Graefes Arch. Clin. Exp. Ophthalmol. [JOURNAL]
Sun
200 papers
Interocular asymmetry of fundus characteristics in patients with unilateral severe carotid artery stenosis.
Zhang L, Han N, Lei CY … +5 more , Jiang FP, Yang TY, Xiao ZH, Gao S, Zhang MX
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41910765 · Publisher ↗
OBJECTIVE: To compare fundus characteristics between ipsilateral and contralateral eyes in patients with unilateral severe carotid artery stenosis (SCAS) and explore their association with acute cerebral infarction (ACI)...
OBJECTIVE: To compare fundus characteristics between ipsilateral and contralateral eyes in patients with unilateral severe carotid artery stenosis (SCAS) and explore their association with acute cerebral infarction (ACI). METHODS: One hundred twelve patients were included in this cross-sectional study and underwent detailed ophthalmic examinations. Retinal vessel diameters were assessed by calculating central retinal arterial equivalent (CRAE), venular equivalent (CRVE), and objective arterio-venular ratio (oAVR). Retinal microvascular abnormalities (RMAs) were assessed by evaluating and grading retinal arteriolar, venular, and arterio-venular characteristics, and by summing up the points in RMAs assessment, the total vascular abnormality scores (TVAS) were obtained. Retinopathies were assessed using multimodel imaging. Interocular asymmetry and its association with ACI were analyzed. RESULTS: Ipsilateral eyes showed significantly larger CRVE (228.8 ± 22.5 μm vs. 222.6 ± 22.5 μm, p = 0.002), higher frequencies of oAVR < 2/3 (65.2% vs. 51.8%, p = 0.042), macular venular tortuosity (VTM) (52.7% vs. 39.3%, p = 0.044), TVAS > 10 (22.3% vs. 9.8%, p = 0.011), and retinal lesions (22.3% vs. 4.5%, p < 0.001). Multivariate regression identified ipsilateral VTM (OR = 3.342, 95%CI:1.119–9.978, p = 0.031) and ipsilateral TVAS > 10 (OR = 3.624, 95%CI:1.142–11.501, p = 0.029) as independent risk factors associated with ACI. CONCLUSIONS: Asymmetric fundus features may indicate unilateral carotid disease. Ipsilateral VTM and a high TVAS are associated with ACI and warrant close monitoring in SCAS patients.
Non neovascular Age - related macular degeneration - Review on clinical and imaging advances.
Savastano MC, Fossataro C, Hu L … +5 more , Mottola F, D'Onofrio NC, Cestrone V, Giannuzzi F, Rizzo S
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41910764 · Publisher ↗
The aim of this review was to provide an overview of the principal features of non-neovascular age – related macular degeneration (NNAMD) and how they appear by multimodal imaging.None are specific of the disease, but th...
The aim of this review was to provide an overview of the principal features of non-neovascular age – related macular degeneration (NNAMD) and how they appear by multimodal imaging.None are specific of the disease, but their simultaneous detection, their distribution and the development in a particular age range allow to make the correct diagnosis. The current availability of different imaging modalities offers the chance to better characterize the disease and to detect the earliest changes, monitoring its progression to the late stage, known as geographic atrophy (GA). A recent consensus has provided a novel definition of GA, based on optical coherence tomography (OCT), introducing two novel concepts: incomplete and complete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA and cRORA, respectively). The main recognized risk factors for progression are soft drusen, drusenoid pigment epithelium detachment (PED), subretinal drusenoid deposits (SDD), intraretinal hyperreflective foci (iHRF) and acquired vitelliform lesion.Soft drusen represent one of the earliest signs of NNAMD and their confluence can lead to the development of drusenoid PED, whose height mainly correlates with progression. SDD have been better characterized after the advent of the OCT and differently from the drusen, the material accumulates above the RPE.iHRF could be observed in different retinal layers, but the involvement of the outer nuclear layer has been recognized to correlate more with GA development.The identification of valid biomarkers is crucial to monitor and predict the disease progression and to evaluate the efficacy of novel proposed therapies in clinical trials.
Multiscale OCTA framework for assessing choriocapillaris flow-void organisation in chronic central serous chorioretinopathy using a vascular coalescence index.
Gurpinar A, Kocak N, Sullu Y
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41910763 · Publisher ↗
PURPOSE: To perform a multiscale assessment of retinal and choriocapillaris microvascular alterations in chronic central serous chorioretinopathy (CSC) using optical coherence tomography angiography (OCTA) metrics and fr...
