significant monthly decreases in CRT and SFCT. This anatomical improvement was accompanied by a modest but statistically significant reduction in macular CBF, whereas ocular perfusion pressure remained stable. Visual acuity significantly improved. In contrast, no significant changes occurred in macular CBF, CRT, or SFCT in the 46 contralateral non-injected eyes. CONCLUSION: Initial faricimab loading therapy yielded marked anatomical improvements with only modest changes in macular choroidal perfusion in treatment-naïve DME. No measurable changes were detected in the contralateral non-injected eyes, suggesting that the early effects of faricimab are predominantly localized to the treated eye.
A deep learning model for automated identification of age-related macular degeneration atrophy.
Avram O, Shwartz Y, Green A … +20 more , Bloom R, Corradetti G, Wu A, Chen ZJ, Lior TE, Durmus B, Rudas A, Pal R, Rakocz N, Soylu C, Alhelaly M, Boscia G, Wykoff CC, Cannesson M, Sadda SR, Levy J, Halperin E, Chiang JN, Chowers I, Tiosano L
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42105087 · Publisher ↗
Age-related macular degeneration (AMD), a leading cause of visual impairment and blindness among the elderly, is projected to affect 288 million individuals globally by 2040. Advanced AMD, including complete retinal pigm...
Age-related macular degeneration (AMD), a leading cause of visual impairment and blindness among the elderly, is projected to affect 288 million individuals globally by 2040. Advanced AMD, including complete retinal pigment epithelium and outer retinal atrophy (cRORA), pose significant challenges for diagnosis and monitoring due to the labor-intensive, costly, and variable nature of manual annotation of volumetric optical coherence tomography (OCT) scans. Automating cRORA diagnosis offers the potential to improve annotation consistency and reduce clinical burden, which could facilitate, for example, the evaluation of recently FDA-approved treatments that delay disease progression. In this study, we compiled two large independent cohorts totaling nearly 5,000 3D OCT scans, labeled them for cRORA presence, and developed a deep learning model for cRORA automated detection. The model achieved state-of-the-art performance, with a ROC AUC of 0.97 on internal validation, and demonstrated robust translatability (zero-shot learning) with a ROC AUC of 0.88 on external evaluation. Notably, it exhibited high accuracy for both non-neovascular (non-nv) and neovascular (nv) AMD subgroups (ROC AUC 0.98 and 0.93, respectively), including complex cases with exudation. This model and dataset combination could facilitate clinical research and trial analyses by providing scalable, standardized assessments across non-nv and nv AMD patient subgroups.
Diagnostic utility of bony nasolacrimal duct area on computed tomography for differentiating malignant lacrimal tumors.
Nagata J, Tanabe M, Seki E … +6 more , Koide R, Takaki K, Yamana K, Akiyama M, Yoshikawa H, Sonoda KH
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42105086 · Publisher ↗
PURPOSE: To determine whether the expansion ratio of the bony nasolacrimal duct on computed tomography (CT) can differentiate malignant lacrimal tumors from benign lesions and primary acquired nasolacrimal duct obstructi...
PURPOSE: To determine whether the expansion ratio of the bony nasolacrimal duct on computed tomography (CT) can differentiate malignant lacrimal tumors from benign lesions and primary acquired nasolacrimal duct obstruction (PANDO). METHODS: The study retrospectively analyzed 19 patients with malignant lacrimal tumors and 195 with unilateral PANDO who visited the Kyushu University Hospital and underwent CT-dacryocystography between April 2018 and March 2023. Of the 195 PANDO cases, 14 that developed a lacrimal sac mass associated with chronic dacryocystitis were defined as the benign mass group. Clinical data including age, sex, tumor location and histopathology, and CT findings of the bony nasolacrimal duct were obtained via medical records. RESULTS: The malignant tumor group included 12 males and 7 females, and the mean age was 54.7 years. The benign mass group included 7 males and 7 females, and the mean age was 67.5 years. The PANDO group included 39 males and 142 females, and the mean age was 70.3 years. Tumor locations in patients with malignant tumors, including overlapping sites, were the lacrimal sac in 17 cases, the nasolacrimal duct in 9, the canaliculus in 2, and the nasal cavity in 1. Histopathological diagnoses were squamous cell carcinoma in 8 cases, malignant lymphoma in 4, adenoid cystic carcinoma in 2, and 1 case each of sebaceous carcinoma, mucoepidermoid carcinoma, apocrine adenocarcinoma, rhabdomyosarcoma, and Langerhans cell histiocytosis. Tumor locations in patients with benign masses were the lacrimal sac in 11 cases, the nasolacrimal duct in 2, and the nasal cavity in 1. Histopathological diagnoses were inflammatory granulation tissue in 11 cases and cyst in 3. Median expansion ratios of the bony nasolacrimal duct (affected side/unaffected side) on axial CT were 167.5% in the malignant tumor group, 123.3% in the benign mass group, and 106.8% in the PANDO group. CONCLUSION: Malignant lacrimal tumors showed considerably greater expansion of the bony nasolacrimal duct on CT. An expansion ratio of ≥ 150% may be a useful adjunctive marker for distinguishing malignant lacrimal tumors in clinical practice.
