BMC Ophthalmol [JOURNAL]
Sun
200 papers
The association between magnesium and diabetic retinopathy: a cross-sectional study.
Wang Y, Li J, Lin Y … +4 more , Hu W, Tu Y, Xiao A, Zhou Q
BMC Ophthalmol · 2026 Jun · PMID 42332654 · Full text
OBJECTIVE: To investigate the clinical significance of serum magnesium in non-diabetic mellitus (non-DM), diabetes mellitus (DM) and diabetic retinopathy (DR). Moreover, to assess magnesium concentration in DR mice model...
OBJECTIVE: To investigate the clinical significance of serum magnesium in non-diabetic mellitus (non-DM), diabetes mellitus (DM) and diabetic retinopathy (DR). Moreover, to assess magnesium concentration in DR mice models. METHODS: Baseline data from 150 patients per group (non-DM, DM, DR) comprised demographics, cardiovascular-metabolic profiles, electrolytes, and systemic immune-inflammatory were collected and analyzed. Logistic regression analysis was used to screen influencing factors for DR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic utility of hemoglobin A1c (HbA1c) and magnesium. Magnesium concentration in both serum and retinal tissues of DR mice were quantified via the methylthymol blue assay. RESULTS: Compared with the non-DM group, the DM group had lower age and blood pressure levels (P < 0.05), while heart rate, HbA1c and serum phosphorus levels were significantly higher (P < 0.05). Serum sodium and magnesium levels decreased gradually across the non-DM, DM and DR groups (P < 0.05), whereas heart rate and HbA1c levels increased progressively in the three groups (P < 0.05). Compared with DM, those with DR had longer diabetic duration. Ordinal multinomial logistic regression among non-DM, DM and DR groups indicated that HbA1c was positively associated with DR risk, whereas magnesium was negatively correlated with DR. Binary logistic regression between DM and DR groups showed that diabetes duration, SBP and HbA1c were positively related to elevated DR risk, and magnesium was negatively associated with the occurrence of DR. The ROC curve analysis revealed that a combined diagnostic of HbA1c and serum magnesium, with cut-off value of 0.500, achieved a sensitivity of 78.7% and a specificity of 90.0% for DM. The combined diagnosis of HbA1c and magnesium, with cut-off value of 0.441, approached a sensitivity of 75.3% and a specificity of 66.0% for DR. DR mice exhibited lower magnesium levels in both serum and retinal tissues compared with the control mice (P < 0.05). CONCLUSION: Patients with DR had longer disease duration, elevated HbA1c levels and decreased serum magnesium concentrations. Combined detection of serum magnesium and HbA1c can significantly improve the diagnostic performance of DR.
Clinically accessible eye-tracking in thyroid-associated ophthalmopathy: exploratory classification modeling and gaze allocation to disease-related periocular images.
Yang C, Shen Y, Song J … +3 more , Chen Y, Zeng C, Wei R
BMC Ophthalmol · 2026 Jun · PMID 42332638 · Full text
BACKGROUND: Thyroid-associated ophthalmopathy (TAO) is an autoimmune orbital disease that may cause ocular motility abnormalities, altered periocular appearance, and psychosocial burden. However, clinically practical too...
BACKGROUND: Thyroid-associated ophthalmopathy (TAO) is an autoimmune orbital disease that may cause ocular motility abnormalities, altered periocular appearance, and psychosocial burden. However, clinically practical tools for early recognition and objective functional assessment remain limited. This study aimed to evaluate whether clinically accessible eye-tracking could support auxiliary classification of thyroid-associated ophthalmopathy and characterize visual attention patterns toward disease-related periocular images. METHODS: In this cross-sectional study, 229 adults from a tertiary ophthalmology center were enrolled, including 181 patients with TAO and 48 healthy controls. Eye movements were recorded using a clinically accessible eye-tracking system during fixation, smooth pursuit with nine-grid spatial analysis, and image-viewing tasks. Random forest models were developed using nine-grid smooth-pursuit gaze-distribution features. A primary model included eye-tracking features plus age and sex, while a secondary model assessed eye-tracking features after demographic adjustment. Group differences in gaze metrics and region-of-interest allocation were analyzed using regression-based methods. RESULTS: Fixation stability did not differ significantly between groups, but patients with TAO showed increased gaze dispersion. In smooth pursuit, the primary model achieved an AUC of 0.903, and the secondary model achieved an AUC of 0.778. In image-viewing tasks, gaze allocation differed between groups: compared with controls, patients with TAO paid less attention to more obvious pathological periocular features in earlier-stage images and more attention to near-recovery appearances in later-stage images. Distinct viewing patterns were also observed across preoperative and postoperative images from different surgical categories. CONCLUSIONS: Clinically accessible eye-tracking may provide behavioral markers for auxiliary TAO classification and reveal altered visual attention to TAO-related periocular appearance. Further validation in larger, independent cohorts is needed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07381413. Prospectively registered.
Association between capsulectomy shunt revision and Ahmed glaucoma valve implant exposure--Shanghai Ahmed glaucoma valve implant exposure (AGVIE) study.
Gao F, Jin M, Yu X … +13 more , Chen J, Dai Y, Chen Y, Wang J, Chen X, Wang L, Fang Y, Wang K, Liu T, Kwan YL, Qian S, Sun X, Kong X
BMC Ophthalmol · 2026 Jun · PMID 42332618 · Full text
BACKGROUND: The Ahmed Glaucoma Valve (AGV) is a drainage device commonly used in the treatment of refractory glaucoma. Implant exposure is a major cause of surgical failure. This study aimed to identify factors associate...