PURPOSE: To perform a multiscale assessment of retinal and choriocapillaris microvascular alterations in chronic central serous chorioretinopathy (CSC) using optical coherence tomography angiography (OCTA) metrics and fractal-based descriptors, and to introduce a novel index quantifying choriocapillaris flow-void organisation. METHODS: This prospective study included 40 eyes with chronic CSC, 40 fellow eyes, and 40 eyes from 40 age- and sex-matched healthy controls. Superficial and deep capillary plexus (SCP/DCP) angiograms were analysed for conventional vascular metrics, foveal avascular zone (FAZ) parameters, and multifractal descriptors. Choriocapillaris (CC) flow voids were quantified as total non-flow area, flow deficit percentage, void count, mean void area, and largest void area. The vascular coalescence index (VCI) was defined as the ratio of the largest void area to the total number of voids to reflect flow-void coalescence. RESULTS: SCP metrics were largely preserved, although FAZ perimeter was greater in CSC eyes than in control eyes. DCP showed significant impairment in CSC eyes, including reduced vessel density and length, and increased vessel diameter index and non-flow area, compared with controls (all p < 0.05). CC analysis revealed higher non-flow area and flow deficit percentage in CSC eyes (both p = 0.001), accompanied by fewer voids and larger mean void areas (p = 0.006, p = 0.001, respectively). VCI was significantly higher in CSC and fellow eyes than in control eyes (p = 0.002 and p = 0.007, respectively). CONCLUSIONS: Chronic CSC demonstrates layer-specific microvascular disruption predominantly affecting the DCP and CC, with CC flow-void reorganisation beyond simple non-perfusion. VCI provides a quantitative descriptor of CC flow-void coalescence, complementing conventional OCTA metrics.
Clinical outcomes of Preserflo MicroShunt implant procedure in open‑angle glaucoma patients - a 1000 eyes case-series; including subanalysis of combined cataract-glaucoma surgery and standalone surgery in pseudophakic eyes.
Klabe K, Werth JP, Kaymak H … +1 more , Fricke A
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41902904 · Publisher ↗
PURPOSE: This retrospective, single-center study aimed to determine the long-term real-world efficacy and safety of the MicroShunt over up to a 6-year period in a heterogeneous glaucoma population of 1001 eyes: including...
PURPOSE: This retrospective, single-center study aimed to determine the long-term real-world efficacy and safety of the MicroShunt over up to a 6-year period in a heterogeneous glaucoma population of 1001 eyes: including pseudophakic eyes and eyes undergoing combined cataract and MicroShunt surgery. METHODS: Data were analyzed from 1001 eyes implanted with the MicroShunt between January 2019 and May 2025. The outcomes collected were intraocular pressure (IOP) reduction, complete and qualified surgical success at targets of 6-14, 6-18, and 6-21 mmHg, the medication burden, and the postoperative complications. Subgroup analyses compared all the eyes implanted with pseudophakic eyes or those undergoing combined cataract and MicroShunt surgery. RESULTS: The mean baseline IOP was 24.8 ± 8.4 mmHg across all eyes. IOP decreased to 9.6 ± 4.4 mmHg on postoperative day 1 and remained significantly reduced at 1 year (13.2 ± 3.9 mmHg) and 6 years (13.9 ± 2.3 mmHg). The IOP trajectories were similar in the subgroups. The IOP was slightly lower in eyes that had combined surgery. At 5 years, the complete success was 54%, 36%, and 8% for IOP thresholds of 6-21, 6-18, and 6-14 mmHg, respectively; while the qualified success rates were 62%, 38%, and 15%, respectively. The number of medications decreased significantly after surgery. Early postoperative complications were infrequent and usually transient. The complications were similar across subgroups with choroidal detachment (≤ 12%) and microhyphaema (10-15%) being the most common. Late complications occurred less often, and device-related failure leading to secondary glaucoma surgery rarely occurred (≤ 4%). CONCLUSION: The MicroShunt provided a sustained reduction in IOP and medication burden with a low incidence of complications over the follow-up period. The outcomes in pseudophakic eyes and those undergoing combined cataract surgery were like the cumulative population. The inclusion of pseudophakic and combined surgery eyes reflects the real-world situation in glaucoma practice. These results build on mid-term evidence to support the reliability and safety of the MicroShunt.
Multimodal imaging of photoreceptor and vascular changes in lamellar macular hole and epiretinal membrane-associated foveoschisis.
Caroli F, Feucht N, Maier M … +1 more , Bleidißel N
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41902903 · Publisher ↗
PURPOSE: Lamellar macular hole (LMH) and epiretinal membrane–foveoschisis (ERM-FS) are distinct subtypes of lamellar macular defects, but clinical differentiation remains challenging. Adaptive optics (AO) and optical coh...
