Soltani G, Nishida T, Moghimi S
… +4 more, Micheletti E, Hashemi S, de Oliveira Pereira A, Weinreb RN
Am J Ophthalmol
· 2026 Jun · PMID 41825843
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PURPOSE: To investigate the relationship of structural progression, β-zone parapapillary atrophy (PPA) progression, and microvascular dropout (MvD) in glaucoma suspect eyes. DESIGN: Retrospective cohort study. METHODS: E...PURPOSE: To investigate the relationship of structural progression, β-zone parapapillary atrophy (PPA) progression, and microvascular dropout (MvD) in glaucoma suspect eyes. DESIGN: Retrospective cohort study. METHODS: Eyes were included if optic disc photographs were available at least 5 years before optical coherence tomography angiography imaging. During follow-up, structural progression and β-zone PPA progression were recorded. Structural progression was graded using stereophotographs; eyes were classified as progressing if new or enlarged retinal nerve fiber layer defects or neuroretinal rim thinning were detected. β-zone PPA was quantified (area, radial width, angular extent), with progression defined as a ≥20% increase in any parameter. The presence of MvD at the last visit was evaluated using en-face choroidal vessel density maps. Multivariable logistic regression was used to assess the association between MvD and structural progression, adjusting for covariates and β-zone PPA progression. Margins analysis was performed to estimate predicted probabilities of structural progression by MvD status and β-zone PPA progression. RESULTS: A total of 180 eyes from 134 glaucoma suspect patients were included, of which 58 eyes (32.2%) had MvD. The mean follow-up duration for fundus photographs was 19.0 (95% CI, 17.9-20.1) years. The presence of MvD and also β-zone PPA progression were significantly associated with structural progression (15.8 [95% CI, 5.6-44.6], P < .001; 3.8 [95% CI, 1.2-11.7], P = .022, respectively). Margin plots indicated that eyes exhibiting both MvD and β-zone PPA progression had the highest estimated probability of structural progression (0.75). CONCLUSIONS: In glaucoma suspect eyes, the presence of both MvD and β-zone PPA progression were independently associated with structural optic disc progression. These structural changes were observed in glaucoma suspect eyes that remained clinically stable and did not convert to perimetric glaucoma during the period of observation in this study. Recognition of these changes may enhance more timely management to prevent glaucomatous vision loss.
Zhang J, Xie X, Yuan H
… +9 more, Jin A, Zhu Y, Lin H, Qiao Y, Luo L, Wang Y, Tan X, Zeng K, Luo L
Am J Ophthalmol
· 2026 Jun · PMID 41819516
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PURPOSE: To develop and validate a new intraocular lens (IOL) power calculation formula for cataract patients with previous myopic corneal refractive surgery (MRS). DESIGN: Retrospective, comparative analysis of lOL powe...PURPOSE: To develop and validate a new intraocular lens (IOL) power calculation formula for cataract patients with previous myopic corneal refractive surgery (MRS). DESIGN: Retrospective, comparative analysis of lOL power calculations. PARTICIPANTS: Patients undergoing MRS were enrolled for formula development, and cataract patients with prior MRS were recruited for evaluation. METHODS: Linear regression model was used to characterize the relationship between preoperative anterior corneal radius (ARC) and postoperative posterior corneal radius (PRC) in patients undergoing MRS. A thick-lens LISA MRS formula was then developed, using predicted preoperative ARC for effective lens position estimation. Its performance was compared with existing formulas (Barrett True K, Emmetropia Verifying Optical [EVO], Haigis-L, Hoffer QST, and Shammas PL) in cataract patients with prior MRS. MAIN OUTCOME MEASURES: Arithmetic and absolute prediction errors. RESULTS: The study included 134 MRS patients (98 small incision lenticule extraction [SMILE] and 36 femtosecond laser-assisted in situ keratomileusis [FS-LASIK]) for formula development, and the changes in anterior and posterior keratometry were comparable between the two procedures. Postoperative PK was a strong predictor of preoperative ARC, with an R of 0.82. In 225 cataract patients from three centers for formula validation, the formula performance index (FPI) was highest for LISA MRS (with or without PRC, 0.43), followed by Hoffer QST (0.37), EVO and Hoffer QST-PRC (both 0.32), EVO-PRC and Barrett True K-PRC (both 0.30), and Barrett True K (0.26). LISA MRS-PRC and EVO-PRC yielded the lowest median absolute prediction error (0.47 D), with EVO-PRC performing relatively better in eyes with AL < 28 mm and LISA MRS-PRC maintaining favorable accuracy in eyes with AL ≥ 28 mm. Incorporating PRC significantly improved the performance of Barrett True K, LISA MRS, and Hoffer QST (all P < .05). CONCLUSIONS: The LISA MRS formula provides accurate IOL power calculation for cataract patients with prior MRS, particularly in eyes with AL ≥ 28 mm. Use of PRC is recommended whenever available.