Comparison of Carlevale and Artisan retropupillary iris-claw intraocular lens fixation for managing aphakia: a systematic review and meta-analysis.
Alghaith O, de Oliveira Rassi TN, Sanadgol N … +5 more , Shamsher E, Pungirum VB, Nghi TB, Khabazianzadeh F, Maia M
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42089999 · Publisher ↗
PURPOSE: Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain. METHODS: PubMed, Embase and the Cochrane Library wer...
PURPOSE: Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain. METHODS: PubMed, Embase and the Cochrane Library were searched to March 2025. PRIMARY OUTCOMES: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). SECONDARY OUTCOMES: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed. RESULTS: Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18% were male; follow-up ranged from 1.3 to 11.5 months. BCVA did not differ between groups (- 0.01 logMAR; 95% CI - 0.13 - 0.11; p = 0.91; I²=43%). Carlevale reduced SIA (- 0.53D; 95% CI - 1.03 to - 0.04; p = 0.03; I²=73.7%), however, the benefit was confined to corneal-incision iris-claw comparators, not scleral-incision. MARE showed no overall difference, yet corneal-incision iris-claw cases were less predictable (MD-0.32; 95% Cl: -0.62-0.19, p = 0.30, I² =81.7%). Carlevale produced a myopic shift relative to iris-claw (- 0.66D; 95% CI - 0.87 to - 0.46; p < 0.01; I²=31.3%). Carlevale procedures were 11.9 min longer (95% CI 5.2-18.6; p < 0.01; I²=80.2%). Complication rates were comparable overall except for fewer IOL dislocations with Carlevale (OR 0.16; 95% CI 0.03-0.87; p = 0.034; I²=0%). CONCLUSIONS: Both lenses provide similar visual acuity and safety in aphakic eyes lacking capsular support. Carlevale confers lower dislocation risk and greater refractive predictability relative to corneal-incision iris-claw implantation, at the expense of a longer operating time. Incision-related heterogeneity highlights the need for standardised surgical and reporting frameworks.
Insights into Tear Viscosity: A Study of 240 Volunteers.
Muñoz GG, Campana DM, Dominguez L … +3 more , Torres RM, Reta JM, Zalazar MA
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42084641 · Publisher ↗
PURPOSE: Tear viscosity is known to influence the flow resistance and stability of the tear film, making it a relevant parameter for the assessment of tear quality. However, limited information is available in the litera...
PURPOSE: Tear viscosity is known to influence the flow resistance and stability of the tear film, making it a relevant parameter for the assessment of tear quality. However, limited information is available in the literature regarding its reference values. This study aimed to establish a baseline for tear viscosity in a cohort without a reported diagnosis of dry eye disease and to explore potential demographic and clinical factors that may influence it, using a prototype viscometer based on quartz crystal microbalance (QCM) technology. METHODS: In this exploratory study, a total of 240 volunteers (170 women and 70 men, aged 18-76 years) without a diagnosis of dry eye syndrome or active ocular infection or inflammation were included. Each participant completed a questionnaire based on the Women's Health Study, and tears were collected using a capillary for analysis with the QCM. The viscosity data were analyzed statistically for distribution fitting and correlations with QCM frequency and dissipation. RESULTS: The raw viscosity data showed a right-skewed distribution (median = 7.0 cP, IQR = 24 cP). A log-normal distribution provided the best fit. No association was found between tear viscosity and QCM frequency or dissipation. Median tear viscosity values across demographic and clinical groups ranged from 3.8 to 16.1 cP, but these differences were not statistically significant (p > 0.05). CONCLUSION: A preliminary reference estimate for tear viscosity in a population without a reported diagnosis of dry eye disease was established, providing a fundamental baseline for future research on viscosity as a potential biomarker for ocular diseases such as dry eye syndrome.
Letter to the editor.
Lanzetta P, Danese C
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42084640 · Publisher ↗
Abstract loading — click title to view on PubMed.
Granzyme B in age-related macular degeneration: mechanistic insights and therapeutic perspectives.
Haroon MM, Akram L, Jalal L … +2 more , Ahmed A, Haider S
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42080917 · Publisher ↗
Granzyme B (GzmB), beyond its established role in corneal and conjunctival disease, is increasingly recognized in the retinal and choroidal distribution of several pathologies. GzmB targets tight-junction proteins (e.g.,...
Granzyme B (GzmB), beyond its established role in corneal and conjunctival disease, is increasingly recognized in the retinal and choroidal distribution of several pathologies. GzmB targets tight-junction proteins (e.g., ZO-1, JAM-A) and extracellular proteins such as fibronectin and laminin within the retinal pigment epithelium (RPE) and Bruch's membrane, thereby disrupting the outer blood-retinal barrier and contributing to the pathogenesis of age-related macular degeneration (AMD) and Macular neovascularization (MNV). This mini review highlights recent mechanistic insights into how GzmB drives extracellular matrix breakdown, inflammation, and angiogenesis; summarizes experimental and clinical evidence supporting its role in AMD; and discusses emerging therapeutic approaches, limitations, and translational potential for targeted therapy.
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