Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
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200 papers
Risk of excessive macular thinning in diabetic macular edema with ellipsoid zone disruption treated with anti-VEGF: 2-year real-world evidence.
Lee YK, Hsu SM, Chang CH … +4 more , Hung JH, Chang YS, Lee CH, Wang JD
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41973127 · Publisher ↗
PURPOSE: This study investigates whether different morphological features affect the best-corrected visual acuity (BCVA) and central macular thickness (CMT) in patients with diabetic macular edema (DME) undergoing anti–v...
PURPOSE: This study investigates whether different morphological features affect the best-corrected visual acuity (BCVA) and central macular thickness (CMT) in patients with diabetic macular edema (DME) undergoing anti–vascular endothelial growth factor (anti-VEGF) therapy. METHODS: We retrospectively collected data from 727 eyes of 464 patients with DME who received either ranibizumab or aflibercept. We constructed mixed-effects regression models to determine if different morphological features shown on optical coherence tomography would affect post-treatment BCVA and CMT after controlling for clinical variables. In eyes with ellipsoid zone disruption (EZD), the relationship between baseline BCVA and achieving a final CMT < 200 μm was further examined. RESULTS: After 24 months of anti-VEGF treatment, patients demonstrated improvements in BCVA and reductions in CMT. Poorer post-treatment BCVA was associated with older age, longer treatment duration, EZD (p = 0.017) and disorganization of the retinal inner layers (DRIL) (p = 0.001). Excessive macular thinning (final CMT < 200 μm) was more frequently observed in eyes with EZD, particularly among those with a baseline BCVA < 15 ETDRS letters, in exploratory subgroup analyses. The association appeared more pronounced among individuals with increased hyperreflective foci (HRF) in the outer retina. CONCLUSION: In DME eyes with EZD, a poorer baseline BCVA and increased HRF appear to be statistically associated with excessive macular thinning following anti-VEGF treatment.
Switching anti-VEGF agents does not improve visual outcomes in branch retinal vein occlusion-related macular edema.
Peretz-Kahlon M, Wood K, Harris A … +2 more , Hod K, Shulman S
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41964889 · Publisher ↗
BACKGROUND: Branch retinal vein occlusion (BRVO) frequently results in macular edema (ME), impairing visual acuity (VA). Intravitreal anti-vascular endothelial growth factor (VEGF) injections are standard first-line ther...
BACKGROUND: Branch retinal vein occlusion (BRVO) frequently results in macular edema (ME), impairing visual acuity (VA). Intravitreal anti-vascular endothelial growth factor (VEGF) injections are standard first-line therapy but the benefit of switching agents (Ranibizumab or Aflibercept) is unclear. This study evaluated VA and treatment burden after switching anti-VEGF agents for persistent ME secondary to BRVO. METHODS: This retrospective cohort study included patients with ME due to BRVO treated at a tertiary referral clinic between August 2015 and December 2022. All received ≥ 3 monthly Bevacizumab injections; those with < 10% or < 50 µm reduction in central retinal thickness on optical coherence tomography (OCT) were eligible to switch to Ranibizumab or Aflibercept. Patients were grouped into “No-switch” or “Switch”. VA and injection frequency were assessed over 36 months using linear mixed-models. RESULTS: Of 385 eyes, 251 (65.2%) remained on Bevacizumab and 134 (34.8%) switched (71 Ranibizumab, 63 Aflibercept). VA significantly improved in both groups (p < 0.001), with no between-group difference (p = 0.897). In the Switch group, VA improved initially but showed no further gains post-switch and remained stable through 36 months (pre-switch 66.43 ± 12.99 and 67.34 ± 14.76 at 36 months, p = 0.144). Switching increased injection frequency in years 1–2 (p < 0.001 for both), but not year 3 (p = 0.207), and no difference between Ranibizumab and Aflibercept (p = 0.331). CONCLUSION: Switching anti-VEGF agents in BRVO-related ME did not improve VA but increased injection burden. VA stability before and after switching suggests no rescue effect, though anatomical stabilization may have contributed to long-term preservation.
Predictors of two-year visual outcomes after surgery for stage 3-4 epiretinal membrane: role of baseline vision and early retinal microstructural recovery.
Lee JH, Park YG, Park YH
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41964888 · Publisher ↗
PURPOSE: To evaluate the retinal and choroidal parameters associated with long-term postoperative visual outcomes of surgery for stage 3 and 4 epiretinal membranes (ERMs) and determine whether intravitreal or periocular...