BACKGROUND: The Ahmed Glaucoma Valve (AGV) is a drainage device commonly used in the treatment of refractory glaucoma. Implant exposure is a major cause of surgical failure. This study aimed to identify factors associated with AGV exposure. METHODS: This retrospective cohort study included all inpatients who underwent primary AGV implantation at the Eye & ENT Hospital of Fudan University between January 2015 and December 2024. Baseline demographic and surgical data were collected. Factors associated with AGV exposure were evaluated using univariate and multivariate logistic regression. RESULTS: In this comprehensive cohort study, involving a total of 2,905 eyes, with participants having a mean age of 49.2 ± 18.0 years and 64% being male, we observed that AGV exposure occurred in 75 eyes, accounting for an incidence rate of 2.6% (95% CI, 2.0-3.2%). Capsulectomy shunt revision (CSR) was associated with AGV exposure in both univariable analysis (OR 3.72, 95% CI 1.73-7.98; P < 0.001) and multivariable analysis (OR 3.95, 95% CI 1.79-8.69; P < 0.001). CONCLUSIONS: The crude incidence of AGV exposure was 2.6%. CSR was statistically associated with AGV exposure, although this finding should be interpreted cautiously given the retrospective design and methodological limitations. Careful surgical planning and close postoperative monitoring may therefore be warranted. CLINICAL TRIAL REGISTRATION: Not applicable.
Diagnostic and therapeutic impact of PCR in uveitis: real-world data from intraocular fluid analysis of 45 uveitis patients in a tertiary referral center in Turkey.
Zorlutuna Kaymak N, Pekel İ, Demir Tekol S … +3 more , Akçay G, Oklar M, Tanyıldız B
BMC Ophthalmol · 2026 Jun · PMID 42332605 · Full text
PURPOSE: To evaluate the diagnostic utility and real-world clinical impact of polymerase chain reaction (PCR) analysis of aqueous humor (AH) and vitreous samples in patients with uveitis including suspected infectious an...
PURPOSE: To evaluate the diagnostic utility and real-world clinical impact of polymerase chain reaction (PCR) analysis of aqueous humor (AH) and vitreous samples in patients with uveitis including suspected infectious and mixed (infectious/non-infectious) etiologies. Although intraocular PCR is a well-established diagnostic technique, its contribution to diagnostic revision and clinical decision-making in routine practice remains incompletely characterized. This study addresses this gap by assessing the impact of PCR on diagnostic revision, clinical management and regional epidemiological patterns in a tertiary referral center in Turkey. METHODS: A retrospective review was conducted on 45 eyes of 45 patients with uveitis. PCR testing was performed on AH (n = 24) and vitreous samples (n = 21) for Herpes simplex virus (HSV), Varicella zoster virus (VZV), Cytomegalovirus (CMV), Toxoplasma gondii, and Mycobacterium tuberculosis based on clinical suspicion. Pathogen-specific uniplex real-time PCR assays providing qualitative and quantitative results were used. PCR findings were evaluated in conjunction with clinical presentation to assess their contribution to diagnostic revision, diagnostic certainty, and clinical management. RESULTS: The mean patient age was 47.4 ± 17.3 years, and 51.1% of the patients were female; 28.9% were immunosuppressed. Overall PCR positivity was 42.2% (19/45). PCR positivity was higher in immunosuppressed patients than in immunocompetent patients (62.0% vs. 34.4%), although this difference did not reach statistical significance (p = 0.094). PCR positivity was higher in AH samples than in vitreous samples (50.0% vs. 33.3%). PCR analysis led to diagnostic revision in 33.3% (15/45) of patients and influenced clinical management decisions in 80.0% of cases. Positive PCR results were significantly associated with diagnostic certainty (p = 0.006), whereas PCR-negative patients had a markedly higher likelihood of requiring diagnostic and therapeutic modification compared to PCR-positive patients (OR 21.0, 95% CI 2.4-182, p = 0.001). CONCLUSION: PCR analysis of intraocular fluids provides meaningful diagnostic value in the evaluation of uveitis. Both positive and negative results inform clinical decision-making by guiding diagnostic revision and supporting appropriate management strategies. These findings provide region-specific epidemiological data and reinforce intraocular PCR as a key adjunct in complex uveitis cases where clinical features alone are insufficient.
Application of subretinal injection of balanced salt solution for the management of large-diameter macular holes.
Wang X, Li X, Wu B … +2 more , Han Q, Wang Y
BMC Ophthalmol · 2026 Jun · PMID 42332604 · Full text
PURPOSE: To evaluate the efficacy and safety of subretinal injection of balanced salt solution (BSS) combined with vitrectomy and internal limiting membrane (ILM) peeling for managing large-diameter macular holes (MHs ≥ ...
PURPOSE: To evaluate the efficacy and safety of subretinal injection of balanced salt solution (BSS) combined with vitrectomy and internal limiting membrane (ILM) peeling for managing large-diameter macular holes (MHs ≥ 400 μm). METHODS: A prospective interventional study was conducted on 31 eyes of 31 patients with full-thickness MHs (including 5 refractory MHs). Patients underwent 25 G vitrectomy, ILM peeling, followed by subretinal BSS injection using a 41 G needle. Outcomes were assessed at 1 and 3 months postoperatively with optical coherence tomography (OCT), best corrected visual acuity (BCVA), and microperimetry. Metrics of the microperimetry included macular integrity index (MII) and macular threshold (MT). Ten eyes completed 6 month followup. Changes in BCVA (LogMAR), MII, and MT before and after surgery, as well as MH closure and complications were compared and analyzed. Functional outcomes were analyzed only in eyes with successful type I closure. RESULTS: At 1 month, 93.54% (29/31) achieved complete MH closure. BCVA improved from 1.34 ± 0.59 preoperatively to 0.67 ± 0.20 at 1 month and 0.48 ± 0.36 at 3 months (p < 0.001). MII improved from 98.77 ± 4.83 to 96.23 ± 11.38 (p = 0.015) and MT from 17.53 ± 5.04 to 22.54 ± 3.91 dB (p < 0.001) at 3 months. In 10 eyes with 6 month followup, BCVA further improved to 0.41 ± 0.30 and MT to 24.64 ± 2.35 dB (bothp < 0.05). The refractory subgroup (n = 5) achieved 100% complete closure. No complications were observed during the follow-up time. CONCLUSION: Combined 41 G subretinal BSS injection with PPV and ILM peeling is effective and safe for treating largediameter MHs (≥400 μm), achieving high anatomical closure rates and sustained visual functional improvement up to 6 months. Preliminary outcomes in refractory MHs are favorable; larger cohorts are needed for validation.