Abboud I, Fam A, Almobayed A
… +4 more, Guillaume GI, ElSheikh RH, Lee RK, Elhusseiny AM
Am J Ophthalmol
· 2026 Jun · PMID 41819515
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PURPOSE: To evaluate whether pseudoexfoliation glaucoma (PXG) is associated with an increased hazard of developing central serous chorioretinopathy (CSCR) compared with primary open-angle glaucoma (POAG). DESIGN: Retrosp...PURPOSE: To evaluate whether pseudoexfoliation glaucoma (PXG) is associated with an increased hazard of developing central serous chorioretinopathy (CSCR) compared with primary open-angle glaucoma (POAG). DESIGN: Retrospective cohort study using a multicenter, real-world electronic health record database. SUBJECTS: Adults aged ≥ 18 years diagnosed with PXG (study group) or POAG (control group). METHODS: We obtained deidentified patient data from the TriNetX U.S. Collaborative Network. Patients with a history of age-related macular degeneration (AMD) or prior anti-vascular endothelial growth factor (anti-VEGF) therapy were excluded. We performed multivariable Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), adjusting for baseline demographics; ocular and systemic comorbidities; psychiatric conditions; medication exposures (including corticosteroids); and prior ocular surgeries. MAIN OUTCOME MEASURES: The primary outcome was the development of CSCR within 1- and 5-year follow-up periods following the glaucoma diagnoses. RESULTS: A total of 10,347 patients with PXG and 205,065 with POAG were included. In the Cox proportional hazards model, PXG was significantly associated with a higher hazard of developing CSCR compared with POAG. The aHR for CSCR was 1.807 (95% CI, 1.041-3.136; P = .036) at the 1-year follow-up and 1.631 (95% CI, 1.014-2.622; P = .044) at 5 years. CONCLUSIONS: PXG is associated with an increased hazard of developing CSCR compared with POAG. These findings suggest that PXG may be associated with an increased susceptibility to posterior segment vascular pathology. Prospective studies incorporating longitudinal imaging are warranted to further elucidate shared choroidal mechanisms underlying this association.
Shields C, Qazi S, Zaldivar A
… +7 more, Cabrera K, Mangwani-Mordani S, Peterson H, Bhatt S, Tang F, Galor A, Felix ER
Am J Ophthalmol
· 2026 Jun · PMID 41812852
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PURPOSE: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, non-pharmacologic therapy with efficacy in treating chronic pain. This study evaluated the analgesic effectiveness of TENS in individuals wit...PURPOSE: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, non-pharmacologic therapy with efficacy in treating chronic pain. This study evaluated the analgesic effectiveness of TENS in individuals with chronic neuropathic/nociplastic ocular pain (NOP) and explored predictors of response. DESIGN: Prospective, randomized, controlled pilot study PARTICIPANTS: Thirty-seven individuals (mean age 58 ± 12 years, 51% female) with moderate to severe chronic NOP. METHODS: Participants were randomized (2:1) to a 20-minute high-frequency TENS (hfTENS, 60 Hz) or low-frequency TENS (lfTENS, 3 Hz) intervention, delivered at the forehead three times/week, for six months. Study visits occurred at baseline, three, and six months, during which data from ocular symptom questionnaires, quantitative sensory testing (QST), and ocular examinations were collected. MAIN OUTCOME MEASURES: The primary outcome was change in ratings of pain intensity (0-10 numerical rating scale [NRS]). Secondary outcomes included changes in other measures of NOP symptom severity, QST metrics assessing evoked somatosensory sensitivity, and ocular signs (eg, corneal staining). RESULTS: Both hfTENS and lfTENS significantly reduced eye pain intensity acutely (within 24-hours of initial treatment), and hfTENS produced long-lasting improvements in the NPSI-Eye subscores of pressing pain (2.50 [5.50] to 1.50 [2.50], p = .03) and paroxysmal pain (1.50 [3.50] to 0.00 [1.50], P = .02) at three months, though without corresponding changes in NRS scores of generalized ocular pain intensity. No changes were noted at six months, and neither intervention impacted ocular exam findings at any time point. Significant baseline predictors of long-term TENS response included lower NPSI-Eye scores and lower sensitivity to noxious heat stimuli. CONCLUSIONS: Both hfTENS and lfTENS effectively reduced NOP short-term, with hfTENS also demonstrating sustained analgesia for neuropathic-like symptoms at three months. Baseline NOP severity and cutaneous sensitivity were predictive of treatment response and suggest reduced disruption of central pain modulatory mechanisms is efficacious for susceptibility to hfTENS analgesia. Together, the results from this pilot study highlight the potential of TENS as a neuromodulatory treatment for NOP, warranting future studies to guide patient selection and optimization of therapeutic benefit. CLINICAL TRIAL REGISTRATION: Pilot Study of TENS for Ocular pain; NCT05531643.