PURPOSE: To evaluate the retinal and choroidal parameters associated with long-term postoperative visual outcomes of surgery for stage 3 and 4 epiretinal membranes (ERMs) and determine whether intravitreal or periocular steroid injection within the first operative year is independently associated with long-term visual improvement. METHODS: This single-center retrospective cohort study included patients diagnosed with stage 3 and 4 ERM who underwent pars plana vitrectomy between January 2019 and December 2022. The follow-up duration exceeded 2 years. The retinal and choroidal parameters were measured using optical coherence tomography. Their preoperative and postoperative best-corrected visual acuities (BCVA) were also measured, and independent predictors were evaluated using multivariable linear regression models. RESULTS: The data of 96 and 31 eyes with stage 3 and stage 4 ERM, respectively, were included. Preoperative BCVA was the strongest independent predictor of visual outcome across all time points (p < 0.001). The ellipsoid zone integrity and intraretinal cystic change showed borderline associations with postoperative BCVA at 3 months (p = 0.052) and 1 year (p = 0.079), respectively. At 2 years, the adjusted mean BCVA improvement (ΔlogMAR) was 0.146 (95% CI, 0.059–0.232) in the no-injection group and 0.203 (95% CI, 0.029–0.377) in the injection group. The adjusted between-group difference was 0.058 logMAR (95% CI, -0.141-0.256; p = 0.558) indicating no statistically significant association. CONCLUSION: This study provides longitudinal evidence that preoperative VA and postoperative EZ and retinal cystic changes are key indicators of 2-year visual outcomes after ERM surgery. However, choroidal thickness and postoperative steroid injection are not independently associated with these outcomes. These findings support the use of baseline vision and retinal microstructural status for preoperative counseling and risk stratification. Due to the retrospective nature of the study, the clinical trial number: not applicable.
Trans-scleral cryotherapy in the management of retinal hemangioblastomas.
Broadhead GK, Wiley HE, Agrón E … +4 more , Dao D, Chew EY, Coleman H, Thavikulwat AT
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41964887 · Publisher ↗
PURPOSE: To evaluate the efficacy of trans-scleral retinal cryotherapy in the management of retinal hemangioblastoma (RH) including in von Hippel Lindau disease (VHL). METHODS: Retrospective cohort study of 24 patients (...
PURPOSE: To evaluate the efficacy of trans-scleral retinal cryotherapy in the management of retinal hemangioblastoma (RH) including in von Hippel Lindau disease (VHL). METHODS: Retrospective cohort study of 24 patients (21 with VHL) receiving trans-scleral cryotherapy performed to RH lesions, with lesion characteristics and visual acuity (VA) assessed pre and post treatment using color photographs, optical coherence tomography and recorded clinical notes. RESULTS: Thirty-six lesions in 26 eyes received cryotherapy, with a mean follow up of 6.7 ± 3.5 years. Mean pretreatment VA was 69.7 ± 20.4 letters (Snellen equivalent of 20/40); 8 (22%) lesions were classified as clusters containing multiple RHs. Twenty-one (64%) lesions underwent retreatment using any modality and 15 (57.7%) eyes had treatment success (14 total success and 1 partial success). The average VA change at 1 year for patients with ≥ 1 year of follow-up was − 4.6 letters (p = 0.36 for VA change from baseline). In a logistic regression model, lower patient age at the time of cryotherapy trended towards increased odds of success (Odds ratio 1.085, 95% CI 1.00–1.180), but no other analyzed factor was statistically significantly associated with treatment success. CONCLUSIONS: Trans-scleral retinal cryotherapy can be effective in treating RHs. A significant proportion of these eyes progress despite cryoablative treatment.
Extraocular silicone oil deposition: a clinicopathologic case series.
DeLuca NJ, Camacho M, Idarraga M … +1 more , Dubovy SR
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41964886 · Publisher ↗
PURPOSE: To characterize the clinicopathologic features of extraocular silicone oil (SO) migration in the ocular adnexae, including the conjunctiva, eyelid, and orbit (CEO). METHODS: Retrospective, single-institution cas...
PURPOSE: To characterize the clinicopathologic features of extraocular silicone oil (SO) migration in the ocular adnexae, including the conjunctiva, eyelid, and orbit (CEO). METHODS: Retrospective, single-institution case series. The Florida Lions Ocular Pathology Laboratory database at the Bascom Palmer Eye Institute was searched for surgical specimens diagnosed with “silicone oil” involving the ocular adnexae from 1997 to 2023. Clinical and histopathologic features were reviewed. All specimens were stained with hematoxylin-eosin, and immunohistochemical stains for histiocytes CD68 (M1, pro-inflammatory) and CD163 (M2, anti-inflammatory). RESULTS: 25 specimens met inclusion criteria. Affected sites included the conjunctiva (76%), orbit (12%), eyelid (8%), and Tenon’s capsule (4%). Histopathology revealed clear dropout spaces consistent with SO surrounded by histiocytes in all cases. CD68 and CD163 both highlighted histiocytes, with CD163 demonstrating significantly higher immunohistochemical staining (p < 0.0001). The average time from SO placement to presentation was 451.1 days (Range: 14 − 1,220 days). SO migration was clinically suspected in 17 cases, presenting with conjunctival injection, irritation, cysts, or eyelid swelling. Imaging (anterior segment OCT, CT) aided diagnosis. CONCLUSION: Diagnosis of silicone oil migration in the ocular adnexae is important to avoid misdiagnosis. The presence of M2 histiocytes (anti-inflammatory) is consistent with the high immunotolerance of these lesions.