Contribution of resting pulse rate to fall risk prediction in patients with glaucoma: a nationwide retrospective study based on an XGBoost model.
Zhang Z, Wang J, Zeng S … +5 more , Gao L, He R, Wu L, Chen Z, Hu J
BMC Ophthalmol · 2026 Jun · PMID 42324504 · Full text
BACKGROUND: Falls are among the most common safety concerns in people with visual impairment and can lead to serious consequences, including fractures, prolonged hospitalization, and even death. Patients with glaucoma ar...
BACKGROUND: Falls are among the most common safety concerns in people with visual impairment and can lead to serious consequences, including fractures, prolonged hospitalization, and even death. Patients with glaucoma are at increased risk of falls due to visual field loss, impaired motor coordination, and declines in cognitive function compared with the general population. Resting pulse rate is an easily obtainable measure in routine clinical practice; however, its contribution to fall risk prediction in patients with glaucoma has not been sufficiently investigated. To address this knowledge gap, we developed and compared multiple predictive approaches by incorporating a broad range of fall-related variables into prediction models, and we used explainable machine learning to quantify the contribution of resting pulse rate to fall risk prediction in glaucoma. In doing so, we aimed to explore the potential contribution of resting pulse rate as one of the model features in fall risk estimation, rather than as a standalone glaucoma-specific ophthalmic indicator. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We included 249 participants with self-reported physician-diagnosed glaucoma who had no history of falls at the 2015 baseline survey and completed follow-up in 2018. The outcome was the occurrence of any fall between 2015 and 2018. To further characterize baseline differences, we also included 12,297 participants without glaucoma and without a history of falls at the 2015 baseline survey for comparative analyses.Candidate predictors comprised demographic characteristics, clinical comorbidities, medication use, self-reported vision status, and relevant laboratory measures. Self-reported near and distance vision were treated as limited visual functional information available in the database and were not considered equivalent to objective glaucoma-specific ophthalmic indicators. To compare machine learning models with a conventional statistical approach, we developed a logistic regression (LR) baseline model and trained six machine learning models: random forest, XGBoost, gradient boosting decision tree (GBDT), support vector machine (SVM), k-nearest neighbors (KNN), and AdaBoost. Feature selection was performed in the training set using recursive feature elimination with 5-fold cross-validation; within each fold, feature selection was conducted using only the fold-specific training subset and evaluated on the corresponding validation subset to reduce the risk of information leakage and overly optimistic performance estimates. After determining the final feature subset, hyperparameters were tuned and models were fitted using cross-validation within the training set. Model stability was assessed using 1,000 bootstrap resamples of the training set, and we reported the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals, accuracy, and F1 score. Calibration curves and decision curve analysis were used to evaluate calibration and clinical net benefit. Finally, SHAP was applied to interpret the best-performing XGBoost model. RESULTS: A total of 249 eligible participants with glaucoma were included. During follow-up, 36 participants reported at least one fall, yielding a fall incidence of 14.46%. In contrast, among the 12,297 non-glaucoma participants included for baseline comparison, 873 reported at least one fall (7.1%; P < 0.001).In model development, the conventional logistic regression model showed the lowest discriminative performance, with an AUC of 0.676 (95% CI, 0.628-0.724). The XGBoost model achieved the best performance, with an AUC of 0.851 (95% CI, 0.812-0.886). Decision curve analysis indicated that, within a threshold probability range of 51.5% to 67.5%, the XGBoost model provided greater net benefit than the other machine learning models. SHAP-based feature importance further identified key predictors of falls in patients with glaucoma, with resting pulse rate ranking among the top contributing features in the XGBoost model. CONCLUSION: In this study, the XGBoost model demonstrated the best performance for estimating fall risk among participants with self-reported glaucoma. SHAP analyses indicated that resting pulse rate, creatinine, age, blood urea nitrogen, frailty status, and height made relatively large contributions within the final model. Given the absence of objective ophthalmic parameters, these findings should be regarded as exploratory and interpreted cautiously. Resting pulse rate may provide supplementary information within model-based fall risk estimation, but it should not be interpreted as a standalone glaucoma-specific indicator or as evidence of causality.
Impact of a structured patient engagement program on treatment adherence, injection persistence, and visual outcomes in real-world anti-VEGF therapy for neovascular age-related macular degeneration.
Lan L, Lan J, Ren X … +1 more , Ye B
BMC Ophthalmol · 2026 Jun · PMID 42323551 · Full text
BACKGROUND: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible visual impairment among older adults. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy h...
