Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
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200 papers
Sponge-assisted intracameral length titration: a new technical modification for Ab externo XEN implantation.
Rubegni G, Fruschelli M, Mercieca K … +1 more , Tosi GM
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42080916 · Publisher ↗
Accurate positioning of the XEN gel stent is critical during ab externo implantation, and fine-tuning is commonly performed with forceps, which may concentrate stress on the gelatin implant. We describe a sponge-assisted...
Accurate positioning of the XEN gel stent is critical during ab externo implantation, and fine-tuning is commonly performed with forceps, which may concentrate stress on the gelatin implant. We describe a sponge-assisted swiping maneuver using sterile ocular sponge swabs as a soft interface to achieve gradual, controlled advancement or retraction of the stent. The technique enables stepwise titration of intracameral length while reducing focal compression and the risk of device deformation during repositioning. This low-cost modification can be readily incorporated into standard ab externo XEN workflows.
Association of papilledema severity with retinal vessel tortuosity in idiopathic intracranial hypertension.
Zou Y, Abdolahi F, Felder AE … +3 more , Huang C, Gokoffski KK, Shahidi M
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42068341 · Full text
PURPOSE: Idiopathic intracranial hypertension (IIH) induces papilledema and can result in progressive visual dysfunction and retinal vascular changes. The purpose of the current study was to determine cross-sectional and...
PURPOSE: Idiopathic intracranial hypertension (IIH) induces papilledema and can result in progressive visual dysfunction and retinal vascular changes. The purpose of the current study was to determine cross-sectional and longitudinal associations between papilledema severity and retinal vessel tortuosity (RVT) in IIH. METHODS: Images from 24 eyes of 15 patients diagnosed with papilledema were acquired at two visits. Papilledema severity was graded by Frisen score (FS). Images were analyzed to determine RVT in arteries and veins within the peripapillary region using the first-order derivative method. Inter-visit differences in FS (ΔFS) and RVT (ΔRVT) were calculated. Generalized estimating equation models determined associations of FS and ΔFS with RVT and ΔRVT, respectively. RESULTS: Based on compiled arterial or venous RVT data from both visits, there was no significant association between RVT and FS (p = 0.89), whereas venous RVT (0.31 ± 0.02; N = 48) was significantly higher than arterial RVT (0.24 ± 0.01; N = 48) (p = 0.03). Compared to the ΔFS = 0 group, venous ΔRVT was higher in the ΔFS = 3 group (β = 0.05, p = 0.005), while arterial ΔRVT was higher in ΔFS ≥ 1 (β ≥ 0.04; p ≤ 0.04). CONCLUSION: The finding of an association between improvement in papilledema and reduction in RVT shows promise for vessel tortuosity as a biomarker for monitoring disease progression and response to therapeutic interventions, as well as advancing knowledge of retinal vascular changes due to papilledema.
Multimodal evaluation of choroidal vascular alterations after panretinal photocoagulation in diabetic retinopathy.
Jeong A, Han YE, Choi L … +4 more , Jung D, Kim Y, Sagong M, Lee J
Graefes Arch Clin Exp Ophthalmol · 2026 May · PMID 42065737 · Publisher ↗
PURPOSE: To evaluate morphological and quantitative changes in the choroid after panretinal photocoagulation (PRP) for diabetic retinopathy using multimodal imaging and to identify factors associated with these changes....
PURPOSE: To evaluate morphological and quantitative changes in the choroid after panretinal photocoagulation (PRP) for diabetic retinopathy using multimodal imaging and to identify factors associated with these changes. METHODS: This retrospective study included 48 eyes of 26 patients with severe non-proliferative or proliferative diabetic retinopathy. Ultra-widefield indocyanine green angiography (UWF-ICGA) and enhanced-depth imaging optical coherence tomography (EDI-OCT) were performed before and after PRP. Choroidal vessel density, fractal dimension (FD), and hyperpermeable area were quantified from fluorescein angiography-subtracted ICGA images using ImageJ and Fractalyse software. Choroidal vascularity index (CVI), subfoveal choroidal thickness (SFCT), and Haller's layer thickness were measured on EDI-OCT. CVI was calculated as the ratio of the luminal area to the total subfoveal choroidal area within a 1,500-µm region. Relationships among choroidal and retinal parameters were analyzed by multivariable regression. RESULTS: After PRP, the mean hyperpermeable area significantly decreased (8.78%→7.95%, p < 0.001), accompanied by reductions in choroidal vessel density (34.67%→33.34%, p < 0.001), FD (1.662→1.632, p = 0.003), SFCT (266.63→242.75 μm, p < 0.001), and CVI (64.34%→62.13%, p < 0.001). Haller's layer thickness was independently associated with the hyperpermeable area, while CVI correlated with central retinal thickness and Haller's layer thickness. CONCLUSION: PRP reduces choroidal vascular congestion and complexity, suggesting structural remodeling of the choroidal vasculature associated with reduced vascular permeability. Quantitative ICGA- and OCT-derived indices may serve as noninvasive biomarkers for evaluating choroidal remodeling and treatment response after PRP in diabetic retinopathy.