Quantitative analysis of trabecular meshwork pigment after ICL implantation and influencing factors.
Yang J, Wang H, Bai Y … +2 more , Jiao X, Wang W
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41964885 · Publisher ↗
PURPOSE: This study aimed to quantitatively analyze the changes in trabecular meshwork pigment after implantable collamer lens (ICL) implantation and its effect on intraocular pressure (IOP), and to analyze the influenci...
PURPOSE: This study aimed to quantitatively analyze the changes in trabecular meshwork pigment after implantable collamer lens (ICL) implantation and its effect on intraocular pressure (IOP), and to analyze the influencing factors of trabecular meshwork pigment changes. METHODS: A total of 80 patients with moderate to high myopia who underwent ICL implantation were monitored for a minimum of 6 months post-operation. Pre- and post-operatively, the temporal, nasal, superior, and inferior trabecular meshwork areas were evaluated using gonioscopy and photographed. ImageJ software was used to calculate the average grayscale value of TM pigment. Anterior segment OCT and ultrasound biomicroscopy (UBM) was utilized to measure the TIA, vault and iris-ICL contact distance. RESULTS: The total TM average gray value decreased by 13.6% (P < 0.001) at 1 month postoperatively compared to the preoperative measurement. By 3 months postoperatively, the total TM gray value had increased by 7.4% (P < 0.001) compared to 1 month postoperatively. At 6 months postoperatively, there was no statistically significant difference (P = 0.063) compared to the 3-month value. There was no correlation between the total average ΔTM grayscale values of the four quadrants and ΔIOP1m (R2 = 0.005, P = 0.316). ΔTM1m grayscale values and ΔILCD1m revealed no correlation. ΔTM1m grayscale value is weakly positively correlated with ICL size (standardized coefficient = 0.027, P = 0.043).ΔTM6m grayscale value is positively correlated with white-to-white (standardized coefficient = 0.242, P = 0.008). CONCLUSION: Quantitative analysis revealed a transient increase in TM pigment levels in all quadrants after ICL implantation. The increase in TM pigment deposition did not impact IOP.
Janus Kinase inhibitors associated with reduced anterior uveitis risk in autoimmune diseases.
Wu SL, Pan SY, Weng CH … +11 more , Lin JF, Hsia Y, Lee MF, Chu YW, Ho WT, Huang SP, Li DX, Lin HJ, Wang IJ, Chen YM, Chou CC
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41961254 · Publisher ↗
PURPOSE: To evaluate the impact of Janus kinase inhibitors (JAKi) compared to anti-tumor necrosis factor-α antibodies (anti-TNF) on anterior uveitis (AU) risk in patients with autoimmune diseases. METHODS: This retrospec...
PURPOSE: To evaluate the impact of Janus kinase inhibitors (JAKi) compared to anti-tumor necrosis factor-α antibodies (anti-TNF) on anterior uveitis (AU) risk in patients with autoimmune diseases. METHODS: This retrospective cohort study analyzed deidentified global electronic medical records from December 2011 to December 2023, with 2-year follow-up. Adults with ankylosing spondylitis, psoriasis, psoriatic arthritis, or inflammatory bowel disease newly prescribed JAKi or anti-TNF were included. After 1:1 propensity score matching, 3,332 matched pairs were analyzed. AU incidence was assessed using Kaplan-Meier analysis. RESULTS: JAKi was associated with lower AU risk compared to total anti-TNF (HR: 0.43, 95% CI: 0.20–0.92) and non-monoclonal anti-TNF (HR: 0.28, 95% CI: 0.11–0.68). In ankylosing spondylitis, JAKi showed lower risk versus all anti-TNF biologics: total (HR: 0.30, 95% CI: 0.10–0.91), non-monoclonal (HR: 0.33, 95% CI: 0.11–0.99), and monoclonal anti-TNF (HR: 0.26, 95% CI: 0.09–0.78). CONCLUSIONS: JAKi use is associated with reduced AU incidence compared to anti-TNF therapies, particularly in ankylosing spondylitis, supporting JAKi as a potential treatment option for autoimmune-related uveitis.
The effect of acute zonular occult outer retinopathy on retinal vessel oxygen saturation.
Salim Al-Hamdani SZ, Al Tweish B, Rickmann A … +5 more , Seitz B, Scholl HP, Szentmáry N, Fries FN, Della Volpe Waizel M
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41961253 · Publisher ↗
PURPOSE: To measure the retinal vessel oxygen saturation alteration with retinal oximetry (RO) in patients with acute zonular occult outer retinopathy (AZOOR) and compare these findings with retinitis pigmentosa (RP) and...