BACKGROUND: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible visual impairment among older adults. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has improved visual outcomes, real-world effectiveness is often limited by poor adherence and treatment discontinuation. This study evaluated the impact of a structured patient engagement program on treatment adherence, injection persistence, visual outcomes, and patient-reported outcomes in patients receiving anti-VEGF therapy for nAMD. METHODS: This single-center retrospective observational comparative cohort study included 350 patients with nAMD treated between January 2022 and December 2024. Patients received either standard care alone (n = 175) or standard care plus a structured patient engagement program (n = 175) incorporating individualized education, adherence counseling, appointment reminders, and proactive follow-up communication. Primary outcomes were treatment adherence and injection persistence. Secondary outcomes included best-corrected visual acuity (BCVA), patient satisfaction, and disease understanding. RESULTS: Patients enrolled in the engagement program demonstrated significantly better adherence than those receiving standard care. The mean number of missed injection visits was lower (0.51 ± 0.68 vs. 1.48 ± 1.27; P < 0.001), and delayed injections exceeding two weeks were less frequent (22.3% vs. 50.9%; P < 0.001). Good adherence was achieved in 89.1% of patients in the engagement group compared with 50.3% in the standard care group (P < 0.001), while treatment persistence was higher (90.9% vs. 77.7%; P = 0.001). Final BCVA was significantly better in the engagement group (0.61 ± 0.30 vs. 0.70 ± 0.34 LogMAR; P = 0.015), and a greater proportion of patients experienced visual improvement (65.1% vs. 52.6%; P = 0.023). Patient satisfaction and disease understanding were also significantly higher among patients receiving the engagement intervention (P < 0.001 for both). Safety outcomes were comparable between groups. CONCLUSIONS: A structured patient engagement program was associated with improved treatment adherence, enhanced injection persistence, and better short- to mid-term visual outcomes in patients receiving anti-VEGF therapy for nAMD. These findings support the integration of patient-centered engagement strategies into routine retinal care to optimize real-world treatment outcomes.
Agreement between Pentacam HR and Visionix VX650 system for corneal and anterior chamber parameters.
Barberán-Bernardos L, Ariza-Gracia MÁ, Piñero DP
BMC Ophthalmol · 2026 Jun · PMID 42321687 · Full text
PURPOSE: To evaluate the agreement in anterior segment measurements obtained with Pentacam HR and Visionix VX650 topographers, in terms of keratometry, pachymetry and anterior chamber parameters in healthy eyes. METHODS:...
PURPOSE: To evaluate the agreement in anterior segment measurements obtained with Pentacam HR and Visionix VX650 topographers, in terms of keratometry, pachymetry and anterior chamber parameters in healthy eyes. METHODS: Inclusion criteria consisted of healthy eyes with no history of ocular pathology or surgery. Measurements of central corneal thickness (CCT), minimum corneal thickness (MCT), anterior and posterior keratometry (K1, K2), anterior chamber depth (ACD), and anterior chamber angle (ACA) were taken using the Pentacam HR and Visionix VX650. Differences between devices were assessed with paired Student's t-tests, and agreement was evaluated using Bland-Altman plots. RESULTS: Fifty-five eyes from 55 healthy participants mean age 32.55 ± 12.60 years) were examined. Anterior keratometry and MCT showed clinically acceptable agreement between devices, with no significant differences (p > 0.164). Pentacam HR reported steeper posterior keratometry, smaller ACD, lower CCT and larger ACA values compared with VX650 (p < 0.001). For CCT and MCT, ranges of agreement were large, with values of ± 27.07 and 55.41 μm, respectively. However, the ranges of agreement for anterior K1 and K2 were smaller, with values of ± 0.11 and 0.11 mm, respectively. Likewise, the ranges of agreement for ACD and ACA were also clinically significant, with a clear trend of VX650 to provide longer ACD measurements and lower ACA estimates. CONCLUSIONS: Anterior corneal keratometry measured with the Pentacam HR and Visionix VX650 exhibit acceptable inter-device agreement. However, caution should be exercised regarding their interchangeability, especially when making decisions that require precise thickness (refractive surgery screening) or anterior chamber parameters (phakic intraocular lens implantation).
En face OCT in branch retinal artery occlusion: quantitative assessment of epiretinal macrophage-like cells and optical intensity ratio.
Zeng Y, Chen X, Zhou Y … +5 more , Chen W, Chen X, Zhu Y, Wen F, Yang R
BMC Ophthalmol · 2026 Jun · PMID 42321678 · Full text
PURPOSE: In branch retinal artery occlusion (BRAO), the regional distribution of epiretinal macrophage-like cells (eMLC) and the objective assessment of ischemic tissue alterations using en face optical coherence tomogra...
PURPOSE: In branch retinal artery occlusion (BRAO), the regional distribution of epiretinal macrophage-like cells (eMLC) and the objective assessment of ischemic tissue alterations using en face optical coherence tomography (OCT) have not been characterized. This study aimed to quantify eMLC and the optical intensity ratio (OIR) on en face OCT in acute BRAO. METHODS: This retrospective study included 17 patients with unilateral acute BRAO. En face OCT was acquired using a 3 × 3 mm scan pattern centered on the fovea. Structural en face images from a 3-µm slab above the inner limiting membrane were used to identify and quantify eMLC, while slabs at the retinal nerve fiber layer, superficial capillary plexus (SCP), and deep capillary plexus (DCP) were used to measure optical intensity and calculate OIR. eMLC density and OIR were compared between affected and unaffected regions. RESULTS: eMLC density was significantly higher in BRAO eyes than in contralateral eyes across all regions, including the global macula, the affected region and the unaffected region (all p ≤ 0.001). Further analysis showed that eMLC density was higher in the affected region than in the unaffected region (p = 0.015). Global SCP OIR in BRAO eyes was comparable to contralateral eyes (p = 0.113), but global DCP OIR was lower (p = 0.001). OIR in the affected region was higher than in the unaffected region for both SCP and DCP (both p < 0.001). Compared with contralateral eyes, DCP OIR was higher in the affected region (p = 0.013) but lower in the unaffected region (p < 0.001). CONCLUSIONS: En face OCT enables simultaneous assessment of cellular and ischemic changes in acute BRAO, revealing presumed eMLC aggregation in the affected region and a paradoxical OIR pattern. This technique offers a noninvasive platform for evaluating ischemic neuroinflammation, though the OIR findings warrant further investigation.