PURPOSE: Mucopolysaccharidosis type III (MPS III, Sanfilippo syndrome) is a group of rare, hereditary, autosomal recessive, lysosomal storage disorders characterized by neurocognitive decline and early mortality. Pronoun...PURPOSE: Mucopolysaccharidosis type III (MPS III, Sanfilippo syndrome) is a group of rare, hereditary, autosomal recessive, lysosomal storage disorders characterized by neurocognitive decline and early mortality. Pronounced visual impairment is frequent and retinal disease is more common in MPS III than in other MPS subtypes. The aim of this study was to characterize the retinal phenotype in MPS III and to provide insights into the disease course. DESIGN: Retrospective monocenter case series. METHODS: In this study, 27 patients with genetically confirmed MPS III (n = 16 MPS IIIA; n = 9 MPS IIIB; n = 2 MPS IIIC) were included. The disease phenotype was classified as rapid or slowly progressive. All patients underwent spectral-domain optical coherence tomography (OCT) imaging to analyze central retinal thickness, peripapillary retinal nerve fiber layer thickness (RNFL), and configuration of retinal layers. Depending on neurocognitive status and compliance, best-corrected visual acuity (BCVA), slitlamp microscopy, and fundoscopy were performed. RESULTS: The median age at the ophthalmological examination was 6.5 years (range, 1-16 years). Slitlamp examination findings were usually unremarkable. BCVA was assessable in 6 of 27 patients and was within the normal age-adjusted range. Parafoveal degeneration of the outer retinal layers was observed in 59% of patients, whereas foveal thickening of the external limiting membrane was noted in 67%. One MPS IIIA patient showed severe foveal atrophy, and another presented with foveal intraretinal fluid accumulation. Quantitative retinal thickness analysis of all patients showed median values at the lower end of the reference spectrum in the inner perifoveal ring and below the normal range in the outer perifoveal ring, with no distinct pattern that distinguishes the subtypes or phenotypes. RNFL thickness was unremarkable in all patients. CONCLUSIONS: This study reveals a pattern of parafoveal degeneration of outer retinal layers in patients with all 3 MPS III subtypes, of whom MPS IIIA patients, known to have a more rapidly progressive neurocognitive disease, show the most severe retinal involvement. We provide natural history data that may contribute to planning and conducting future clinical trials, and we recommend further systematic ophthalmological examinations of MPS III patients to evaluate ocular involvement.