PURPOSE: Lamellar macular hole (LMH) and epiretinal membrane–foveoschisis (ERM-FS) are distinct subtypes of lamellar macular defects, but clinical differentiation remains challenging. Adaptive optics (AO) and optical coherence tomography angiography (OCTA) may offer novel biomarkers for structural and vascular differences. This study aimed to evaluate photoreceptor integrity and macular microvasculature in LMH and ERM-FS compared with healthy controls. DESIGN AND PARTICIPANTS: This prospective observational cross-sectional study was conducted at the Department of Ophthalmology, Technical University of Munich, between January 2022 and January 2025. Sixty-one eyes were included: 20 LMH, 21 ERM-FS, and 20 healthy controls. Exclusion criteria were other retinal diseases, high myopia, or prior intraocular surgery except cataract extraction. METHODS: Best-corrected visual acuity (BCVA), spectral-domain OCT (SD-OCT), OCTA, and AO retinal imaging (rtx1, Imagine Eyes, Orsay, France) were performed. MAIN OUTCOME MEASURES: AO-derived metrics included cone density (CD), spacing, regularity, and dispersion. OCTA evaluated foveal and parafoveal vessel density (VD) in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), and choriocapillaris flow. SD-OCT assessed central subfield thickness (CST), central subfield volume (CSV), and outer retinal integrity. RESULTS: Mean [SD] age was 75.7 [7.5] years for LMH, 70.6 [8.7] for ERM-FS, and 71.5 [7.1] for controls. ERM-FS eyes showed increased cone spacing (e.g. at 4° inferior ERM-FS vs. LMH, P = 0.0159, Table 2) and dispersion (e.g. at 4° inferior ERM-FS vs. CG, P = 0.0115, Table 2) compared with LMH and controls, whereas cone density (e.g. at 0° ERM-FS vs. LMH, P =. 0.036, Table 2) and regularity (e.g. at 4° inferior ERM-FS vs. LMH, P = 0.060, Table 2) followed the same direction but did not remain statistically significant after correction for multiple testing. FAZ was larger in LMH than ERM-FS (0.342 vs. 0.236 mm²; P = 0.01). Foveal SCP VD was higher in ERM-FS than LMH and controls (28.16% vs. 22.53% vs. 21.82%; P = 0.01 ERM-FS vs. LMH). LMH eyes more frequently showed ellipsoid zone and external limiting membrane disruptions. ERM-FS was associated with greater CST and CSV. CONCLUSIONS: AO and OCTA reveal distinct photoreceptor and vascular alterations in LMH and ERM-FS. LMH is characterized by larger FAZ and more outer retinal disruption, whereas ERM-FS shows increased retinal thickness and more pronounced photoreceptor mosaic disorganization (increased cone spacing/dispersion), with trends toward lower cone density and reduced regularity. Higher foveal SCP VD in ERM-FS may, at least in part, reflect traction-related mechanical effects. Multimodal imaging may enhance diagnostic accuracy and monitoring in lamellar macular defects.
Intravitreal plungerless injector device (IPLID) for anterior chamber paracentesis: a novel approach to aqueous humor sampling.
Yepez JB, Murati FA, Kozak I … +1 more , Arevalo JF
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41893889 · Publisher ↗
PURPOSE: To evaluate the feasibility and preliminary safety of a plungerless intravitreal injector device (IPLID) adapted for aqueous humor aspiration during anterior chamber paracentesis. METHODS: In this proof-of-conce...
PURPOSE: To evaluate the feasibility and preliminary safety of a plungerless intravitreal injector device (IPLID) adapted for aqueous humor aspiration during anterior chamber paracentesis. METHODS: In this proof-of-concept pilot study, ten consecutive eyes undergoing diagnostic anterior chamber paracentesis with the IPLID were prospectively enrolled and compared with a retrospective cohort of ten eyes that underwent conventional syringe-based aspiration. Procedures were performed under slit-lamp visualization. Primary outcomes included feasibility and procedure duration. Secondary outcomes included aspirated volume, intraocular pressure (IOP) changes, wound integrity, patient discomfort (visual analogue scale), and surgeon-reported usability. RESULTS: All procedures were successfully completed without intraoperative complications. The device achieved consistent aqueous humor aspiration (48 ± 5 µL) compared with greater variability using conventional methods (59 ± 17 µL). No anterior chamber instability or hypotony occurred. Wounds were self-sealing in all cases, whereas two control cases required bandage contact lenses. Procedure time was shorter and patient discomfort lower with the IPLID (p < 0.01). No adverse events were observed during one-week follow-up. CONCLUSIONS: The plungerless intravitreal injector device appears to be a feasible and safe alternative for anterior chamber paracentesis, enabling controlled and reproducible aqueous humor sampling with improved procedural consistency and patient comfort. Larger prospective studies are warranted to confirm these findings and assess long-term safety.
Global burden of age-related macular degeneration: Trends, regional disparities, and projections from the Global Burden of Disease study 2021.
Azizmohammad Looha M, Amanollahi M, Hashemi E … +6 more , Jameie M, Mohammadpoor A, Mozafar M, Samiee R, Jalalinejad M, Arevalo JF
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41893888 · Publisher ↗
PURPOSE: Age-related macular degeneration (AMD) is one of the major causes of visual loss globally. This study assessed the global, regional, and national burden of AMD between 1990 and 2021 based on data from the Global...