Unilateral vision loss as the initial symptom of chronic myeloid leukemia with bilateral retinal infiltration: a case report.
Chen W, Qin B
BMC Ophthalmol · 2026 Jun · PMID 42321675 · Full text
BACKGROUND: Ophthalmic manifestations as the initial presentation of chronic myeloid leukemia (CML) are rare. CASE PRESENTATION: This case describes a 38-year-old man who presented with unilateral severe vision loss alon...
BACKGROUND: Ophthalmic manifestations as the initial presentation of chronic myeloid leukemia (CML) are rare. CASE PRESENTATION: This case describes a 38-year-old man who presented with unilateral severe vision loss alongside bilateral ocular findings, including intraretinal hemorrhages, vascular tortuosity, cotton wool spots, and optic disc edema. Ophthalmic imaging, particularly optical coherence tomography (OCT), revealed bilateral retinal involvement, which was more severe in the left eye despite worse vision in the right eye. Systemic evaluation revealed critical hyperleukocytosis, splenomegaly, and Philadelphia chromosome positivity, confirming CML. The subsequent MRI during remission showed no abnormality. Treatment with hydroxyurea and nilotinib rapidly normalized white blood cell counts and reached major molecular response (MMR) along with complete visual recovery and normal retina and optic nerve. CONCLUSIONS: This case highlights the importance of recognizing ocular signs as potential indicators of life-threatening systemic diseases such as CML, warranting prompt diagnosis and intervention. Ocular signs not only help to confirm the primary diagnosis, but also may serve as a useful adjunctive marker for monitoring treatment response.
Cortico-retinal decoupling in anisometropic amblyopia: OCTA-VEP multimodal biomarkers reveal neurovascular mismatch patterns.
Meng X, Wang Q, Zhang Y
BMC Ophthalmol · 2026 Jun · PMID 42321674 · Full text
BACKGROUND: To investigate the retinal microcirculation changes in children with anisometropic amblyopia through multimodal assessment and explore its correlation with neurophysiological dysfunction. METHODS: This prospe...
BACKGROUND: To investigate the retinal microcirculation changes in children with anisometropic amblyopia through multimodal assessment and explore its correlation with neurophysiological dysfunction. METHODS: This prospective cross-sectional study recruited 68 treatment-naïve children (aged 4-14 years) with primary monocular anisometropic amblyopia. The fellow healthy eye served as the control. Macular microvascular parameters, including foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) perfusion density, were quantified using optical coherence tomography angiography (OCTA). Pattern visual evoked potentials (P-VEP) assessed P100 latency and amplitude. Central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were measured. Correlations and multiple linear regression analyses were performed to identify predictors of best-corrected visual acuity (BCVA) in amblyopic eyes. RESULTS: Compared to fellow eyes, amblyopic eyes exhibited significant microcirculatory impairment: reduced SCP perfusion density (central: 0.27 vs. 0.29, P < 0.001; full: 0.44 vs. 0.46, P < 0.05), enlarged FAZ area (0.30 vs. 0.26 mm², P = 0.035), and increased CMT (141.00 vs. 131.50 μm, P < 0.05) and RNFL thickness (113.00 vs. 110.00 μm, P < 0.001). P-VEP revealed prolonged P100 latency (119.0 vs. 109.5 ms, P < 0.001) and decreased amplitude (12.8 vs. 19.25 µV, P < 0.001). SCP perfusion density correlated negatively with P100 latency (ρ=-0.341, P = 0.004), and SCP vessel density correlated negatively with CMT (ρ=-0.363, P = 0.002) and FAZ area (ρ=-0.424, P < 0.001). Multiple linear regression analysis (adjusted R²=0.625, P < 0.001) identified RNFL thickness (β = -0.546, P < 0.001) as a significant negative predictor of BCVA (logMAR), while SCP full perfusion density (β = 0.375, P < 0.001) and axial length (β = 0.237, P = 0.007) were significant positive predictors. CONCLUSION: Anisometropic amblyopia is marked by a neurovascular mismatch, manifested through simultaneous retinal hypoperfusion, paradoxical thickening of structures, and delayed neural conduction. The combined OCTA-P-VEP assessment provides a comprehensive biomarker framework. RNFL thickness, SCP perfusion density, and axial length emerge as key independent predictors of visual acuity, suggesting complex interplays between structure, perfusion, and function.
Reactivation of retinopathy of prematurity after intravitreal bevacizumab: incidence, risk factors, and retreatment requirements.
Gül C, Özal E, Ermiş S … +3 more , Karapapak M, Bayraktar H, Özal SA
BMC Ophthalmol · 2026 Jun · PMID 42321667 · Full text
BACKGROUND: This study aimed to evaluate the incidence and risk factors of reactivation following intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP) and to determine which cases required additi...