Italian consensus on pediatric myopia: findings from a three-round modified delphi study.
Schiavetti I, Villani E, Serafino M … +5 more , Caputo R, Buzzonetti L, Vagge A, Nucci P, Italian study group on pediatric myopia
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42059905 · Publisher ↗
BACKGROUND: Pediatric myopia is a growing public health concern, influenced by genetic and environmental factors such as limited outdoor time and excessive near work. It entails long-term risks beyond refractive correcti...
BACKGROUND: Pediatric myopia is a growing public health concern, influenced by genetic and environmental factors such as limited outdoor time and excessive near work. It entails long-term risks beyond refractive correction. Despite expanding evidence on pharmacologic and optical interventions, clinical practice remains variable and several operational issues persist. OBJECTIVES: To develop evidence-informed consensus statements on pediatric myopia management in Italy, covering epidemiology, risk factors, prevention, monitoring, policy, and economic aspects. METHODS: Surveys were administered through REDCap between November 2024 and August 2025. Pediatric ophthalmologists rated domain-specific items using Likert scales and optional comments. After each round, anonymized summaries were shared. Items reaching consensus were removed; others were revised when appropriate. RESULTS: All 37 ophthalmologists completed every round. Fifty-three statements reached consensus. Key recommendations included early screening at age three, specialized clinics, awareness campaigns, financial support, prioritizing outdoor activity, not recommending red-light therapy, endorsing simultaneous competitive defocus spectacle lenses, and monitoring via cycloplegic refraction and axial length every 6 months. CONCLUSIONS: This consensus offers a structured framework for Italian practice and policy, while highlighting priorities for future research.
Structural retinal and choroidal changes in keratoconus: A cross-sectional OCT study stratified by ABCD grading.
Mohammed MH, Hashemian H, Jadidi K … +7 more , Naroo SA, Ambrósio R, Aghamolaei H, Nejat F, Naseri M, Narooie-Noori F, Khorrami-Nejad M
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42059904 · Publisher ↗
PURPOSE: To evaluate posterior segment structural changes in patients with keratoconus (KC), and to assess their association with anterior segment parameters across disease severity stages using the ABCD classification s...
PURPOSE: To evaluate posterior segment structural changes in patients with keratoconus (KC), and to assess their association with anterior segment parameters across disease severity stages using the ABCD classification system. METHODS: This cross-sectional observational study graded staged KC severity I-IV based on the ABCD grading system. All participants underwent comprehensive ophthalmic evaluation, including corneal tomography (Pentacam HR), optical coherence tomography with enhanced depth imaging (Spectralis EDI-OCT), and ocular biometry. Posterior segment parameters were compared across KC stages and with controls. Correlation analyses were performed to assess associations between anterior and posterior segment metrics. RESULTS: The study included 124 eyes from 124 patients with keratoconus and 32 right eyes from healthy control individuals. RNFL thickness was significantly reduced in KC eyes compared to controls (103.7 ± 11.6 μm vs. 110.0 ± 12.0 μm; P = 0.008), with a progressive decline observed from stage I to IV. Central foveal retinal thickness showed a mild, non-significant reduction in stages III and IV (234.6 ± 20.9 μm and 232.8 ± 19.7 μm, respectively) compared to earlier stages and controls (P = 0.066). SFCT remained relatively unchanged across all KC stages and between KC and control groups (416.6 ± 85.4 μm vs. 420.3 ± 70.2 μm; P = 0.824). Correlation analyses revealed no significant associations between anterior segment parameters (e.g., apex pachymetry, thinnest corneal thickness) and posterior segment measurements (P > 0.05 for all). CONCLUSION: KC is associated with significant RNFL thinning, particularly in advanced stages, suggesting posterior segment involvement. However, retinal and choroidal thicknesses remain largely unaffected.
Risk factors and timing of ocular complications after screening for retinopathy of prematurity.
Xing SX, Kim DK, Joshi Ojha K … +6 more , Hark LA, Hyman N, Horowitz JD, Yeager LB, Rosenberg SE, Talsania SD
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42059903 · Publisher ↗
PURPOSE: Retinopathy of prematurity (ROP) remains a leading cause of childhood vision loss, often resulting in long-term complications such as strabismus, amblyopia, and glaucoma. Despite advances in screening, limited d...