Abdelaal A, Abu Serhan H, Alsaadi M
… +6 more, Abou Jabal K, Rustam Z, Talaparthy T, Adelpour M, Khouri AS, Elhusseiny AM
Am J Ophthalmol
· 2026 Jun · PMID 41812849
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TOPIC: To evaluate whether metformin use is associated with a reduced risk of developing glaucoma. CLINICAL RELEVANCE: Glaucoma is a leading cause of irreversible blindness worldwide. Identifying systemic medications tha...TOPIC: To evaluate whether metformin use is associated with a reduced risk of developing glaucoma. CLINICAL RELEVANCE: Glaucoma is a leading cause of irreversible blindness worldwide. Identifying systemic medications that may modify glaucoma risk could have important implications for prevention strategies in patients with diabetes, a population frequently treated with metformin. METHODS: This systematic review and meta-analysis of observational cohort studies, registered on PROSPERO (CRD420250655975), was done through PubMed, Scopus, Web of Science, and Google Scholar until June 16, 2025. Eligible studies compared glaucoma incidence among metformin users versus nonusers or users of other antidiabetic drugs (ADDs). Risk of bias was assessed using the Newcastle-Ottawa Scale. Binary outcomes were pooled using random-effects models to calculate odds ratios (ORs), and time-to-event outcomes were synthesized using hazard ratios (HRs). Subgroup analyses explored confounder adjustment methods and comparator types. Certainty of evidence was graded using GRADE framework. RESULTS: Twelve retrospective cohort studies (n = 1,247,325; 732,423 metformin users; 513,292 controls) were included. The pooled crude OR showed no association between metformin use and glaucoma risk (OR = 0.96; 95% CI, 0.87-1.06; I² = 79.14%; low certainty). A leave-one-out sensitivity analysis excluding a study with a nonmetformin active comparator resulted in a modest but significant reduction in risk (OR = 0.92; 95% CI, 0.87-0.98; low to moderate certainty). No effect modification was detected by the confounder adjustment method (propensity-score matched vs regression; P = .20; low certainty) or comparator type (no metformin vs other ADDs; P = .34; very low certainty). The follow-up duration did not significantly modify the effects. Four studies contributed time-to-event analyses: pooled unadjusted HR indicated a lower risk among metformin users (HR = 0.86; 95% CI, 0.79-0.93; I² = 0%; moderate certainty), which persisted in adjusted models (aHR = 0.88; 95% CI, 0.80-0.96; I² = 0.01%; moderate certainty). There was no evidence of small-study effects (Egger's P = .955). CONCLUSION: Across observational cohorts, metformin use was not associated with a reduced glaucoma risk in crude analyses; however, sensitivity analyses suggested a possible protective effect. Time-to-event analyses consistently demonstrated a modest reduction in glaucoma risk, supported by moderate-certainty evidence after adjusting for confounders. Overall, certainty of evidence ranged from very low (comparator analyses) to moderate (time-to-event analyses).
Banerjee S, Mihailovic A, Lee MJ
… +6 more, Miller R, Chen X, Almidani L, Diaz M, Gitlin LN, Ramulu PY
Am J Ophthalmol
· 2026 Jun · PMID 41802483
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OBJECTIVE: To determine if home environmental features (ie, lighting and home hazards) are associated with difficulties in instrumental activities of daily living (IADLs) in persons with glaucoma. DESIGN: Cross-sectional...OBJECTIVE: To determine if home environmental features (ie, lighting and home hazards) are associated with difficulties in instrumental activities of daily living (IADLs) in persons with glaucoma. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: A total of 174 adults with suspect or primary glaucoma were recruited. METHODS: IADLs, fear of falling (FoF), and glaucoma quality of life (GQL) were assessed via questionnaire. FoF and GQL were prespecified as negative controls to assess discriminant/external validity, as they are not expected to be influenced specifically by in-home lighting or hazards. We classified IADL difficulty as a binary outcome (≥1 IADL difficulty vs none). Person-measure scores for FoF and GQL were calculated in logits using Rasch modeling. The home environment assessment for the visually impaired (HEAVI) tool assessed homes for the total number of hazards, frequency of hazards among graded items, and average home lighting. Multivariable logistic and linear regression models evaluated associations between home environmental measures with IADL difficulty and FoF and GQL scores, controlling for severity of visual field damage, age, race, sex, comorbidity, and polypharmacy. MAIN OUTCOME MEASURES: Association between home environmental features with difficulties in IADLs, FoF, and GQL. RESULTS: Better home lighting was associated with less difficulty completing IADL tasks (odds ratio [OR] = 0.88 per 0.1 log unit light increment, 95% CI = 0.77-1.00, P = .04). No association was found between the number of home hazards (OR = 0.97 per 10 additional hazard, 95% CI = 0.62-1.53, P = .89) or the frequency of home hazards among graded items (OR = 1.10 per 10% increment in hazard frequency, 95% CI = 0.65 to 1.86, P = .73) with IADL difficulty. No significant associations were noted between lighting levels, frequency or number of home hazards with FoF or GQL scores. CONCLUSION: Better home lighting was associated with less frequent difficulty with IADLs (but not FoF or GQL) in a cohort enriched for glaucoma; no associations were noted with any measure for home hazards. Lighting may be able to improve specific aspects of function in persons with glaucoma.