BACKGROUND: This study aimed to evaluate the incidence and risk factors of reactivation following intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP) and to determine which cases required additional treatment. METHODS: A retrospective cohort study was conducted including 62 premature infants (119 eyes) diagnosed with type 1 ROP or aggressive ROP (A-ROP) who received IVB monotherapy between September 2021 and July 2024. Demographic and clinical parameters such as gestational age, birth weight, disease zone and stage, duration of oxygen therapy, and timing of IVB administration were analyzed. Reactivation and retreatment rates were compared to identify potential risk factors. RESULTS: Reactivation occurred in 36 eyes (30.3%), and 31 of these eyes (86.1%) required additional treatment. The mean gestational age and birth weight in reactivated eyes were 24.4 ± 1.2 weeks and 643 ± 149 g, respectively. Reactivation was significantly associated with lower gestational age (p < 0.001), lower birth weight (p < 0.001), longer pre- and post-IVB oxygen therapy (p = 0.006 and p < 0.001), zone 1 disease (p < 0.001), and the presence of A-ROP (p < 0.001). Reactivation developed on average 9.4 weeks after IVB administration. Female infants showed a higher proportion of treatment-requiring reactivation (p = 0.031). CONCLUSIONS: Reactivation following IVB therapy is common among infants with low gestational age, low birth weight, prolonged oxygen exposure, and aggressive or zone 1 disease. Although most reactivations required retreatment, some resolved spontaneously, highlighting the importance of individualized and extended post-treatment monitoring.
Efficacy and safety of ultrasound cycloplasty versus ahmed glaucoma valve for neovascular glaucoma.
Zhang S, Ji S, Li X … +2 more , Hu S, Fu Y
BMC Ophthalmol · 2026 Jun · PMID 42321652 · Full text
PURPOSE: To evaluate the efficacy and safety of Ultrasound Cycloplasty (UCP) versus Ahmed Glaucoma Valve (AGV) implantation in the treatment of neovascular glaucoma. METHODS: A total of 80 patients (80 eyes) were enrolle...
PURPOSE: To evaluate the efficacy and safety of Ultrasound Cycloplasty (UCP) versus Ahmed Glaucoma Valve (AGV) implantation in the treatment of neovascular glaucoma. METHODS: A total of 80 patients (80 eyes) were enrolled and assigned to receive either UCP or AGV treatment (40 eyes each). Patients were followed up for 6 months postoperatively. Intraocular pressure (IOP), number of IOP-lowering medications, pain score, visual acuity, and complications were recorded. Complete surgical success was defined as an IOP reduction of ≥ 20% from baseline and maintained between 5 and 21 mmHg, without the need for additional medications or further surgery. RESULTS: Preoperative baseline characteristics showed no significant differences between the two groups. On postoperative day 1, the AGV group showed a greater reduction in IOP compared to the UCP group (p < 0.01). At 6 months postoperatively, the UCP group demonstrated better outcomes in terms of the IOP reduction rate (61.62% vs. 66.97%, p = 0.04) and pain score (0.13 vs. 0.43, p < 0.01) compared to the AGV group. There were no significant differences between the groups in the number of medications used or the rate of surgical success. The AGV group experienced more complications, commonly including tube blockage and plate exposure. CONCLUSION: Both UCP and AGV are effective in reducing IOP. However, UCP resulted in more stable postoperative IOP, fewer complications, and offered better safety and patient comfort.
The prevalence of refractive errors among patients with keratoconus attending Damascus hospital, Syria: a cross-sectional study.
Akwan R, Alhouri AN, Alhouri HN … +3 more , Aljaramani R, Olabi H, Issa S
BMC Ophthalmol · 2026 Jun · PMID 42321641 · Full text
BACKGROUND: Keratoconus (KC) is a progressive ectatic corneal disease characterized by corneal thinning and cone-like protrusion, leading to significant refractive errors. Despite its global impact, local data for the Sy...
BACKGROUND: Keratoconus (KC) is a progressive ectatic corneal disease characterized by corneal thinning and cone-like protrusion, leading to significant refractive errors. Despite its global impact, local data for the Syrian population remains scarce. This study aimed to investigate refractive error patterns, prevalence, and disease grading among a sample of Syrian patients with KC. METHODS: This prospective cross-sectional study evaluated 173 eyes from 93 patients at Damascus Hospital. Corneal Tomography was performed using the Pentacam Scheimpflug system. Refractive status was determined via subjective refraction, and KC severity was graded using the Buxton keratometric classification. Statistical analysis included Chi-square tests and Pearson correlations. RESULTS: The mean age of participants was 29.7 ± 10.9 years, with most patients (34.4%) aged 19-30 years. Bilateral involvement was observed in 92.5% of patients. Mild and moderate disease were the most frequent grades, accounting for 45.1% and 43.9% of eyes, respectively. A significant association between KC grading and gender was identified (P = 0.04), whereas no significant association was found between grading and age. Oblique compound myopic astigmatism was the most prevalent refractive error (25.4%). Kmax showed a strong positive correlation with absolute spherical equivalent (r = 0.669, P < 0.001), whereas corneal thickness at the thinnest location showed a weak negative correlation (r = -0.393, P < 0.001). CONCLUSION: The clinical profile of KC in Syrian patients is comparable to reports from other regional and global populations, manifesting as bilateral mild-to-moderate disease in young adults, with compound myopic astigmatism as the hallmark refractive error. Future research should prioritize multicenter genetic and environmental studies within the Syrian population to optimize disease management strategies and early detection.
Investigating PRPH2-associated retinal degeneration patient-reported outcomes in vision-related quality of life.
Folk GA, Wagner NE, Walker EH … +1 more , Borooah S
BMC Ophthalmol · 2026 Jun · PMID 42316356 · Full text
BACKGROUND: PRPH2-associated retinal degeneration (PARD) is one of the most common causes of inherited retinal disease and can impair visual function and quality of life. While genetic and clinical features of PARD have...