PURPOSE: To measure the retinal vessel oxygen saturation alteration with retinal oximetry (RO) in patients with acute zonular occult outer retinopathy (AZOOR) and compare these findings with retinitis pigmentosa (RP) and controls. METHODS: Prospective observational study examining 189 eyes of 98 patients: 12 eyes of 6 AZOOR patients (1♂5♀; 48.5 ± 19.2 years (mean ± SD) were compared to 77 eyes from 39 patients with RP (15♀ 24♂; 45.6 ± 14.7 years) and 100 eyes from 53 controls (31♀ 22♂; 40.2 ± 13.4 years). Main outcome measures were the mean arterial (A-SO2; %), venular (V-SO2; %) oxygen saturation, as well as their difference (A-V SO2; %) measured with the oxygen saturation tool of the Retinal Vessel Analyzer (IMEDOS Systems UG, Germany). RESULTS: Eyes affected by AZOOR differed significantly from both RP and control eyes in terms of retinal oxygen metabolic parameters. Compared to controls, AZOOR eyes showed significantly higher A-SO₂ and V-SO₂ values (p = 0.031 and p = 0.044, respectively), while V-SO₂ was significantly lower in AZOOR compared to RP eyes (p = 0.035). A–V SO₂, which reflects retinal oxygen consumption, was significantly reduced only in RP eyes, but not in AZOOR eyes, when compared to controls. CONCLUSION: Assessments of retinal oxygen metabolism might contribute to a correct diagnosis and a better understanding of the pathogenesis of AZOOR and RP.
Is it really keratoconus or pseudo-keratoconus? - Topographic mimicry.
Wykrota AA, Seitz B, Flockerzi E
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41961252 · Publisher ↗
PURPOSE: This case series aimed to present eyes with a topographic pseudo-keratoconus configuration resulting from corneal diseases other than keratoconus (KC). METHODS: Inclusion criteria were a topographic classificati...
PURPOSE: This case series aimed to present eyes with a topographic pseudo-keratoconus configuration resulting from corneal diseases other than keratoconus (KC). METHODS: Inclusion criteria were a topographic classification of the cornea as KC by Scheimpflug imaging, considering the topographic keratoconus classification (TKC), and a typical height-data profile with irregular astigmatism and an inferior-superior asymmetry value (I-S value) > 1.4 at 6 mm of the cornea. Clinical slit-lamp examination, best-corrected visual acuity, and Scheimpflug tomography (Pentacam®, OCULUS, Wetzlar, Germany) were analyzed. Standard deviations and 95% confidence intervals were added where applicable to enhance descriptive precision. RESULTS: Fifty-seven eyes of 37 patients were included (mean age 49 years, range 18–78; female-to-male ratio 16:21). The mean Kmax was 50 D (42.4–57.8), mean TKC 2, and I-S value 2.87 (1.4–4.91). Mean corneal thickness at the thinnest point was 528 μm (274–709). Study eyes were divided into three groups according to the underlying cause of topographic change: (1) inferior steepening (e.g. Map-Dot-Fingerprint dystrophy); (2) superior configuration (e.g. dry-eye disease or Salzmann nodular degeneration); and (3) newly developed keratoconus-like configuration after phototherapeutic keratectomy. CONCLUSIONS: Different corneal pathologies can imitate a topographic KC configuration. Differentiating pseudo-keratoconus from true ectasia is clinically relevant to avoid inappropriate treatment and ensure correct patient counseling. Identifying and distinguishing these pathologies – particularly at the slit lamp – are essential for accurate diagnosis and adequate therapy.
Utility of handheld optical coherence tomography imaging in the surgical management of preterm infants with advanced retinopathy of prematurity.
Mangalesh S, Narawane A, Zheng Y … +9 more , Tran-Viet D, Imperio R, Li AS, Lai TT, Vajzovic L, Prakalapakorn SG, Freedman SF, Toth CA, Chen X
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41954766 · Full text
PURPOSE: The advent of handheld optical coherence tomography (OCT) as a research instrument has significantly advanced our understanding of retinopathy of prematurity (ROP). We aim to determine if OCT imaging can aid in...
PURPOSE: The advent of handheld optical coherence tomography (OCT) as a research instrument has significantly advanced our understanding of retinopathy of prematurity (ROP). We aim to determine if OCT imaging can aid in surgical decision-making for preterm infants with advanced ROP. METHODS: This case series included seven preterm infants with clinical stage 4 or 5 ROP who underwent bedside OCT imaging at a single academic center. Handheld OCT was performed before and/or after treatment (i.e. intravitreal bevacizumab, laser photocoagulation, and/or vitrectomy). OCT images were reviewed for presence of retinoschisis or retinal detachment, foveal involvement, and posterior extent of retinal elevation observed on indirect ophthalmoscopy. RESULTS: Among the seven preterm infants included, six infants (8 eyes) had clinical stage 4 ROP, and one infant (one eye) had stage 5 ROP. Preoperative OCT demonstrated foveal involvement and/or progressive traction in two eyes, which informed the decision to proceed with vitrectomy. In one eye with stage 5 ROP, postoperative OCT one month following vitrectomy revealed retinal reattachment not evident on clinical examination, supporting deferral of additional surgery. In six eyes treated with intravitreal bevacizumab and/or laser photocoagulation, OCT was helpful in monitoring posterior extension of retinal elevation. The absence of progression and/or improvement in retinoschisis in context with the clinical findings, supported the decision to avoid surgery in these cases. CONCLUSIONS: Handheld OCT provided valuable insights in evaluating foveal involvement, monitoring progression of retinal elevation, supporting informed clinical decision-making, and reducing the need for surgical intervention in select infants with advanced ROP.