Am J Ophthalmol
· 2026 Jun · PMID 41794059
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PURPOSE: To evaluate the incremental cost-effectiveness of extended depth of focus (EDOF) compared with trifocal intraocular lenses (IOLs) among patients undergoing bilateral cataract surgery who elect for presbyopia-cor...PURPOSE: To evaluate the incremental cost-effectiveness of extended depth of focus (EDOF) compared with trifocal intraocular lenses (IOLs) among patients undergoing bilateral cataract surgery who elect for presbyopia-correcting IOL implantation. DESIGN: Cost-effectiveness analysis using a state-transition (Markov) model. SUBJECTS: Hypothetical cohort of 65-year-old patients undergoing bilateral cataract surgery with presbyopia-correcting IOLs. METHODS: A lifetime Markov model simulated postoperative health states reflecting spectacle independence, visual disturbances, and mortality. The analysis was framed as a conditional comparison within a presbyopia-correcting IOL population. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). A willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted life year (QALY) was applied. One-way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty. RESULTS: EDOF IOLs resulted in an incremental gain of 0.02 QALYs at an additional cost of $106, yielding an ICER of $6,515 per QALY. The incremental net monetary benefit differed by $1,534 at a WTP threshold of $100,000 per QALY, reflecting minimal economic separation between strategies. One-way sensitivity analyses demonstrated that modest changes in spectacle dependence and visual disturbance resolution could reverse economic preference, indicating proximity to economic neutrality. In probabilistic sensitivity analysis, EDOF IOLs were cost-effective in 56.7% of 10,000 simulations at a WTP threshold of $100,000 per QALY, demonstrating persistent decision uncertainty. CONCLUSIONS: EDOF and trifocal IOLs provide comparable economic value within a presbyopia-correcting IOL population. Given the small incremental differences and persistent uncertainty, lens selection should emphasize individualized, preference-sensitive decision-making rather than population-level economic preference.
OBJECTIVE: To expand the spectrum of gastrointestinal (GI) manifestations associated with pentosan polysulfate sodium (PPS) maculopathy. DESIGN: Retrospective case series. SUBJECTS: Eight patients (16 eyes) diagnosed wit...OBJECTIVE: To expand the spectrum of gastrointestinal (GI) manifestations associated with pentosan polysulfate sodium (PPS) maculopathy. DESIGN: Retrospective case series. SUBJECTS: Eight patients (16 eyes) diagnosed with PPS maculopathy who also underwent GI evaluation between 2019 and 2025. METHODS: Electronic medical records were reviewed for demographics, PPS dosage and duration, ocular findings, GI history, diagnostic presentation, and histopathology. Multimodal imaging included fundus photography, fundus autofluorescence, fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. Colonoscopy was performed in all patients with histopathologic analysis in selected cases. PPS maculopathy was staged according to Wang et al.'s classification system. Genetic testing was obtained in selected cases to exclude any form of inherited maculopathy or familial adenomatous polyposis. MAIN OUTCOME MEASURES: Clinical and imaging features of PPS maculopathy and GI pathological diagnosis, including polyposis, dysplasia, and inflammatory bowel disease. RESULTS: The cohort included 6 women and 2 men (median age: 68.5 years). Median PPS exposure was 25.4 years with a median cumulative dose of 2899 grams. At presentation, 62.5% of eyes were stage 1, 31.3% stage 2, and 6.3% stage 3. At final follow-up, 25% of eyes were stage 1, 50% stage 2, and 25% stage 3. Overall, 37.5% of eyes showed progression of maculopathy stage, and cRORA was present in 75% of eyes at last follow-up. Additional findings included acquired vitelliform lesions, outer retinal tubulations, epiretinal membranes, and type 2 macular neovascularization. Colonoscopy revealed severe adenomatous polyposis in 6 of the 8 patients (75%), with 3 requiring partial or total colectomy and 2 undergoing endoscopic resection. One patient developed ulcerative colitis, and 2 additional patients were diagnosed with Crohn's disease or microscopic colitis. The median latency to GI diagnosis was 10 years after PPS initiation. CONCLUSIONS: This study expands the recognized systemic toxicity of PPS, demonstrating that PPS maculopathy patients are at risk of concomitant colonic disease, including severe polyposis and dysplasia. The frequent detection of asymptomatic polyposis underscores the importance of colonoscopy screening in exposed patients, even in the absence of GI symptoms. Heightened interdisciplinary awareness and long-term surveillance are warranted to mitigate the vision- and life-threatening consequences of PPS toxicity.