PURPOSE: Retinopathy of prematurity (ROP) remains a leading cause of childhood vision loss, often resulting in long-term complications such as strabismus, amblyopia, and glaucoma. Despite advances in screening, limited data exist on which infants are at highest risk and when these complications typically emerge-an important gap given the nationwide shortage of pediatric ophthalmologists. This study aimed to identify predictors of post-ROP ocular complications and determine the optimal timing and frequency of pediatric ophthalmology follow-up visits. METHODS: We retrospectively reviewed 223 infants who underwent ROP screening between 2018 and 2021 and subsequently followed up with pediatric ophthalmology. The primary outcome was the development of ocular complications following ROP resolution, including their type and timing of detection. Univariate and multivariate logistic regression were used to identify independent risk factors, and Kaplan-Meier analysis assessed time to complication onset. RESULTS: Of 223 infants, 54 (24.2%) developed at least one ocular complication. The most common were refractive error (17.0%), strabismus (13.9%), and amblyopia (4.5%). Most complications occurred within two years after ROP clearance. Strabismus was diagnosed earliest, followed by refractive error and amblyopia. Longer NICU stay was an independent predictor of ocular complications (OR 1.30, 95% CI 1.04-1.63; p = 0.022). CONCLUSIONS: Nearly one in four infants developed ocular complications after ROP screening, typically within the first two years. NICU length of stay independently predicted risk, supporting the need for risk-stratified surveillance to ensure timely detection, optimize resource allocation, and reduce preventable vision loss in infants screened for ROP.
Choroidal vascularity across aging and the spectrum of age-related macular degeneration: an AI-based OCT study.
Vahldiek B, Heine L, Vahldiek A … +7 more , Schröter J, Wolf JN, Swora M, Reissberg L, Pauleikhoff L, Kleesiek J, Pauleikhoff D
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42059902 · Publisher ↗
PURPOSE: To characterize the choroidal morphology across a spectrum of participants affected by normal aging as well as age-related macular degeneration (AMD) using various metrics. METHODS: Four cohorts were analyzed: h...
PURPOSE: To characterize the choroidal morphology across a spectrum of participants affected by normal aging as well as age-related macular degeneration (AMD) using various metrics. METHODS: Four cohorts were analyzed: healthy young (n = 42), healthy elderly (n = 19), iAMD (n = 20), and treatment-naive nAMD eyes (n = 79). Quantification of choroidal volume (CV) and choroidal vessel volume (VV) resulting in choroidal vascularity index (CVI) as well as mean choroidal thickness (CT), vessel thickness (VT) and foveal vessel area (FVA) and vessel count (FVC) were derived from spectral-domain optical coherence tomography using an artificial intelligence (AI)-based semantic segmentation model with manual validation. Cohort differences were statistically assessed. RESULTS: All choroidal parameters were reduced in healthy elderly, iAMD and nAMD eyes compared with young controls. While most of these reduced choroidal measurements were largely similar between healthy elderly, iAMD and nAMD eyes, only CVI and FVA showed a specific reduction in nAMD eyes. CONCLUSIONS: This study demonstrates a decline in several choroidal parameters with age, which can be quantified using AI-based segmentations. While age-related reductions were comparable between elderly and iAMD eyes, a significantly higher reduction of the CVI and FVA was observed in eyes with nAMD which may indicate a more pronounced alteration of choroidal structure in this condition.
Retinal changes in neurofibromatosis type 1 patients without optic pathway glioma: A systematic review and meta-analysis of optical coherence tomography findings.
Ziafati M, Barresi C, Giuffrè C
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42053615 · Publisher ↗
PURPOSE: Neurofibromatosis type 1 (NF1) is a genetic disorder with recognized ocular involvement, primarily optic pathway gliomas (OPGs). However, retinal structural changes in NF1 patients without gliomas remain poorly...
PURPOSE: Neurofibromatosis type 1 (NF1) is a genetic disorder with recognized ocular involvement, primarily optic pathway gliomas (OPGs). However, retinal structural changes in NF1 patients without gliomas remain poorly defined. This study aimed to evaluate optical coherence tomography (OCT) findings in glioma-free NF1 patients. METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science through January 2025 identified studies comparing OCT parameters in NF1 patients without OPGs versus healthy controls. RESULTS: A total of eight studies comprising 129 patients with NF1 and 243 healthy controls were included in the analysis. Among pediatric participants, no significant differences were detected in peripapillary retinal nerve fiber layer (pRNFL) thickness, ganglion cell–inner plexiform layer (GC-IPL) thickness, or macular volume. In contrast, adult NF1 patients exhibited a significant reduction in GC-IPL (p < 0.001) and outer nuclear layer (ONL) thickness (p = 0.03), whereas macular RNFL thickness remained comparable to healthy controls. CONCLUSION: Retinal structure appears preserved in pediatric NF1 patients without gliomas. However, significant thinning of inner and outer retinal layers in adults suggests progressive, glioma-independent retinal neurodegeneration. OCT may serve as a valuable tool for detecting subclinical changes in adult NF1 patients.