PURPOSE: Age-related macular degeneration (AMD) is one of the major causes of visual loss globally. This study assessed the global, regional, and national burden of AMD between 1990 and 2021 based on data from the Global Burden of Disease (GBD) study. METHODS: AMD burden was evaluated using two outcomes, the age-standardized prevalence rate (ASPR) and the age-standardized years lived with disability rate (ASYR), both expressed per 100,000 population. Data from 204 countries and territories were analyzed and aggregated into 21 regions and 7 super-regions based on the GBD 2021 dataset. Temporal trends were evaluated using joinpoint regression, future estimates were forecasted using autoregressive integrated moving average models, and development-related inequalities were examined using multilevel modeling. Geographic clustering of AMD burden was determined through spatial analysis. RESULTS: In 2021, the global ASPR of AMD was 94.0 per 100,000 population, and the global ASYR was 6.78 per 100,000 population. Between 1990 and 2021, there was a consistent global reduction, with an AAPC of − 0.15 (95% CI: − 0.19 to − 0.12) for ASPR and − 0.69 (95% CI: − 0.71 to − 0.67) for ASYR. The declines were steepest in South Asia (AAPC: − 1.05 for ASPR, − 1.50 for ASYR) and High-Income regions (–0.90 and − 1.21, respectively; all p < 0.001). Conversely, Southeast Asia, East Asia, and Oceania experienced no significant change in ASPR (AAPC: 0.01; p = 0.463) and only minimal reduction in ASYR (AAPC: − 0.33; p < 0.001). Throughout all super-regions, females consistently had a higher AMD burden than males. Longitudinal multilevel analysis revealed quicker reductions in ASPR and ASYR of AMD in more developed nations, with significant time-development status interaction effects (– 0.36 for ASPR and − 0.02 for ASYR; both p < 0.001). Spatial analysis revealed AMD hotspots in West Africa, the Middle East, and the Caribbean, with high clustering of both ASPR and ASYR in these areas. Projections suggest that global ASPR and ASYR will remain broadly stable through 2040. CONCLUSIONS: While the ASPR and ASYR of AMD have decreased worldwide, there are still regional and sex disparities. Hotspot regions indicate where targeted interventions are warranted. With an aging population, the absolute burden will increase, so early detection and planning are crucial.
The forgotten story behind the first published retinal paintings.
Keunen JEE, Keeler CR, Boon CJF … +1 more , Koken PW
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41893887 · Publisher ↗
KEY MESSAGES: WHAT IS KNOWN : • Helmholtz invented the ophthalmoscope in 1850 and published his observations in a monograph in 1851. However, he did not include an illustration of what he observed; • The first published...
KEY MESSAGES: WHAT IS KNOWN : • Helmholtz invented the ophthalmoscope in 1850 and published his observations in a monograph in 1851. However, he did not include an illustration of what he observed; • The first published retinal paintings were created in 1853 by the artistically gifted physician Adrien Christophe van Trigt. WHAT IS NEW: • Shortly after Helmholtz's publication of the ophthalmoscope, the Amsterdam instrument maker Epkens designed and constructed a table-model ophthalmoscope that left the dominant hand free; • The ophthalmologist Donders in Utrecht recognized in Epkens' table model ophthalmoscope the opportunity to produce retinal paintings for publication purposes. He recruited the artistically skilled physician Adrien van Trigt as PhD student to carry out this work; • The collaboration of Donders, Van Trigt and Epkens resulted within 19 months following Helmholtz' monograph, in the publication of retinal paintings - a remarkably fast achievement, given that retinal photography was not yet available.
Postoperative demarcation lines in rhegmatogenous retinal detachment: what en-face imaging reveals about visual outcomes.
Valsecchi N, Padovani L, Fava CS … +5 more , Finzi A, Moramarco A, dell'Omo R, Fontana L, Mete M
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41893886 · Publisher ↗
PURPOSE: To investigate postoperative demarcation lines using en-face optical coherence tomography (OCT) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and assess association with v...
PURPOSE: To investigate postoperative demarcation lines using en-face optical coherence tomography (OCT) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and assess association with visual outcomes. METHODS: Consecutive patients undergoing PPV for primary RRD with gas tamponade were prospectively enrolled. Postoperative demarcation lines on en-face OCT were defined as hyper-reflective lines following contour of previous detachment edge. Postoperative best-corrected visual acuity (BCVA) and metamorphopsia were analyzed in relation to location of demarcation lines (within the central 3-mm ETDRS zone vs. between 3 and 6 mm). A control group of patients treated with silicone oil (SO) was included for comparison. RESULTS: A total of 31 eyes met inclusion criteria. En-face OCT identified postoperative demarcation lines in 30 eyes (96.7%). None were seen in 25 eyes after SO removal (p < 0.001). Ellipsoid zone (EZ) disruption at demarcation line was found in 21 eyes, persistent subretinal fluid (SRF) in 6 eyes, and outer retinal folds (ORF) in 3 eyes. Eyes with persistent SRF had longer interval between symptom onset and surgery compared with those showing EZ disruption or ORF (p = 0.025). Demarcation lines within central 3-mm ETDRS zone were significantly associated with greater horizontal metamorphopsia (B = 0.232, p = 0.003), whereas no significant association was found with postoperative BCVA (B = − 0.094, p = 0.280). CONCLUSIONS: En face OCT accurately detects postoperative demarcation lines, which may represent a previously overlooked factor influencing visual dysfunction after PPV for RRD with gas tamponade.
Referral for glaucoma surgery and types of surgery in different European regions in 2025, the EURACCUR study.
Martinez-de-la-Casa J, Stalmans I, Abegão-Pinto L … +22 more , Topouzis F, Pazos M, Beckers H, Januleviciene I, Oddone F, Mercieca K, Miguel A, Jóhannesson G, Kolko M, Geber MZ, Cvenkel B, Carbonaro F, Babic N, Garcia-Bardera J, Ikinci M, Kalasauskiene A, Roberti G, Simonsen JH, Križ T, Mifsud A, Liegl C, Holló G
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41886082 · Publisher ↗
PURPOSE: To investigate the characteristics of referral for glaucoma surgery and compare surgical practices in various European regions in 2025. METHODS: Data of 300 eyes of 300 consecutive patients undergoing glaucoma s...