Kang S, Hsu J, Koo EH
… +6 more, Donaldson KE, Culbertson WW, Amescua G, Cabot F, Galor A, Yoo SH
Am J Ophthalmol
· 2026 Jun · PMID 41785986
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PURPOSE: To characterize patient-surgeon sex concordance and evaluate sex-based trends in cataract surgical volume over a 14-year period. DESIGN: Retrospective cohort and trend study. SUBJECTS: All cataract surgeries per...PURPOSE: To characterize patient-surgeon sex concordance and evaluate sex-based trends in cataract surgical volume over a 14-year period. DESIGN: Retrospective cohort and trend study. SUBJECTS: All cataract surgeries performed and all surgeons performing cataract surgery at the Bascom Palmer Eye Institute between January 1, 2011, and November 7, 2024. METHODS: Cataract surgery counts were aggregated by surgeon sex, patient sex, and calendar year to assess patient-surgeon sex concordance and longitudinal trends in surgical volume. Surgeon workforce composition and annual surgical productivity were evaluated using procedure counts. Associations between surgeon sex, sex distribution of operated eyes, and changes in surgical volume over time were examined. MAIN OUTCOME MEASURES: Primary outcomes were patient-surgeon sex concordance at the cataract surgery level and surgeon-level cataract surgery volume. Secondary outcomes included temporal trends in surgeon workforce composition and sex-stratified distributions of cataract surgeries. RESULTS: Among 88,420 cataract surgeries (mean age of 68.2 ± 11.1 years; 55.9% female patients; 122 surgeons), women comprised approximately one-third of active surgeons, a proportion that remained stable over time. Patient-surgeon sex concordance was modest (OR, 1.06; 95% CI, 1.03-1.09), indicating limited deviation from equal odds of same-sex pairing. Despite stable workforce representation, female surgeons' share of institutional cataract volume increased from 37.8% in 2011 to 52.8% in 2024 (β = 10.8 cases/year; P < .001), with higher mean annual productivity per surgeon in 2023-2024 compared with male surgeons (249.2 vs 122.7 cases; P = .03). Female surgeon productivity was strongly correlated with patient-surgeon sex concordance over time (ρ=0.83; P < .001). CONCLUSIONS: In this large longitudinal cohort, patient-surgeon sex concordance was modest and closely aligned with changes in surgeon productivity and workforce output. These findings suggest that sex-based productivity disparities are modifiable and that institutional factors related to surgical volume distribution may influence gender equity in ophthalmic surgical practice.
Zhao W, Luo X, Yang J
… +4 more, Liao Y, Jin L, Chen Z, Liang L
Am J Ophthalmol
· 2026 Jun · PMID 41780738
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PURPOSE: To observe the longitudinal changes in meibomian gland structure and function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to investigate the potential associated factors....PURPOSE: To observe the longitudinal changes in meibomian gland structure and function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to investigate the potential associated factors. DESIGN: Single-center retrospective clinical cohort study. PARTICIPANTS: Sixty-eight patients after allo-HSCT, including 48 patients (92 eyes) with and 20 patients (40 eyes) without chronic ocular graft-versus-host disease (coGVHD). METHODS: Medical records were retrospectively reviewed. Data collected included demographic characteristics, medical history, ocular surface disease index questionnaire, corneal fluorescein staining, bulbar conjunctival injection, Schirmer's test, noninvasive break-up time, lid margin abnormalities, meibum quality scores, and meibomian gland area ratio (MGAR). Follow-up data were compared. A generalized estimating equation was used to analyze the associated factors. MAIN OUTCOME MEASURES: Change in MGAR. RESULTS: All patients were followed up for 22.9 ± 10.7 months since first visit (coGVHD group vs non-coGVHD group = 23.6 ± 10.8 months vs 21.3 ± 10.5 months, P = .441). Compared with baseline, the severity of coGVHD at the last follow-up visit improved (International Chronic Ocular Graft-versus-Host Disease [ICCGVHD] score: 7.3 ± 2.3 vs 8.5 ± 1.7, P < .001), but no significant change in MGAR (51.7% ± 14.8% vs 52.6% ± 14.8%, P = .341). Specifically, MGAR remained stable in 59 eyes (64.1%), deteriorated in 14 eyes (15.2%), and improved in 19 eyes (20.7%). In the non-coGVHD group, while ICCGVHD scores remained stable compared to baseline, MGAR showed a decrease at the final follow-up (70.2 ± 11.0% vs 73.5 ± 10.0%, P = .001). Cessation or tapering of systemic immunosuppressants was associated with MGAR worsening in both the coGHVD group (odds ratio [OR]: 4.60, 95% confidence interval [CI]: 1.24-17.00) and the non-coGHVD group (OR: 2.48, 95%CI: 1.14-5.40). Further subgroup analysis revealed that in coGVHD patients, the subgroup with cessation or tapering of systemic immunosuppressants showed a significant worsening in meibum quality (8.4 ± 5.3 vs 5.9 ± 4.6, P = .005). CONCLUSIONS: Improvement in coGVHD is not necessarily accompanied by improvement in Meibomian gland dysfunction (MGD). Cessation or tapering of systemic immunosuppressants was associated with the progression of MGD after allo-HSCT.