Correction: Analysing myopia in Europe: A comprehensive meta-analysis.
Martinez-Perez C, Alvarez-Peregrina C, Villa-Collar C … +1 more , Sánchez-Tena MÁ
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41949612 · Publisher ↗
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Epiretinal membrane prevalence in asymmetrical pseudoexfoliation glaucoma and its impact on glaucoma monitoring parameters including peripapillary vessel density.
Solmaz N, Kutucu EEO, Uysal O … +1 more , Ulukartal AG
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41945091 · Publisher ↗
PURPOSE: To determine the prevalence of epiretinal membrane (ERM) in asymmetrical pseudoexfoliation glaucoma (PXG) and to assess its impact on glaucoma monitoring parameters, including peripapillary radial capillary vess...
PURPOSE: To determine the prevalence of epiretinal membrane (ERM) in asymmetrical pseudoexfoliation glaucoma (PXG) and to assess its impact on glaucoma monitoring parameters, including peripapillary radial capillary vessel density (RPC-VD) and macular vessel density (VD). STUDY DESIGN: Prospective, cross-sectional study. METHODS: The study included 160 eyes from 80 patients with asymmetrical PXG (PX material present in only one eye) and 80 right eyes from age-matched patients with primary open-angle glaucoma (POAG). All participants underwent optical coherence tomography angiography (OCTA) imaging. Differences between PXG, PX-negative fellow eyes, and POAG eyes were analyzed using generalized linear mixed models (GLMMs) to account for inter-eye dependency. RESULTS: There were no significant differences between PXG and POAG eyes in terms of age, visual field mean deviation (VF-MD), retinal nerve fiber (RNFL), ganglion cell complex (GCC), RPC-VD or most macular VD parameters (all p > 0.05). However, PXG eyes had a significantly higher risk of ERM than POAG eyes (OR = 5.60, 95% CI: 1.75–17.88, p = 0.004), after adjustment for age, sex, cataract and/or glaucoma surgery, diabetes, hypertension, and prostaglandin use. PX-negative fellow eyes exhibited an intermediate ERM prevalence, higher than in POAG eyes but not significantly different from either PXG or POAG eyes. Among PXG eyes, those with ERM had worse VF-MD (median: -7.62 dB vs. -2.53 dB, p = 0.008) and lower average RPC-VD and macular VD (p < 0.001– 0.008), while RNFL and GCC thicknesses were comparable. CONCLUSION: PXG was associated with a higher prevalence of ERM, and PX-negative fellow eyes may represent an intermediate stage within the pseudoexfoliation spectrum. In PXG eyes, the presence of ERM was associated with worse VF-MD, and reduced RPC-VD and macular VD. Detailed macular imaging and OCTA evaluation may improve the interpretation of VF changes and support clinical follow-up.
Global epigenetic immunohistochemical markers reveal developmental connections of distinct cell types during fetal development.
Jost MT, Loeffler KU, Holz FG … +4 more , Sharma A, Schmitz MT, Müller AM, Herwig-Carl MC
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41925818 · Publisher ↗
PURPOSE: The prenatal development of the human retina is a complex process orchestrated by several epigenetic mechanisms. This study investigated some global epigenetic markers (histone H3, histone H4, 5-methylcytosine,...
PURPOSE: The prenatal development of the human retina is a complex process orchestrated by several epigenetic mechanisms. This study investigated some global epigenetic markers (histone H3, histone H4, 5-methylcytosine, 5-hydroxymethylcytosine) during the fetal development of the human retina in 34 human eyes from 11 to 38 weeks of gestation. METHODS: Immunohistochemical staining was performed to assess the distribution and intensity of the selected epigenetic markers across developmental stages. For the general retinal staining intensity, a score from 0 to 3 was used, whereas for the percentage of stained retinal nuclei, a score from 0 to 4 was applied. The two scores were multiplied resulting in the final staining score. The mean of the two graders was used for statistical analysis. Staining patterns were analyzed with regard to regional disparities (central versus periphery), distinctions among retinal cell layers, individual cell types, and changes over time. RESULTS: The immunohistochemical staining reaction varied across developmental stages, showing regional disparities and distinctions among retinal cell layers and individual cell types. We observed consistent trends of decreasing staining scores for histone 3 and 4 acetylation and DNA methylation decrease with advancing gestational age. Significant differences among trimesters indicated dynamic epigenetic changes during fetal retinal development. Morphological analysis revealed distinct staining patterns that correlated with cellular morphology and differentiation levelsGganglion cells, amacrine cells, and Müller cells demonstratednotable similarities in staining patterns with regard to the developmental stage. Furthermore, differences between central and peripheral retina diminished with age. CONCLUSION: The study provides novel insights into the epigenetic regulation of retinal development in humans and underscores the importance of analyzing the epigenome at the cellular level for a comprehensive understanding. Understanding these epigenetic processes may pave the way for further investigations on retinal development and the communication between different cell types.