PURPOSE: To investigate the characteristics of referral for glaucoma surgery and compare surgical practices in various European regions in 2025. METHODS: Data of 300 eyes of 300 consecutive patients undergoing glaucoma surgery were analysed using a standardized questionnaire and compared between geographical regions. Glaucoma specialists from one centre per country provided data on demographics, glaucoma types, intraocular pressure (IOP), visual field and structural metrics, types of surgery and referral timeliness (timely, later than optimal, late). RESULTS: The median (quartiles) age was 72 (64–78) years. Primary open angle glaucoma (52.0%) and pseudoexfoliative glaucoma (23.0%) were the most common glaucoma types. Median disease duration was 75 (28–144) months, preoperative IOP 22 (18–28) mmHg, mean deviation − 14.47 (− 21.60 to − 7.85) dB, and retinal nerve fibre layer thickness 60 (50–75) µm. Trabeculectomy (38.3%), minimally invasive bleb forming surgeries (28.3%), and drainage devices (11.3%) were the predominant procedures; 18.7% of the surgeries were combined with phacoemulsification. More severe disease was associated with filtering or drainage device surgery (p < 0.001). Referral was timely in 34.7%, later than optimal in 35.7%, and late in 29.7%. Late referrals were associated with higher IOP, more advanced MD, and thinner RNFL (p < 0.001). Regional differences were significant for common glaucoma types (p = 0.013) and surgical choice (p < 0.0001). Late and later-than-optimal referrals ranged between 22% and 38.3%, and 30.0% and 41.7% between the regions, respectively. The proportion of timely referrals in the East European region (20%) was significantly lower than that in the South and West European (approximately 40%) and North European (31.7%) regions (p = 0.019). CONCLUSIONS: Marked differences exist in Europe in glaucoma referral timeliness and surgical practice. Late referral remains frequent and associated with advanced structural and functional damage in Europe.
Letter to the Editor: Macular volume in macular pucker.
Sebag J
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41886081 · Publisher ↗
Abstract loading — click title to view on PubMed.
Impact of glaucoma on outcomes after epiretinal membrane surgery. a pairwise and post-hoc single-arm meta-analysis.
Masetto C Fuganti R, O Rassi TN, Fuganti MV … +7 more , Narainswami N, Rocha J, Garg S, Maia M, B Casella AM, Masetto C Fuganti R, B Casela AM
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41886080 · Publisher ↗
PURPOSE: To evaluate whether glaucoma modifies functional, anatomical, and intraocular pressure outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane...
PURPOSE: To evaluate whether glaucoma modifies functional, anatomical, and intraocular pressure outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM). METHODS: PubMed, Embase, and Cochrane Library were searched through April 27, 2025, for comparative studies of PPV with ILM peeling in glaucomatous versus non-glaucomatous eyes. Primary outcome was the change (Δ) in best-corrected visual acuity (BCVA); secondary outcomes were changes (Δ) in central macular thickness (CMT), intraocular pressure (IOP), and number of glaucoma medications. Risk of bias was assessed with ROBINS-I and certainty of evidence with GRADE. A post-hoc single-arm synthesis summarized outcomes in glaucomatous eyes. PROSPERO registration: CRD420251041680. RESULTS: Six studies (779 eyes: 256 glaucomatous, 523 non-glaucomatous) contributed to the pairwise meta-analysis, and three additional studies (325 glaucomatous eyes) informed single-arm data. Non-glaucomatous eyes achieved greater BCVA improvement (mean difference − 6.95 ETDRS letters; 95% CI − 11.54 to − 2.35; p < 0.01) and larger CMT reduction after outlier removal (+ 39.50 μm; 95% CI 11.48 to 67.53; p = 0.006). Glaucomatous eyes still improved significantly (BCVA + 10.03 ETDRS letters; CMT − 102.05 μm), with stable IOP (Δ + 0.64 mmHg; p = 0.12) but increased medication use (+ 0.61 drops; p < 0.001). Follow-up ranged from 6 to 12 months, and overall evidence certainty was high. CONCLUSIONS: Glaucoma attenuates, but does not eliminate, the visual and anatomical benefits of ERM surgery. However, central visual field safety cannot be guaranteed, particularly in moderate to advanced disease. Careful postoperative glaucoma monitoring and individualized management are recommended.
Fundus tessellation density as a quantitative marker of myopia progression: a five-year longitudinal deep learning study.
Ten W, Mao Z, Lin IC … +5 more , Lei Y, Wang X, Zhou X, Chen X, Wang X
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41886079 · Publisher ↗
PURPOSE: To investigate five-year changes in fundus mosaic density (FTD) and their associations with refractive parameters in high and extreme myopia using deep learning. METHOD: A total of 102 eyes from 102 individuals...