Correction to: Transplantation of human trabecular meshwork stem cells induces cell proliferation and intraocular pressure reduction in a cell loss model of glaucoma.
Iswarya R, Haribalaganesh R, Senthilkumari S … +2 more , Krishnadas S, Priya CG
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42047777 · Publisher ↗
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The risk of glaucoma in chronic rhinosinusitis and allergic rhinitis: A systematic review and meta-analysis.
Wang C, Liao YH, Chou WY … +2 more , Lin YT, Hsia Y
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42047776 · Publisher ↗
PURPOSE: To investigate the association between chronic upper airway inflammatory diseases, specifically chronic rhinosinusitis (CRS) and allergic rhinitis (AR), and the risk of glaucoma. METHODS: Two independent reviewe...
PURPOSE: To investigate the association between chronic upper airway inflammatory diseases, specifically chronic rhinosinusitis (CRS) and allergic rhinitis (AR), and the risk of glaucoma. METHODS: Two independent reviewers systematically searched PubMed and Embase through December 2025 to identify observational studies evaluating the association between CRS or AR and glaucoma. Risk of bias was assessed using the ROBINS-E tool. Risk estimates, including odds ratios and hazard ratios, as well as glaucoma incidence rates, were extracted. Pooled risk ratio (RR) for glaucoma was calculated using a random-effects model with inverse-variance weighting. RESULTS: Among 1,620 records identified, seven studies met the inclusion criteria, comprising a total of 83,557,354 individuals (three CRS studies and four AR studies), including five retrospective cohort studies, one case–control study, and one cross-sectional study. The incidence of open-angle glaucoma was 5.5 per 1,000 person-years in patients with CRS, while the incidence of glaucoma was 7.1 per 1,000 person-years in patients with AR. CRS was associated with a significantly increased risk of glaucoma (RR 1.49, 95% CI 1.25–1.79). AR was similarly associated with an elevated risk (RR 1.39, 95% CI 1.33–1.45). CRS and AR were associated with a higher risk of open-angle glaucoma and low-tension glaucoma (RR 1.47, 95% CI 1.32–1.63). In studies adjusting for corticosteroid exposure, the increased risk of glaucoma remained consistent (RR 1.37, 95% CI 1.29–1.48). CONCLUSION: Both CRS and AR are associated with an increased risk of glaucoma, independent of corticosteroid use.
Stereotactic radiosurgery in symptomatic circumscribed choroidal hemangiomas.
Kahvecioglu A, Koc I, Cengiz M … +4 more , Yilmaz A, Gumeler E, Kiratli H, Yazici G
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42043513 · Publisher ↗
PURPOSE: To evaluate visual outcomes following stereotactic radiosurgery (SRS) in patients with symptomatic circumscribed choroidal hemangioma (cCH). METHODS: This retrospective study included 30 patients with symptomati...
PURPOSE: To evaluate visual outcomes following stereotactic radiosurgery (SRS) in patients with symptomatic circumscribed choroidal hemangioma (cCH). METHODS: This retrospective study included 30 patients with symptomatic cCH treated with SRS between 2014 and 2025. SRS was performed using either the CyberKnife or ZAP-X platform depending on the treatment period. Visual outcomes were assessed by changes in best-corrected visual acuity (BCVA). A lower score on the logarithm of the minimum angle of resolution (logMAR) scale indicates better vision. RESULTS: The median patient age was 46 years. Ten patients (33.3%) were treatment-naive, while 20 (66.7%) had prior therapies. A single-fraction dose of 10 Gy was delivered in 29 patients (96.7%), and one patient received 14 Gy. Median BCVA improved from 1.9 logMAR (range, 0.1–3.0) at baseline to 1.3 logMAR (range, 0.1–3.0) after SRS (p = 0.01). Among 26 patients with baseline subretinal fluid, 12 (46.1%) showed complete and 10 (38.5%) partial resolution. Of six patients with retinal detachment (RD), three (50.0%) achieved anatomical resolution, but only one showed visual improvement. Logistic regression suggested a trend toward reduced likelihood of visual improvement after SRS in patients with baseline RD (OR: 0.121, p = 0.063). No clinically significant acute toxicity was observed. Two patients (6.7%) experienced grade 3 late visual acuity decrease, associated with foveal atrophy despite favorable anatomical response. CONCLUSIONS: SRS appears to be a safe and effective treatment for symptomatic cCH, providing visual improvement or stabilization in most cases. However, baseline RD may predict poorer visual outcomes, even with anatomical recovery. Early diagnosis and timely treatment may help optimize visual results and guide patient selection.