The hidden primary glaucoma in retinal vein occlusion: a call for systematic screening.
Bao Q, Zheng Y, Zeng W … +8 more , Zheng T, Liu Y, Ye Z, Li Y, Li X, Xia H, Chen X, Ke M
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41925817 · Publisher ↗
BACKGROUND: To investigate the epidemiological characteristics of primary glaucoma in patients with retinal vein occlusion (RVO), providing evidence-based insights for clinical diagnosis and management. METHODS: This ret...
BACKGROUND: To investigate the epidemiological characteristics of primary glaucoma in patients with retinal vein occlusion (RVO), providing evidence-based insights for clinical diagnosis and management. METHODS: This retrospective study included patients diagnosed with RVO at the Department of Ophthalmology, Zhongnan Hospital of Wuhan University, from January 2018 to April 2024. Primary glaucoma screening followed a two-step protocol: (1) preliminary evaluation using existing ophthalmic records; and (2) confirmatory testing with additional examinations for suspected cases. RESULTS: Among 610 enrolled RVO patients, 94 (15.4%) were diagnosed with primary glaucoma, including 9.2% (56/610) with primary open-angle glaucoma, 6.2% (38/610) with primary angle-closure glaucoma. Of the primary glaucoma cases, 43/94 (45.7%) were previously undiagnosed, consisting of 37 primary open-angle glaucoma (including 20 normal-tension glaucoma) and 6 chronic angle-closure glaucoma. CONCLUSIONS: This study demonstrates a high prevalence of primary glaucoma—particularly normal-tension glaucoma—in patients with RVO compared to the general population, with nearly half of cases previously undiagnosed. These observations highlight the importance of clinical awareness and the potential benefit of glaucoma screening in this population. However, given the observational design, prospective studies are needed to confirm the value of systematic screening before practice-level recommendations can be made.
Vitreous collagen fragment dimensions after vitrectomy: a pilot study addressing the cut-rate enigma.
Rossi T, Bocedi A, Notari S … +12 more , Sbardella D, Fazi L, Priorello A, Querzoli G, Giammaria S, Anselmi G, Romano MR, Gaboardi MG, Romanelli G, Senesi R, Steel DH, Minniti T
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41925816 · Publisher ↗
PURPOSE: to measure vitreous fragments generated at 5,000 and 20,000 cuts-per-minute (CPM) by means of Scanning Electronic Microscopy (SEM; fragments > 550 nm), Optical Profilometry and Dynamic Light Scattering (DLS; fra...
PURPOSE: to measure vitreous fragments generated at 5,000 and 20,000 cuts-per-minute (CPM) by means of Scanning Electronic Microscopy (SEM; fragments > 550 nm), Optical Profilometry and Dynamic Light Scattering (DLS; fragments 10-550 nm) and assess if cur-rate affects vitreous fragment size. METHODS: Vitreous samples at 5k and 20 K CPM were collected from 3 patients undergoing 25G pars plana vitrectomy for macular pucker. SEM and Profilometry measured fragment size in 6 drops from each sample, DLS analysed the remainder. Each patient contributed 2 samples at 5 K and 20 K CPM taken at the beginning of surgery. RESULTS: The median volume was 1,153.6 µm3 (IQR 2,322.3 µm3) at 5k and 72,4 µm3 (IQR 923.4 µm3) at 20k, respectively (Mann-Whitney p = 0.074); the variability of vitreous fragment volume was higher for 5 K CPM group (p = 0.036). DSL median fragment dimension in the 10-550 nm range was 50.7 nm (IQR 87.8 nm) for the 5 K CPM group and 43.8 nm (IQR 95.9 nm) for the 20 K CPM group (p < 0.001). CONCLUSION: A fourfold increase in cut-rate did not produce significantly smaller vitreous fragments but the 20 K CPM samples showed less variability. Fragments size spanned 5 orders of magnitude (from nanometers to hundreds of microns), challenging the assumption that blade action produces uniform fragments. Fragment size variability minimally affected by cut-rate, questions the blade action as the main or only factor shearing vitreous. Elongation stress and shear stress most likely play a prominent role.
Octa evaluation of macular and optic disc vascular changes after PRP.
Karabacak DD, Doğruya S, Altınışık M … +1 more , Kayıkçıoğlu ÖR
Graefes Arch Clin Exp Ophthalmol · 2026 Apr · PMID 41920326 · Publisher ↗
PURPOSE: This study aimed to evaluate the impact of panretinal photocoagulation (PRP) on macular and optic nerve head microvascular parameters using optical coherence tomography angiography (OCTA) in eyes with proliferat...