PURPOSE: To investigate five-year changes in fundus mosaic density (FTD) and their associations with refractive parameters in high and extreme myopia using deep learning. METHOD: A total of 102 eyes from 102 individuals with high myopia (spherical equivalent [SE]: -9.55 ± 2.53 D) were enrolled. Participants were divided into a high myopia group (-10.0 D < SE ≤ -6.0 D, 54 eyes) and an extreme myopia group (SE ≤ -10.0 D, 48 eyes). All patients completed a five-year follow-up. Ultrawide-field fundus images were processed by artificial intelligence software to quantify FTD (whole fundus, macular), cup-to-disc ratio, and parapapillary atrophy (PPA). Statistical analysis was performed using R software, and the significance level was set at p < 0.05. RESULTS: FTD increased significantly across all regions in both groups. The extreme myopia group also exhibited a marked enlargement of PPA. In the high myopia group, SE was negatively correlated with changes in macular (r = -0.331, p = 0.014) and peripapillary FTD (r = -0.285, p = 0.037). Changes in axial length (AL) were significantly positively correlated with changes in pan-fundus FTD (r = 0.274, p = 0.045), macular FTD (r = 0.508, p < 0.001), peripapillary FTD (r = 0.339, p = 0.012), and PPA area (r = 0.441, p = 0.001). However, in the extreme myopia group (0.23 ± 0.28 mm) with faster axial growth, these refractive parameters and changes in the axial axis were not significantly correlated with FTD changes. CONCLUSION: Fundus alterations in high myopia continue to progress during adulthood and are strongly associated with axial elongation at the high myopia stage. FTD provides a robust quantitative biomarker for monitoring these structural changes.
Comparing lateral rectus recession and bupivacaine injection of medial rectus with conventional recession-resection in moderate-angle intermittent exotropia.
Mirmohammadsadeghi A, Razavi A, Akbari MR … +3 more , Sadeghi M, Masoomian B, Asadigandomani H
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41879984 · Publisher ↗
PURPOSE: To compare the clinical outcomes of lateral rectus (LR) recession and bupivacaine injection of medial rectus (MR) with conventional recession–resection (R&R) surgery in patients with moderate-angle intermittent...
PURPOSE: To compare the clinical outcomes of lateral rectus (LR) recession and bupivacaine injection of medial rectus (MR) with conventional recession–resection (R&R) surgery in patients with moderate-angle intermittent exotropia. METHODS: This prospective study included 105 patients with intermittent exotropia between 25 and 30 prism diopters (PD), treated at a single tertiary center. Patients were assigned to either bupivacaine injection of MR combined with LR recession (n = 53) or standard R&R surgery (n = 52). Follow-up evaluations were conducted at 1, 6, 12, 18, and 24 months postoperatively. The primary outcome was surgical success, defined as exotropia ≤ 10 PD or esotropia ≤ 5 PD in the primary position. Secondary outcomes included postoperative angle changes, need for prism, and complication rates. RESULTS: The bupivacaine group demonstrated higher success rates than the R&R group across all follow-up intervals; however, the differences were not statistically significant (all P-values > 0.05). The R&R group had significantly higher overcorrection rates (P-value < 0.001), while none of the bupivacaine patients were overcorrected. The bupivacaine group consistently showed an undercorrection rate of 20.7%, which was significantly higher than the 7.7% rate in the R&R group at all follow-up time points (P-value < 0.001). No serious complications were reported in either group at all follow-up time points. CONCLUSIONS: Adding bupivacaine injection of MR to LR recession appears to be a safe, effective, and minimally invasive alternative to traditional R&R surgery for moderate-angle intermittent exotropia. It is associated with favorable outcomes, low complication rates, and no overcorrection. Further randomized, controlled trials with extended follow-up are necessary to confirm these findings.
Anterior chamber stability during phacoemulsification: comparing different phacoemulsification systems.
Rossi T, Querzoli G, Deng CP … +6 more , Deng GR, Parravano M, Placentino L, Dell'Omo R, Steel DH, Romano MR
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41879983 · Publisher ↗
PURPOSE: To compare in vitro performance of phacoemulsification platforms during critical surgical phases including aspiration, occlusion and occlusion break. METHODS: Five phacoemulsification platforms (Alcon Centurion,...
PURPOSE: To compare in vitro performance of phacoemulsification platforms during critical surgical phases including aspiration, occlusion and occlusion break. METHODS: Five phacoemulsification platforms (Alcon Centurion, Bausch & Lomb PC Stellaris, BVI Virtuoso, DORC Eva Nexus and Zeiss Quatera) underwent standardized testing including controlled occlusion within a collapsible test chamber. Tests were conducted with 21G tips, infusion pressure presets 30 and 55 mmHg, flow-rate 30 ml/min and vacuum range 200–600 mmHg. Outcome measures included Intraocular Pressure (IOP) at rest, during aspiration, occlusion and standardized occlusion break as well as chamber volume loss and time to regain 90% of IOP after/during occlusion break. RESULTS: All devices kept target IOP at rest. During aspiration, IOP changed significantly (p < 0.01): Stellaris showed the greatest IOP reduction, Quatera had small decrease, Virtuoso maintained preset, Centurion and Eva Nexus slightly overcompensated. During occlusion, Eva Nexus and Stellaris PC exceeded the preset 55 mmHg (p < 0.05) whereas other machines remained on target. Upon occlusion break, volume loss ranged 35-200μL (p < 0.001) and recovery time to 90% of preset IOP varied between 0.30–2 s (p < 0.001) with Centurion and Virtuoso outperforming others at 30 mmHg IOP and Centurion, Quatera and Virtuoso at 55 mmHg IOP. CONCLUSION: Phacoemulsifiers exhibited distinct behaviour under standardized conditions and fluidic settings significantly influenced performance. Surgeon must understand machines’ fluidic to master different platforms.