Espinoza S, Labetoulle M, Rousseau A
… +7 more, Tuil E, Lafitte F, Tahar IB, Capatina S, Ambarki K, Borderie V, Nguyen TH
Am J Ophthalmol
· 2026 Jun · PMID 41771335
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PURPOSE: To characterize high-resolution MRI (HR-MRI) findings of orbital, cranial nerve, and vascular involvement in herpes zoster ophthalmicus (HZO), and to distinguish inflammatory from ischemic patterns in patients w...PURPOSE: To characterize high-resolution MRI (HR-MRI) findings of orbital, cranial nerve, and vascular involvement in herpes zoster ophthalmicus (HZO), and to distinguish inflammatory from ischemic patterns in patients with acute neuro-ophthalmologic symptoms. DESIGN: Retrospective, single-center observational case series. METHODS: Immunocompetent, PCR-confirmed HZO patients referred to a tertiary center between January 2016 and June 2025 for HR-MRI due to neuro-ophthalmologic complaints were included. Exams were performed on 3T systems using 3D FLAIR, TOF angiography, DWI, axial T2, coronal T2 STIR, and postcontrast fat-saturated 2D/3D T1 sequences, including vessel-wall assessment. RESULTS: Twenty patients were included (median age 77.5 years). Oculomotor disorders were the most common neuro-ophthalmologic manifestation (70%). HR-MRI showed optic perineuritis (OPN) in 60%, retrobulbar episcleral inflammation in 45%, associated with orbital fat infiltration. Extraocular muscle inflammation consistent with myositis was present in most patients with ophthalmoplegia. Cavernous sinus enhancement extended to the cisternal segments of CN V, III, VI in approximately 25% of patients. Optic neuropathy was identified in 10% with diffusion restriction suggesting ischemia. Vessel-wall enhancement consistent with VZV vasculopathy affected the superficial temporal artery in 40% and the supraclinoid ICA in three patients; one had acute stroke. MRI impacted short- and long-term management in 14/20 patients. CONCLUSIONS: In HZO with neuro-ophthalmologic deficits, HR-MRI frequently reveals perineuritis, myositis, cavernous sinus pachymeningitis, cranial nerve inflammation, and small- or large-vessel vasculopathy. Imaging helps differentiate inflammatory from ischemic complications and supports timely, tailored antiviral and adjunctive therapies. Early HR-MRI, including vessel-wall sequences, should be considered in severe or atypical HZO presentations.