Oral therapeutic interventions for central serous chorioretinopathy: A systematic review.
Hamzah F, Azrina A, Supanji S … +2 more , Adriono GA, Shinojima A
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42043512 · Publisher ↗
PURPOSE: Central serous chorioretinopathy (CSCR) is characterized by serous neurosensory retinal detachment that predominantly affects working-age men. Many acute cases resolve spontaneously, but chronic or recurrent for...
PURPOSE: Central serous chorioretinopathy (CSCR) is characterized by serous neurosensory retinal detachment that predominantly affects working-age men. Many acute cases resolve spontaneously, but chronic or recurrent forms can lead to permanent visual impairment. Oral pharmacological therapies have emerged as a noninvasive alternative to photodynamic therapy (PDT), particularly in the context of verteporfin shortage. This systematic review aims to evaluate the efficacy of oral agents for CSCR, focusing on subretinal fluid (SRF), best-corrected visual acuity (BCVA), choroidal thickness, and recurrence. METHODS: Following PRISMA 2020 guidelines, we searched MEDLINE, the Cochrane Library, and Web of Science (January 1990 to May 2025) for randomized controlled trials (RCTs) assessing oral therapies for CSCR. Risk of bias was assessed using the Cochrane RoB 2. RESULTS: Our search returned 14 trials that met our inclusion criteria. We found that mineralocorticoid receptor antagonists appeared to reduce SRF in most studies (6 of 8 trials), while their effects on BCVA and choroidal thickness were inconsistent. Helicobacter pylori eradication therapy showed no significant SRF reduction or effects on BCVA compared to placebos or control group. Propranolol improved both complete SRF resolution and BCVA, while metipranolol demonstrated no significant effects. Due to high heterogeneity between studies, we did not perform a meta-analysis. CONCLUSION: Mineralocorticoid receptor antagonists may reduce SRF in CSCR, although visual outcomes remain uncertain. Propranolol may offer potential benefit based on limited evidence. Other oral therapies lack supportive evidence. Given study heterogeneity and absence of meta-analysis, findings should be interpreted with caution. Further large-scale RCTs are needed.
Validation of the FIRST-ROP algorithm in a tertiary care center in Greece.
Chaaya C, Moutzouri S, Altamirano F … +7 more , Pandiri S, Hoyek S, Raad E, Brant A, Vavvas DG, Mataftsi A, Patel NA
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42043511 · Publisher ↗
PURPOSE: We aim to validate the previously published FIRST-ROP algorithm in a tertiary-level center. METHODS: This is a retrospective consecutive study that includes premature infants screened for retinopathy of prematur...
PURPOSE: We aim to validate the previously published FIRST-ROP algorithm in a tertiary-level center. METHODS: This is a retrospective consecutive study that includes premature infants screened for retinopathy of prematurity (ROP) at a tertiary referral center in Thessaloniki, Greece. Infants who did not meet criteria for microprematurity or nanoprematurity (i.e., infants born at ≥ 27 weeks gestational age and weighing ≥ 800 g) were included in the study. RESULTS: Of the 1251 infants screened, 1094 (87.4%) met the inclusion criteria. ROP was detected in 103 patients (9.4%). Fourteen infants (1.3%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 34.7 weeks. No patients were diagnosed with type 1 ROP on either of the first two inpatient exams. The median PMA at first treatment was 38.1 weeks. The upper 95% confidence limit for missing a type 1 case when omitting the first and second ROP examinations was calculated to be 0.27% (95% CI, 0-0.27%). No patients were treated on the first or second exam. CONCLUSION: In this medium-risk cohort of neonates not meeting criteria for microprematurity or nanoprematurity, in Greece, there were no patients treated on the first or second inpatient examinations. The FIRST ROP algorithm was validated to start screening at 34 weeks PMA. This is the first ex-US validation and may support the principle of risk-stratified ROP screening.
Bidirectional Retro mode differential imaging improves drusen boundary depiction in early and intermediate AMD: a pilot study.
Desmettre T, Ledesma-Gil G, Paques M
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42033485 · Publisher ↗
PURPOSE: Off-axis retroillumination (known as “Retro mode”) has been shown to enhance the detection of drusen, particularly smaller lesions. Images are obtained by shifting the aperture left (DL) or right (DR), each reve...