Ocular microvascular changes in hypoestrogenism: an OCT/OCTA systematic review and meta-analysis.
Chattha I, Ji PX, Kang Y … +4 more , Balas M, Popovic M, Muni R, Kohly R
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41879982 · Publisher ↗
PURPOSE: To examine retinal and choroidal structural and microvascular changes in hypoestrogenic states, including natural menopause, premature ovarian failure (POF), and functional hypothalamic amenorrhea (FHA), relativ...
PURPOSE: To examine retinal and choroidal structural and microvascular changes in hypoestrogenic states, including natural menopause, premature ovarian failure (POF), and functional hypothalamic amenorrhea (FHA), relative to reproductive-age controls using OCT or OCTA. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library was performed from database inception to October 2025. Eligible studies compared women with natural menopause, POF, or FHA to reproductive-age controls and reported quantitative OCT or OCTA outcomes. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analysis. This review was registered with PROSPERO (CRD42025641738). RESULTS: Six case-control studies (n = 653 participants) were included. Subfoveal choroidal thickness was significantly lower in postmenopausal women compared with controls (mean difference − 45.24 μm; p < 0.001; 325 eyes; I² = 9%). OCTA showed reduced retinal and choroidal vessel density in postmenopausal women compared to controls (-2.74%; p = 0.002; 185 eyes; I² = 51%). A pooled OCTA analysis using standardized effect sizes showed reduced retinal and choroidal perfusion in postmenopausal women compared to controls (Hedges g = -0.63; 281 eyes; I² = 85%). POF cohorts showed early choroidal thinning across all regions; FHA cohorts showed increased choriocapillaris perfusion indicative of an adaptive vascular response. The foveal avascular zone was larger in postmenopausal women and inferior RNFL thickness was reduced compared to controls. CONCLUSION: Estrogen deficiency is associated with measurable reductions in choroidal thickness and OCTA-derived retinal and choroidal perfusion, which may be mediated by hormonal and age-related effects.
Artificial intelligence in pediatric myopia - a narrative review.
Pawar N, Berendschot TTJM, Bauer NJC … +4 more , R M, Maheshwari D, Giap BD, Nallasamy N
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41879981 · Publisher ↗
This review examines the promising potential of Artificial Intelligence (AI) in pediatric ophthalmology, specifically in the assessment, prediction, management, and treatment of myopia in children. The use of AI, particu...
This review examines the promising potential of Artificial Intelligence (AI) in pediatric ophthalmology, specifically in the assessment, prediction, management, and treatment of myopia in children. The use of AI, particularly machine learning (ML) and deep learning (DL), in predicting myopia in children has garnered significant interest for its potential in early screening, detection, prognosis prediction, monitoring of anti-myopia treatment, personalized interventions, and proactive management strategies. This review aims to summarize the current literature on myopia and AI, presenting them as emerging trends and future directions in the pediatric population, and highlighting emerging strategies for the future of myopia management.
Technical feasibility of suprachoroidal filler injection using ultrathin needle in animal model.
Moon TG, Kook KY, Ji YS
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41879980 · Publisher ↗
PURPOSE: To evaluate the technical feasibility and short-term safety of suprachoroidal buckling (SCB) through direct filler injection using an ultrathin 40-gauge needle in an animal model without induced rhegmatogenous r...
PURPOSE: To evaluate the technical feasibility and short-term safety of suprachoroidal buckling (SCB) through direct filler injection using an ultrathin 40-gauge needle in an animal model without induced rhegmatogenous retinal detachment (RRD). METHODS: Ex vivo experiments were conducted using enucleated pig eyes, and in vivo experiments using New Zealand White rabbit eyes. Filler material was injected into the suprachoroidal space using a 40-gauge ultrathin needle, and the resulting buckling effect was observed. Subsequently, 12 eyes of 12 rabbits were divided into four groups (n = 3 each) based on two types of filler (Healon5, HealonGV) and two injection volumes (0.05 mL, 0.1 mL). The duration of the buckling effect was monitored until it resolved. Intraocular pressure (IOP) was measured before the injection, immediately after, 30 min later, and one day later. RESULTS: A dome-shaped choroidal elevation was observed in both ex vivo and in vivo experiments. The mean duration of the buckling effect was 20.0 days in the 0.1 mL-Healon5 group, 16.0 days in the 0.05 mL-Healon5 group, 12.7 days in the 0.1 mL-HealonGV group, and 10.0 days in the 0.05 mL-HealonGV group. After injection, the IOP increased immediately but returned to normal within 30 min. CONCLUSIONS: Direct suprachoroidal filler injection using a 40-gauge ultrathin needle was technically feasible and induced localized choroidal elevation in animal eyes without serious adverse events except transient IOP elevation. This study demonstrates the morphological feasibility of the procedure, and further studies using RRD models are warranted to investigate its potential therapeutic utility. KEY MESSAGES: WHAT IS KNOWN : Rhegmatogenous retinal detachment (RRD) can be treated using scleral buckling (SB) or pars plana vitrectomy (PPV), with the choice influenced by factors such as age, tear location, and lens status. While PPV is increasingly favored due to the prevalence of small-gauge vitrectomy, SB remains useful for selected cases due to its advantages, including lower cost and reduced cataract risk. WHAT IS NEW : A novel ultrathin suprachoroidal needle was developed to enable direct filler injection into the suprachoroidal space (SCS) without the need for conjunctival peritomy or scleral dissection. This simplified suprachoroidal buckling (SCB) technique demonstrated a sustained buckling effect for up to 20 days in an animal model, with no serious complications such as suprachoroidal hemorrhage (SCH). Compared to catheter-based SCB techniques, this approach is more intuitive, minimally invasive, and potentially applicable in outpatient settings with minimal training.