PURPOSE: This study aimed to evaluate the impact of panretinal photocoagulation (PRP) on macular and optic nerve head microvascular parameters using optical coherence tomography angiography (OCTA) in eyes with proliferative diabetic retinopathy (PDR) and very severe non-proliferative diabetic retinopathy (NPDR). MATERIAL AND METHOD: In this prospective study, 56 treatment-naive eyes diagnosed with PDR or very severe NPDR and without diabetic macular edema were enrolled. PRP was performed over two sessions using a pattern scan laser in multispot mode. For each eye, the total laser ablation area (LAA) was calculated. OCTA imaging was performed before PRP, after the first PRP session, and at the 1-month follow-up. The following parameters were assessed: central macular thickness (CMT), subfoveal choroidal thickness (SFCT), foveal avascular zone (FAZ), superficial capillary plexus (SCP) vascular density (VD), deep capillary plexus (DCP) VD, and radial peripapillary capillary plexus (RPCP) VD. RESULTS: Twenty-seven eyes had very severe NPDR and 29 had PDR. One month after PRP, CMT increased significantly, while SFCT and best-corrected visual acuity remained unchanged. SCP-VD values (whole image, superior/inferior hemi-fields, parafoveal and perifoveal regions) were significantly reduced both 30 min and 1 month after PRP. DCP-VD values were significantly reduced at 30 min in all regions but returned to baseline by month one. FAZ area and perimeter did not change significantly, whereas foveal density-300 (FD-300) decreased both at 30 min and at one month. Regarding optic nerve head parameters, RPCP-VD inside the disc decreased at 30 min, and peripapillary RPCP-VD decreased significantly at the one-month visit. No correlation was found between LAA and changes in any OCTA parameter or OCT metrics. CONCLUSION: OCTA revealed that PRP induces measurable microvascular alterations in both the macula and optic nerve head. These findings suggest that PRP has acute and subacute effects on retinal and peripapillary microvasculature independent of total laser ablation area.
Short-term natural history of non-perfusion areas in treatment-naive diabetic retinopathy patients using swept-source OCT angiography.
Ding X, Romano F, Garcia MD … +14 more , Garg I, Gan J, Overbey KM, Vingopoulos F, Bennett CF, Shan M, Stettler I, Finn MJ, Vavvas DG, Husain D, Wu DM, Patel NA, Kim LA, Miller JB
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41915053 · Publisher ↗
PURPOSE: To investigate the longitudinal progression of non-perfusion areas (NPA) in treatment-naïve patients with diabetic retinopathy (DR) using swept-source OCT angiography (SS-OCTA), and to identify clinical and imag...
PURPOSE: To investigate the longitudinal progression of non-perfusion areas (NPA) in treatment-naïve patients with diabetic retinopathy (DR) using swept-source OCT angiography (SS-OCTA), and to identify clinical and imaging predictors. METHODS: Retrospective longitudinal study. At each visit, 6 × 6-mm and 12 × 12-mm SS-OCTA (PLEX® Elite 9000) macular scans were performed. NPA was measured using ImageJ. The ischemic index (ISI) was calculated as NPA divided by total scan area. ISI progression rate was quantified by the change from baseline to the last visit, normalized by time. Additional OCTA metrics, including vessel density and skeletonized vessel density, were calculated using the ARI Network. RESULTS: A total of 101 eyes from 70 DR patients were included, with a median age of 59 [52–68] years. During follow-up (median duration: 15.5 [6.0–27.0] months), ISI progression rate per year in the proliferative DR group (0.01 [-0.01-0,06]) is significantly faster than both mild non-proliferative DR (0.00 [0.00–0.00]) and moderate-severe non-proliferative DR (0.00 [0.00-0.02]) groups (all P < 0.05). Mixed-effects linear regression identified DR severity and baseline ISI as the only factors significantly associated with ISI progression rate, with beta values of 0.33 (95% CI: 0.04–0.63, P = 0.03) for DR severity and 3.75 (95% CI: 0.03–7.47, P < 0.05) for baseline ISI. CONCLUSION: This study is the first to characterize progression rate of SS-OCTA–derived ISI in treatment-naïve DR eyes, showing a strong linear correlation with baseline DR severity and ISI, but not with other OCTA metrics. These findings support ISI as a robust OCTA biomarker for monitoring DR progression.
Autologous platelet-rich plasma versus autologous serum in treatment of dry eye disease.
Mandour SS, Mariey H, Elgyoshy A … +1 more , Fayed AS
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41915052 · Publisher ↗
PURPOSE: This work aimed to assess the efficacy and safety of autologous PRP versus AS in treatment of moderate to severe DED. METHODS: A prospective, comparative, randomized controlled clinical trial involved 96 eyes of...