PURPOSE: Off-axis retroillumination (known as “Retro mode”) has been shown to enhance the detection of drusen, particularly smaller lesions. Images are obtained by shifting the aperture left (DL) or right (DR), each revealing complementary aspects of drusen. This study evaluated whether combining DL and DR images could enhance drusen boundary depiction. METHODS: Multimodal images from 11 patients (mean age 74.5 ± 12.1 years; 8 females) with early or intermediate age-related macular degeneration (AMD) were retrospectively analyzed. Imaging included pseudocolor photographs, Retro mode (Mirante, NIDEK), and optical coherence tomography (OCT; Cirrus 5000, Zeiss). DL and DR Retro mode images were manually aligned using vascular landmarks, and differential images (DIF) were generated with FIJI (ImageJ). RESULTS: DIF images appeared to facilitate lesion boundary depiction compared with individual DL or DR images. Hard drusen were barely visible on pseudocolor photographs and en face OCT but were identifiable with Retro mode; on DIF images, they appeared larger than on DL or DR images. Intermediate drusen were visible across all modalities, and Bland–Altman analysis showed a small positive bias toward larger areas on DIF compared with en face OCT (mean difference: +2.2%). Soft drusen also appeared larger on DIF, with a systematic positive bias of 14.5% relative to pseudocolor imaging. DIF images further supported the qualitative characterization of cuticular drusen and subretinal drusenoid deposits (SDD). CONCLUSION: This pilot study suggests that Retro mode imaging of drusen can be refined through alignment and differential analysis of DL and DR images, providing a more complete visual depiction of drusen surface features and offering complementary information for the characterization of AMD stages.
Amblyopia and strabismus: Psychosocial characteristics - results from the Gutenberg Health Study (GHS).
Holley FT, Schuster AK, Welzel AM … +11 more , Wild PS, Lackner K, Lurz P, Beutel ME, Schmidtmann I, Konstantinides S, Tüscher O, Weinmann-Menke J, Pfeiffer N, Michal M, Elflein HM
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42033484 · Publisher ↗
BACKGROUND: Amblyopia and strabismus are associated with a reduced health-related quality of life in children. This study aimed to investigate whether there is a relationship between amblyopia or strabismus and mental di...
BACKGROUND: Amblyopia and strabismus are associated with a reduced health-related quality of life in children. This study aimed to investigate whether there is a relationship between amblyopia or strabismus and mental distress (depression, anxiety disorder), as well as differences in psychosocial characteristics. METHODS: The Gutenberg Health Study is a population-based cohort study in Mainz, Germany, with 15,010 participants aged 35–74. The prevalence of depression and anxiety, and the presence of psychosocial characteristics were examined in individuals with and without strabismus or amblyopia. Logistic regression analyses were conducted to calculate associations. RESULTS: 14,431 individuals were included in the analysis for strabismus, of which 355 had a squint. The socioeconomic status was lower in individuals with strabismus (12.0 vs. 13.0, p = 0.01), and a higher percentage had a secondary school diploma (43.1% vs. 38.7%) rather than a high school diploma (30.7% vs. 37.5%; p = 0.04). There was no association between strabismus and depression (OR = 1.06; p = 0.77), nor with anxiety (OR = 0.92; p=0.71). CONCLUSIONS: Amblyopic or strabismic individuals have a lower socioeconomic status and lower educational attainment. There was no association found with depression or anxiety disorder.
Optical coherence tomography characteristics in myopic children with large cup-disc ratios.
Lim MK, Chong RS, Al Ajmi M … +2 more , Htoon HM, Chia A
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42033483 · Publisher ↗
PURPOSE: This study aims to evaluate the association of optic cup-to-disc ratio (CDR) with magnification-adjusted optical coherence tomography (OCT) peripapillary retinal nerve fibre layer (RNFL) and macula ganglion cell...
PURPOSE: This study aims to evaluate the association of optic cup-to-disc ratio (CDR) with magnification-adjusted optical coherence tomography (OCT) peripapillary retinal nerve fibre layer (RNFL) and macula ganglion cell complex (GCC) thickness in Asian myopic children, to help clinicians better evaluate glaucoma risk in myopic children with increased CDR. METHODS: In a prospective clinical cohort study, myopic children aged 7–16 years were assessed annually over 2 years, excluding children with overt glaucomatous changes. Right eye data including visual acuity, intraocular pressure, cycloplegic autorefraction, axial length, fundus photographs and magnification-adjusted OCT of the optic disc and macula were collected. Children were divided into three OCT-assessed vertical CDR (vCDR) subgroups (0.00-0.39, 0.40–0.59, and 0.60–0.90) for analyses. RESULTS: Among 901 eyes, 162 (18.2%) eyes had a vCDR ≥ 0.6. Multivariate analysis found that larger vCDR was associated with non-Chinese race, younger age, flatter corneas, decreased optic disc tilt, larger disc area with smaller disc rim, increased AL, sectoral RNFL thinning with nasal RNFL thickening, and reduced use of combined atropine-optical treatment. In 452 eyes with two-year follow-up data of sufficient quality, no change in OCT RNFL and GCC were noted over time. Interestingly, increased vCDR was associated with greater myopia progression. CONCLUSION: In eyes with larger CDR, the presence of flatter corneas, larger optic disc area (e.g. >2mm2), and stable OCT RNFL and GCC thickness over time are reassuring for a non-glaucomatous state. However, given the increased risk of myopia progression, closer myopia monitoring and management may be necessary.