Bibliometric analysis and visualization of inflammation in the field of diabetic retinopathy research (2006-2025).
Gan W, Lu Z
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41874679 · Publisher ↗
BACKGROUND: DR, one of the most common and sight-threatening complications of Diabetes Mellitus (DM), remains a leading cause of vision impairment among the working-age population. In recent years, growing evidence has h...
BACKGROUND: DR, one of the most common and sight-threatening complications of Diabetes Mellitus (DM), remains a leading cause of vision impairment among the working-age population. In recent years, growing evidence has highlighted the pivotal role of inflammation in the onset and progression of DR. These mechanisms involve immune cells and inflammatory mediators, oxidative stress, and VEGF signaling. This study employed bibliometric approaches to systematically identify research trends and emerging hotspots concerning inflammation-related DR literature. METHODS: Publications concerning inflammation and diabetic retinopathy from 2006 to 2025 were systematically retrieved from the Web of Science Core Collection (WoSCC) in June 2025. Bibliometric analyses and visualization were performed using CiteSpace, VOSviewer, and Bibliometrix, focusing on countries, institutions, journals, authors, co-cited references, and keywords. RESULTS: A total of 2,576 publications were identified, demonstrating a continuous upward trend in annual output and citation frequency. China contributed the highest number of publications, with Shanghai Jiao Tong University being the most productive institution. Kern TS. was the most prolific author, whereas Antonia M. achieved the highest citation count. Investigative Ophthalmology & Visual Science ranked first in both publication frequency and co-citation counts. Keyword clustering revealed that Oxidative Stress (OS) and Vascular Endothelial Growth Factor (VEGF) were closely associated with this research domain. CONCLUSION: This study systematically summarized the research landscape of inflammation in DR over the past two decades, not DR in general. We focus on global mapping of contributors, quantification of mechanistic hotspots, identification of geographic/thematic imbalances, and potential guidance for future research priorities. We noticed current research focuses on immune cells and inflammatory factors, oxidative stress, and VEGF in DR. These findings provide a comprehensive understanding of the inflammation–DR relationship and offer valuable insights for future research and therapeutic development. Controlling chronic retinal inflammation, mitigating OS, and downregulating VEGF expression are beneficial for patients with DR. These findings underscore the rationale for therapeutic strategies that combine durable VEGF inhibition with modulation of chronic inflammation and oxidative stress.
Anti-VEGF therapy for symptomatic exudative retinal arterial macroaneurysms: functional and anatomic outcomes with OCTA findings.
Tang W, Yang X, Wang K … +3 more , Wang M, Xu G, Liu W
Graefes Arch Clin Exp Ophthalmol · 2026 Mar · PMID 41874678 · Publisher ↗
PURPOSE: To evaluate the clinical outcomes of symptomatic exudative retinal arterial macroaneurysms (RAMs) following anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS: This retrospective study included...
PURPOSE: To evaluate the clinical outcomes of symptomatic exudative retinal arterial macroaneurysms (RAMs) following anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS: This retrospective study included treatment-naïve patients with exudative RAM who received anti-VEGF injections and were followed for ≥ 6 months. Clinical data and multimodal imaging findings, including optical coherence tomography angiography (OCTA), were analyzed. RESULTS: Thirty-seven eyes (37 patients) were included. The mean number of anti-VEGF injections was 2.4 ± 1.5 over a mean follow-up of 10.1 ± 4.3 months. BCVA, measured as the logarithm of the minimum angle of resolution (Snellen equivalent), improved significantly from 0.97 ± 0.42 (20/187) at baseline to 0.62 ± 0.36 (20/84) at the final visit (P < 0.001). CST decreased from 548.3 ± 180.4 μm to 285.8 ± 76.9 μm (P < 0.001). Baseline OCTA identified two morphologic types of RAMs: type 1 (distended, 68.3%) and type 2 (meshed, 31.7%). Both types exhibited reduced flow signals and shrank after treatment. B-scan OCTA revealed the absence of flow signals in RAM lesions in 22 eyes (59.5%) and complete resolution of macular edema in 32 eyes (86.5%). Subgroup analysis showed that type 1 RAMs required more anti-VEGF injections than type 2 RAMs (2.79 ± 1.59 vs. 1.69 ± 1.11, P = 0.03). Baseline BCVA was an independent predictor of final BCVA (P < 0.001). CONCLUSION: Intravitreal anti-VEGF therapy for exudative RAMs is associated with functional and anatomical improvement. OCTA-based morphologic classification may predict therapeutic response, with type 1 RAMs requiring a higher treatment burden.
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