PURPOSE: This work aimed to assess the efficacy and safety of autologous PRP versus AS in treatment of moderate to severe DED. METHODS: A prospective, comparative, randomized controlled clinical trial involved 96 eyes of 48 cases with moderate and severe DED divided into 3 groups (16 patients each). Group 1 received PRP eye drops, Group 2 received AS eye drops and Group 3 (control group) received sodium hyaluronate eye drops. All participants were subjected to Ocular Surface Disease Index (OSDI), tear film break-up time (TBUT), Schirmer 1 test, ocular surface staining, and best corrected visual acuity (BCVA). RESULTS: PRP and AS showed significant improvements in all parameters compared to sodium hyaluronate, with greater improvement in OSDI, Schirmer test and ocular surface staining with PRP compared to AS. CONCLUSION: PRP and AS have high safety and efficacy rates in moderate and severe DED, providing better symptom relief and clinical improvements than artificial tears with superiority for PRP over AS.
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 Mar · PMID 41910767 · Publisher ↗
PURPOSE: This study aimed to evaluate the therapeutic potential of trabecular meshwork stem cells (TMSC) transplantation in enhancing the trabecular meshwork (TM) cell proliferation and intraocular pressure (IOP) reducti...
PURPOSE: This study aimed to evaluate the therapeutic potential of trabecular meshwork stem cells (TMSC) transplantation in enhancing the trabecular meshwork (TM) cell proliferation and intraocular pressure (IOP) reduction in a cell loss human organ cultured anterior segment (HOCAS) model of glaucoma. METHODS: A cell loss HOCAS model of glaucoma was established using saponin. IOP was monitored at regular intervals, and immunohistochemistry was performed to quantify the cell loss. Qtracker-labeled cultured TMSCs (3 × 10⁵ cells/500µl) were transplanted into the model, with periodic monitoring of IOP changes. After five days of transplantation, tissues were subjected to immunohistochemistry (ABCG2, p75) to evaluate the localization of the transplanted stem cells. The effectiveness of the transplanted cells in promoting TM proliferation was further evaluated by Ki67 staining. RESULTS: The saponin treatment in the HOCAS model resulted in 32.08 ± 4.74% cell death and decrease in the outflow facility by 15% at day 6. Transplantation of cultured TMSCs into this model mitigated the outflow resistance induced by saponin and increase the outflow by 38%. Confocal microscopic analysis confirmed the homing of transplanted TMSCs to both filtering and non-filtering regions of the TM. Additionally, TMSC transplantation resulted in a significant increase in TM cell proliferation, which was 17.94 ± 4.45% compared to the sham treatment, which showed 5.29 ± 4.2%. CONCLUSIONS: The cell loss HOCAS model for glaucoma was established using saponin which resulted in IOP increase and TM cell loss. Further, in this model, the transplanted TMSCs, home to TM, and resulted in the reduction of IOP which was increased upon saponin treatment. The TMSC transplantation also enhanced TM cell proliferation.
Imaging infants and children with investigational handheld optical coherence tomography with widefield lens: a pilot study.
Li AS, Imperio R, Tran-Viet D … +6 more , Mangalesh S, Prakalapakorn SG, Vajzovic L, Maldonado R, Freedman SF, Chen X
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41910766 · Publisher ↗
PURPOSE: This pilot study evaluated the field-of-view (FOV) and ability to visualize vitreoretinal features using an investigational handheld swept-source optical coherence tomography (OCT) system with widefield contact...
PURPOSE: This pilot study evaluated the field-of-view (FOV) and ability to visualize vitreoretinal features using an investigational handheld swept-source optical coherence tomography (OCT) system with widefield contact lens in infants and children. METHODS: Infants and children undergoing examination at bedside or examination under anesthesia (EUA) were enrolled. Images were acquired using T1-W investigational handheld OCT system (Theia Imaging, Durham, NC), with 145-degree FOV and volume capture time of 1.2–2.4 s. Scans were processed with custom MATLAB software. The FOVs and visualized clinical features were evaluated. RESULTS: OCT scans were captured in 26 eyes of 14 infants and children (postmenstrual age: 36 weeks to 15 years). Images were acquired during EUA in 24 eyes and at bedside in 2 eyes. The optic nerve, fovea, and mid-peripheral retina were captured in a single OCT volume in 100% of imaged eyes. En face OCT images had a comparable or larger FOV when compared to same day widefield fundus photography qualitatively side-by-side. Cross-sectional OCT images allowed for widefield visualization of the vitreoretinal interface (i.e. vitreous traction over operculated hole), intraretinal features (i.e. tractional retinoschisis or retinal thickening near the vascular-avascular junction), and subretinal features (i.e. subretinal exudates or subfoveal nodule in Coats disease). CONCLUSIONS: In this pilot study, use of investigational widefield handheld OCT system captured high-quality en face and cross-sectional OCT images. The vitreoretinal interface, intraretinal, and subretinal features were visualized across the posterior pole and periphery. Further application of this system can provide valuable information about the pediatric retina.
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