Predicting bleb revision after XEN gel stent surgery in a real-world open-angle glaucoma cohort.
Wenzel CJ, Pagonidou C, Wenzel DA … +3 more , Druchkiv V, Nasyrov E, Voykov B
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42033482 · Publisher ↗
PURPOSE: To evaluate the incidence, timing, and risk factors for postoperative needling procedure and incisional bleb revision following XEN gel stent implantation in a large single-center cohort with a long-term follow-...
PURPOSE: To evaluate the incidence, timing, and risk factors for postoperative needling procedure and incisional bleb revision following XEN gel stent implantation in a large single-center cohort with a long-term follow-up. METHODS: This retrospective observational cohort study included 773 eyes from 596 patients who underwent XEN gel stent implantation between December 2015 and July 2023. Patients had primary or secondary open-angle glaucoma and at least 12 months of follow-up. Primary outcomes were the need for surgical bleb revision (needling procedure or incisional bleb revision). Secondary outcomes included timing and frequency of interventions. Cox regression models were used to identify risk factors. RESULTS: A total of 417 eyes (53.9%) underwent at least one needling procedure, and 137 eyes (17.8%) required incisional bleb revision. Most interventions occurred within the first 100 weeks. Mean time to first needling procedure was 33.6 ± 49.1 weeks, and to first incisional revision 60.9 ± 62.5 weeks. The mean interval between needling procedure followed by incisional revision was 31.8 weeks, and 22.2 weeks for the reverse sequence. Cox regression revealed that male sex (HR 1.43; 95% CI, 1.03–1.99; p = 0.035) and phakic lens status (HR 0.59 for pseudophakia; 95% CI, 0.42–0.82; p = 0.002) were independently associated with incisional bleb revision. No examined baseline variables predicted the need for needling procedures. CONCLUSION: Postoperative bleb interventions are common after XEN gel stent implantation, occurring most frequently within the first two years but also extending into long-term follow-up. Male sex and phakic lens status are associated with a higher risk of incisional bleb revision, while needling procedure appears less dependent on baseline characteristics. These findings may help refine patient counselling, risk stratification, and postoperative management strategies.
Prevalence of anterior corneal scars impairing visual acuity after Descemet membrane endothelial keratoplasty (DMEK) and treatment by phototherapeutic keratectomy (PTK).
Menzel-Severing J, Stollenwerk L, Ullrich K … +3 more , Steindor F, Geerling G, Seiler TG
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42033481 · Publisher ↗
PURPOSE: To investigated the prevalence of anterior corneal scars after Descemet’s membrane endothelial keratoplasty (DMEK), and the results of transepithelial phototherapeutic keratectomy (transPTK) in affected patients...
PURPOSE: To investigated the prevalence of anterior corneal scars after Descemet’s membrane endothelial keratoplasty (DMEK), and the results of transepithelial phototherapeutic keratectomy (transPTK) in affected patients. METHODS: Records were reviewed of all patients who underwent DMEK at the study center between March 2014 and December 2020. Patients were included if surgery had been performed for Fuchs endothelial corneal dystrophy or bullous keratopathy and no relevant concomitant eye disease was documented. Two groups were formed based on postoperative CDVA (Snellen): CDVA ≤ 0.7 (group 1), and CDVA ≥ 0.8 (group 2). After PTK was established at the study center, records of group 1 were reviewed again (“follow-up”), including pre- and postoperative data in those patients that had undergone wavefront-guided PTK. RESULTS: Of 760 eyes that received DMEK, 420 were included in the analysis. A corneal scar was documented in 11.2% (47/420). These had a mean (± SD) CDVA of 0.66 ± 0.17. Mean CDVA in eyes without corneal scarring was 0.81 ± 0.11 (p < 0.01). A corneal scar was present in group 1 in 25% (29/116), and in group 2 in 6% (18/304) (p < 0.01). Fifty-seven eyes of group 1 were re-examined during the follow-up, yielding a prevalence of corneal scars of 29.8% (17/57). Of these, 23.5% (4/17) were candidates for PTK and 3 received treatment. Six months after transPTK, no corneal scar was seen, and CDVA was 1.0. CONCLUSION: Patients with reduced CDVA after DMEK should be examined for corneal scars, since transPTK can achieve full recovery of vision in selected cases.
Subconjunctival injectable platelet-rich fibrin for severe dry eye disease: Preliminary clinical results.