BACKGROUND: PRPH2-associated retinal degeneration (PARD) is one of the most common causes of inherited retinal disease and can impair visual function and quality of life. While genetic and clinical features of PARD have been described, patient-reported experiences of visual symptoms remain less well characterized. This study aims to evaluate self-reported visual function and quality of life among individuals with genetically confirmed PARD. METHODS: This cross-sectional study surveyed patients with confirmed PARD at a single academic center using the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). The questionnaire was administered digitally and assessed 11 vision-related domains, including general vision, near and distance activities, and vision-related mental health. A composite score was calculated as the mean of all subscale scores excluding the general health item. Descriptive statistics were used to summarize responses, with higher scores indicating better perceived visual function. RESULTS: Twenty-two participants completed the VFQ-25. The median (IQR) composite score was 76.9 (16.4), reflecting moderate perceived visual dysfunction. The highest-rated domains were ocular pain (87.5 (37.5)) and color vision (100.0 (0.0)). Domains related to functional activities demonstrated greater impairment, including general vision (80.0 (20.0)), near activities (79.2 (39.6)), distance activities (75.0 (29.2)), and driving (75.0 (33.3)). The vision-specific mental health domain had the lowest score (59.4 (40.6)), underscoring the psychological impact of PARD. CONCLUSIONS: Individuals with PARD report significant challenges in visual function and emotional well-being. These results highlight the importance of incorporating patient-reported outcome measures into the clinical characterization of PARD and the design of future therapeutic studies.
Early detection of tamoxifen-induced retinal injury: ellipsoid zone reflectivity as a sensitive structural marker.
Unlu BH, Koksaldı S, Durmaz Engin C … +1 more , Varol U
BMC Ophthalmol · 2026 Jun · PMID 42316354 · Full text
PURPOSE: To investigate early structural alterations in the outer retina and choroid of tamoxifen-treated patients without clinically detectable retinopathy by quantitatively assessing reflectivity changes of the externa...
PURPOSE: To investigate early structural alterations in the outer retina and choroid of tamoxifen-treated patients without clinically detectable retinopathy by quantitatively assessing reflectivity changes of the external limiting membrane (ELM), ellipsoid zone (EZ), and retinal pigment epithelium (RPE), along with the choroidal vascularity index (CVI). METHODS: The study included 45 eyes of 45 tamoxifen-treated women and 50 eyes of 50 age- and sex-matched healthy female controls. ELM, EZ, and RPE reflectivity was measured along foveal, parafoveal, and perifoveal axes. CVI was derived using a standardized binarization method. Correlations between reflectivity metrics and tamoxifen exposure indices were analyzed. RESULTS: Tamoxifen users showed a marked reduction in EZ reflectivity at the central fovea and at the temporal perifovea (p = 0.005 and p = 0.037, respectively), accompanied by a corresponding decrease in relative EZ values at the central fovea and at the temporal parafovea (p = 0.012 and p = 0.039, respectively). In contrast, ELM and RPE reflectivity metrics remained stable across all evaluated regions (p > 0.05). CVI measurements revealed no significant differences between the patient and control groups (p > 0.05). Within the tamoxifen cohort, treatment duration demonstrated weak but significant positive associations with central foveal ELM reflectivity (r = 0.389, p = 0.008), whereas age was negatively correlated with EZ reflectivity in the nasal parafoveal region (r = - 0.331, p = 0.026). CONCLUSIONS: Early tamoxifen exposure appears to affect the EZ before detectable alterations become evident in the ELM, RPE, or choroid. These findings suggest that subtle EZ disruption may represent an early structural indicator of tamoxifen-related retinal involvement and could potentially aid in identifying patients who may require closer monitoring. However, longitudinal studies are needed to confirm these findings and clarify their clinical significance.
The role of DNMT3B, GSK-3β and GJA3 in lens epithelial cell apoptosis and age-related cataract.
Chen X, Su D, Zhang G … +9 more , Xiang Z, Fu Y, Sun Z, Hu Y, Li S, Zhang Y, Ma X, Hu S, Wei Q
BMC Ophthalmol · 2026 Jun · PMID 42316121 · Full text
Age-related cataract (ARC) is a degenerative change following the aging of the lens, with its specific pathogenesis still unclear. This study investigates the expression of GSK-3β, DNMT3B, and GJA3 in ARC through in vivo...
Age-related cataract (ARC) is a degenerative change following the aging of the lens, with its specific pathogenesis still unclear. This study investigates the expression of GSK-3β, DNMT3B, and GJA3 in ARC through in vivo and in vitro studies, elucidating the regulatory mechanisms among them. Additionally, it preliminarily explores the role of DNMT3B in the epigallocatechin gallate (EGCG)-mediated delay of apoptosis in lens epithelial cells (LECs). Immunohistochemistry and Western blot results showed that the protein expression level of DNMT3B was elevated, while the protein expression levels of GJA3 and p-GSK-3β (Ser9) were decreased in the ARC group and the aged mouse group (P < 0.05). CCK-8 and Hoechst 333,42 apoptosis assays indicated that DNMT3B, GJA3, and p-GSK-3β (Ser9) were involved in HO-induced apoptosis of LECs. Further investigation revealed that DNMT3B regulates lens epithelial cell apoptosis by modulating GJA3 expression, and the expression of DNMT3B is regulated by GSK-3β. Additionally, we found that EGCG effectively alleviates DNMT3B-mediated apoptosis of LECs (P < 0.05). In summary, our study indicates that p-GSK-3β, DNMT3B, and GJA3 play significant roles in ARC and oxidative stress-induced apoptosis of LECs, with interrelated regulatory mechanisms. EGCG can target DNMT3B to reduce apoptosis in LECs, offering a new direction for the development of cataract treatments.
Indications and outcome of intravitreal bevacizumab injection in a Community Eye Hospital, Nepal.
Thakali S, Shrestha M, Gauchan A … +1 more , Gurung HB
BMC Ophthalmol · 2026 Jun · PMID 42316110 · Full text
BACKGROUND: This study aimed to evaluate the indications and real-world treatment outcomes of intravitreal bevacizumab in a resource-limited community eye hospital setting. METHODS: This retrospective study included pati...