Verstraaten JH, Buzzi M, Masalkhi M
… +13 more, Behndig A, Cochener B, Day AC, Dick HB, Findl O, Lapid-Gortzak R, Kohnen T, Nuijts R, Rosen P, van den Biggelaar FJHM, Abulafia A, Virgili G, Dickman MM
Am J Ophthalmol
· 2026 Jun · PMID 41771334
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PURPOSE: Astigmatism is one of the most common refractive conditions, with a large proportion of patients undergoing cataract surgery presenting with 1.0 D or more. Toric IOLs are the standard of care for astigmatism cor...PURPOSE: Astigmatism is one of the most common refractive conditions, with a large proportion of patients undergoing cataract surgery presenting with 1.0 D or more. Toric IOLs are the standard of care for astigmatism correction during cataract surgery. This overview of reviews synthesizes current evidence on the use of toric IOLs, focusing on clinical indications, surgical outcomes, and emerging technologies. DESIGN: Narrative review of reviews. METHODS: The following databases were searched from inception to 2 June 2025: MEDLINE, Embase, the Cochrane Library (including CENTRAL and the Cochrane Database of Systematic Reviews), KSR Evidence, and the Trip Database. Keywords included astigmatism, toric intraocular lenses, cataract surgery, intraocular lens implantation, and postoperative outcomes. Included studies were systematic and narrative reviews, meta-analyses, and clinical guidelines related to the use of toric IOLs in cataract surgery. RESULTS: Eighty-five reviews were included. This overview summarizes key topics including the prevalence and impact of astigmatism, toric IOL technology, preoperative assessment, power calculation methods, surgical considerations, and postoperative outcomes such as rotational stability and surgically induced astigmatism. Reporting standards, patient-reported outcome measures, adverse events, and considerations in special populations are also discussed. Knowledge gaps and debated areas are highlighted. CONCLUSIONS: Toric IOLs improve uncorrected visual acuity and refractive outcomes in cataract patients with significant astigmatism. Advances in diagnostics, lens design, calculation formulas, and intraoperative tools continue to enhance accuracy and patient satisfaction. Further research is needed to address unresolved questions and support best practices in diverse clinical settings.
Gregori G, Sahoo NK, Hasan N
… +32 more, Zarnegar A, Lupidi M, Zhang M, Wu L, Cao J, Piccoli G, Vujosevic S, Shah P, Singhanetr P, Rossin E, Checchin L, Pili L, Parodi MB, Kim M, Desideri LF, Munk MR, Chotcomwongse P, Ruamviboonsuk P, Fung A, Small K, Khateb S, Wang JC, Khurana RN, Villafeurte C, Yiu G, Momenaei B, Garg S, Lai T, Ashfaq Y, Kroeger Z, Chhablani J, Macula Society International CSCR Research Network (MICRoN)
Am J Ophthalmol
· 2026 Jun · PMID 41765268
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PURPOSE: To evaluate the characteristics and longitudinal outcomes of chronic central serous chorioretinopathy (CSCR) in women compared to an age-matched cohort of men with CSCR. DESIGN: Retrospective, multicenter clinic...PURPOSE: To evaluate the characteristics and longitudinal outcomes of chronic central serous chorioretinopathy (CSCR) in women compared to an age-matched cohort of men with CSCR. DESIGN: Retrospective, multicenter clinical cohort study from the Macula Society CSCR Study Group. PARTICIPANTS: This study included 426 eyes (213 women and 213 age-matched men) with a diagnosis of CSCR. METHODS: Baseline and final best-recorded visual acuity (BRVA) and multimodal imaging parameters such as area of retinal pigment epithelium (RPE) alterations, choroidal macular thickness (CMT), sub-foveal choroidal thickness (SFCT), subretinal fluid (SRF), pigment epithelium detachment (PED), double layer sign (DLS), hyperreflective dots (HRD), as well as the presence of choroidal neovascularization (CNV) and subretinal hyperreflective material (SHRM) were assessed. Regression analysis was used to evaluate baseline predictors of final visual acuity. MAIN OUTCOME MEASURES: Longitudinal changes in BRVA and imaging parameters in men and women stratified for age; factors affecting subretinal fluid (SRF) persistence, and change in BRVA. RESULTS: A total of 426 eyes (213 women and 213 age-matched men) with CSCR were analyzed. Women showed better BRVA at presentation (0.25 ± 0.24 vs 0.31 ± 0.35 logMAR; P = .05), and exhibited smaller areas of RPE alterations (2.37 ± 2.64 vs 1.59 ± 1.55 disc areas; P = .003), less frequent peripapillary RPE changes (13.6% vs 7.5%; P < .001), shorter DLS (1353.9 ± 970.2 vs 1071.6 ± 888.7 µm; P = .039), and smaller PEDs (644.9 ± 546.4 vs 442.1 ± 278.9 µm; P = .022). During follow-up, women exhibited higher rates of complete SRF resolution (P = .001) while persistence and the number of recurrences were significantly more common in men (P = .006 and P = .02, respectively). Logistic regression analysis revealed that persistent SRF was independently associated with complex CSCR, male gender, baseline PROS irregularities, worse BRVA, SHRM, and CNV, while PDT was protective. CONCLUSION: Women had better visual outcomes and more favorable structural evolution while men tended to present with more complex anatomical alterations and experience higher rates of persistent SRF.