Sabur H, Coban AN, Arslan N … +1 more , Bahar A
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42029909 · Publisher ↗
PURPOSE: To evaluate the prelaminary clinical effects of subconjunctival injectable platelet-rich fibrin (i-PRF) in patients with severe dry eye disease (DED). METHODS: This study included two groups: an i-PRF group cons...
PURPOSE: To evaluate the prelaminary clinical effects of subconjunctival injectable platelet-rich fibrin (i-PRF) in patients with severe dry eye disease (DED). METHODS: This study included two groups: an i-PRF group consisting of 28 eyes treated with subconjunctival i-PRF injection and a control group of 32 eyes. The ocular surface disease index (OSDI-12), tear break-up time (TBUT), corneal fluorescein staining (CFS), tear meniscus height (TMH), and tear meniscus area (TMA) were assessed at baseline and during follow-up. Changes in clinical parameters were compared between the groups. RESULTS: Baseline demographic characteristics and dry eye parameters were comparable between the groups (all p > 0.05). After three injections, the i-PRF group showed a significantly greater reduction in OSDI-12 and CFS scores, as well as a significant increase in TBUT, compared with the control group. Tear meniscus parameters also improved in the i-PRF group, with TMH increasing from 145.9 ± 28.5 (143.0) to 254.3 ± 35.3 (258.5) µm and TMA from 0.015 ± 0.004 (0.016) to 0.043 ± 0.005(0.043) mm². CONCLUSION: Subconjunctival i-PRF injection was associated with improvements in both subjective symptoms and objective ocular surface parameters in patients with severe DED. These preliminary results suggest that i-PRF may be a promising adjunctive treatment option for patients refractory to conventional therapies. Further prospective controlled studies with longer follow-up are needed to confirm its efficacy and durability.
Comparison of choroidal biomarkers and scleral thickness in keratoconus in relation to corneal cross-linking.
Valsecchi N, Folgaria G, Febbraro S … +8 more , Lorenzi A, Shhada S, Rasheed MA, di Geronimo N, Moramarco A, Chhablani J, Fontana L, Mete M
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 42029908 · Publisher ↗
PURPOSE: To investigate whether corneal collagen cross-linking (CXL) is associated with measurable remodeling of extra-corneal tissues in KC, by comparing choroidal and scleral structural biomarkers between treatment-naï...
PURPOSE: To investigate whether corneal collagen cross-linking (CXL) is associated with measurable remodeling of extra-corneal tissues in KC, by comparing choroidal and scleral structural biomarkers between treatment-naïve and CXL-treated eyes. METHODS: This is a single center, cross-sectional, observational study. Anterior scleral thickness (ST) was quantified using swept-source anterior segment optical coherence tomography (AS-OCT; CASIA2, Tomey, Japan). Ocular biomechanical parameters were measured with the Ocular Response Analyzer (ORA; Reichert, Germany). Subfoveal choroidal thickness (SFCT), peripapillary choroidal thickness (PPCT) were assessed with spectral-domain OCT (SPECTRALIS HRA-OCT, Heidelberg Engineering, Germany). Choroidal vascularity index (CVI) and total choroidal area (TCA) were computed using a validated semi-automated algorithm. A subgroup analysis compared treated and untreated fellow eyes in unilateral CXL cases. RESULTS: 65 keratoconic eyes of 65 patients were recruited – 35 treatment-naïve versus 30 post–epithelium-off cross-linking (≥ 6 months post-treatment). CXL-treated eyes exhibited significantly greater Sub-Foveal Choroidal Thickness (SFCT) (421.1 ± 81.9 μm vs. 352.9 ± 81.9 μm; p = 0.016), mean Peripapillary Choroidal Thickness (PPCT) (238.0 ± 72.9 μm vs. 199.5 ± 65.3 μm; p = 0.038), and mean Total Choroidal Area (TCA) (1.45 ± 0.32 mm² vs. 1.29 ± 0.27 mm²; p = 0.046) compared with treatment-naïve eyes, whereas Choroidal Vascularity Index (CVI) and Scleral Thickness (ST) showed no significant differences (p > 0.05). In unilateral cases, treated eyes demonstrated consistent increases in SFCT, TCA, and PPCT relative to fellow untreated eyes (p < 0.05). PPE alterations occurred exclusively in the CXL group (16.7%). Multivariate regression analysis identified previous CXL as the only independent factor associated with increased SFCT (β = 0.340, p = 0.040). CONCLUSIONS: CXL appears to be associated with thicker choroids in keratoconic eyes, independent of biomechanical or scleral thickness variations. These findings support the hypothesis that CXL might be linked to subclinical remodeling of deeper ocular layers, potentially affecting choroidal-scleral fluid dynamics. Further prospective longitudinal studies with larger cohorts and multimodal assessment are warranted to clarify the mechanisms, time course, and long-term implications of choroidal changes following CXL.
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