BACKGROUND: This study aimed to evaluate the indications and real-world treatment outcomes of intravitreal bevacizumab in a resource-limited community eye hospital setting. METHODS: This retrospective study included patients who received IVB injection at Hetauda Community Eye Hospital between January 2019 and December 2022. INCLUSION CRITERIA: [Formula: see text]1 IVB injection; retinal diagnosis confirmed clinically and by Optical Coherence Tomography (OCT) where available. EXCLUSION CRITERIA: missing baseline Visual Acuity (VA) or OCT,[Formula: see text] month follow-up. Median visual acuity (VA) and central macular thickness (CMT) changes were compared using Wilcoxon signed‑rank test. RESULTS: A total of 418 injections were administered to 247 patients (260 eyes). After excluding those lost to follow‑up, 221 patients (234 eyes) were included in the analysis. Median baseline CMT was 366 μm and improved to 236 μm (p < 0.001). Most patients received one injection (57%) followed by two injections (30%). The median baseline VA was 0.78 log MAR and remained 0.78 log MAR overall (p = 0.108), but subgroup improvements were significant in DME, nAMD, BRVO, and central retinal vein occlusion (CRVO). CONCLUSION: IVB resulted in significant anatomical and functional improvements in patients with retinal diseases. The findings reflect real‑world outcomes in a community‑level eye hospital, where cost barriers limit repeated injections. The limitations of this study include its retrospective design, variable follow‑up, absence of control group, and limited numbers of injections.
Rhythmic suture movement on gonioscopy after penetrating canaloplasty: a case report.
Liu S, Wu Z, Yu P … +1 more , Zeng L
BMC Ophthalmol · 2026 Jun · PMID 42316105 · Full text
BACKGROUND: Previous studies with advanced imaging like phase-sensitive optical coherence tomography suggest the trabecular meshwork-Schlemm's canal complex may show subtle motion related to intraocular pressure fluctuat...
BACKGROUND: Previous studies with advanced imaging like phase-sensitive optical coherence tomography suggest the trabecular meshwork-Schlemm's canal complex may show subtle motion related to intraocular pressure fluctuations or cardiac rhythm. However, direct visualization of rhythmic motion in the Schlemm's canal region during routine gonioscopy has been undocumented. Here, we report an incidental finding during dynamic gonioscopy, where a retained 10 - 0 suture within Schlemm's canal exhibited subtle, regular back-and-forth movement at the 2-year follow-up after penetrating canaloplasty. CASE PRESENTATION: A 53-year-old man was diagnosed with chronic angle-closure glaucoma in both eyes and had a history of uveitis. His left eye had previously undergone trabeculectomy, but intraocular pressure remained poorly controlled, prompting a subsequent penetrating canaloplasty. During the procedure, a 10 - 0 suture was placed through Schlemm's canal to enhance the conventional outflow pathway. Postoperative follow-up remained stable, and no further glaucoma surgery was needed. At the 2-year postoperative visit, gonioscopy during slit-lamp examination revealed a 10 - 0 suture crossing Schlemm's canal at approximately 1 o'clock in the superior angle. Within a relatively stable visual field, the suture exhibited consistent, rhythmic back-and-forth movement, and this pattern was reliably observed throughout the same examination session. At that time, the anterior chamber was quiet and showed no signs of active inflammation. CONCLUSION: This case reports an incidental gonioscopic finding of subtle, rhythmic movement of a retained 10 - 0 suture within Schlemm's canal 2 years after penetrating canaloplasty. The retained suture may act as a visible marker of local dynamic behavior in Schlemm's canal.
Effect of topical phenylephrine on aqueous flare levels and anterior scleral thickness in healthy adult eyes.
Esen Baris M, Guclu A, Guven S … +1 more , Palamar M
BMC Ophthalmol · 2026 Jun · PMID 42316074 · Full text
BACKGROUND: Phenylephrine is widely used for pharmacological mydriasis in routine ophthalmic practice. While its vascular and pupillary effects are well established, its influence on anterior segment structures and intra...
BACKGROUND: Phenylephrine is widely used for pharmacological mydriasis in routine ophthalmic practice. While its vascular and pupillary effects are well established, its influence on anterior segment structures and intraocular inflammatory parameters remains unclear. This study aimed to evaluate the effects of topical phenylephrine on anterior scleral thickness (AST) and aqueous humor flare levels in healthy eyes. METHODS: This prospective study included the right eyes of 20 healthy volunteers. Topical phenylephrine 2.5% was administered three times at 5-minute intervals. Measurements were obtained 45 min after the final instillation. Nasal and temporal AST were measured at the scleral spur (AST-0) and at 1000 μm (AST-1) and 2000 μm (AST-2) posterior to the scleral spur using anterior segment optical coherence tomography. Aqueous flare levels were assessed using laser flare photometry. Fellow untreated eyes served as controls. RESULTS: At the scleral spur level (AST-0), scleral thickness increased significantly in both nasal and temporal regions following phenylephrine administration (p = 0.0003 and p = 0.01, respectively). At 1000 μm posterior to the scleral spur, temporal AST decreased significantly (p = 0.005), while other changes in AST-1 and AST-2 were not statistically significant. Aqueous flare levels showed an increase after phenylephrine instillation; however, this change was not statistically significant (p = 0.2). No significant changes were observed in the fellow control eyes. CONCLUSIONS: Topical phenylephrine was associated with localized changes in anterior scleral thickness, characterized by thickening at the scleral spur and relative thinning posteriorly. Although aqueous flare levels tended to increase, this effect was not statistically significant and likely reflects a minimal effect size. These findings suggest that phenylephrine may be associated with alterations in scleral configuration without a clinically meaningful impact on intraocular inflammatory status in healthy eyes.
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