BMC Ophthalmol [JOURNAL]
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200 papers
Experimental knotless scleral fixation with expanded polytetrafluoroethylene (ePTFE): dynamics of anchoring strength in the early postoperative period.
Hatlova V, Cendelin J, Stefkova M … +6 more , Hecova L, Vankova L, Klein P, Rusnak S, Krizkova V, Studeny P
BMC Ophthalmol · 2026 Jun · PMID 42316071 · Full text
PURPOSE: To investigate short-term scleral response to expanded polytetrafluoroethylene (ePTFE) sutures using the dynamics of its mechanical stabilization in an animal model. METHODS: Ten rabbits underwent unilateral len...
PURPOSE: To investigate short-term scleral response to expanded polytetrafluoroethylene (ePTFE) sutures using the dynamics of its mechanical stabilization in an animal model. METHODS: Ten rabbits underwent unilateral lens extraction followed by implantation of two knotless scleral fixation techniques using ePTFE (Gore-Tex CV-8): Z-suture and chain-of-knots. Both techniques were implanted in each eye. At postoperative days 1, 5, 10, 20, and 30, two rabbits were analyzed per time point (n = 10), each contributing one independent dynamometric measurement per technique. The tensile force required to disinsert the implanted material from the sclera was quantified using a dynamometer. RESULTS: Dynamometric evaluation of tensile force of the Z-suture ranged from 0.12 to 0.32 N, whereas the chain-of-knots scleral fixation ranged from 0.07 to 0.27 N. Both techniques showed an increase in the force required to disinsert fibers from the sclera in the early postoperative period. CONCLUSIONS: In this rabbit model, knotless ePTFE scleral fixation demonstrated increasing early mechanical stabilization. The differences between the two fixation techniques may be caused by a combination of mechanical factors and tissue adaptation, although these findings remain exploratory. Both techniques may provide sufficient early fixation strength in an experimental setting and support further preclinical and clinical evaluation.
Type I to type II Boston keratoprosthesis exchange: a report of two patients.
Tielas LS, Bednar M, Haddadin R … +2 more , Chodosh J, Dohlman TH
BMC Ophthalmol · 2026 Jun · PMID 42310641 · Full text
BACKGROUND: To report two cases of Boston Keratoprosthesis (BKPro) type I failure in patients with severe ocular surface disease and to describe the successful replacement of the BKPro type 1 with a BKPro type II, highli...
BACKGROUND: To report two cases of Boston Keratoprosthesis (BKPro) type I failure in patients with severe ocular surface disease and to describe the successful replacement of the BKPro type 1 with a BKPro type II, highlighting clinical indications, surgical considerations, and postoperative outcomes. This is a case report of two patients with a history of complex ocular surface pathology-one with Stevens-Johnson Syndrome and the other with bilateral chemical burns-both of whom had previously undergone type I BKPro implantation and subsequently developed complications including corneal melt and backplate exposure. Clinical presentation, surgical intervention, and follow-up are detailed. A literature review was conducted to identify previously reported cases and recommendations regarding type I BKPro replacement with type II BKPro. CASE PRESENTATION: Both patients underwent successful explantation of the type I BKPro and implantation of a type II BKPro in a combined procedure with pars plana vitrectomy. In one case, corneal melt around the type 1 BKPro developed in the setting of Stevens-Johnson Syndrome prompting replacement with a type 2 BKPro. In the second case, dacryoadenectomy may have contributed to ocular surface instability and corneal melt. Visual acuity improved in both cases postoperatively, with stable device positioning and no signs of infection or retinal complications at last follow-up. CONCLUSIONS: Transitioning from type I BKPro to type II is a feasible and effective strategy in patients with severe ocular surface disease and BKPro failure due to corneal melt in the setting of history of Stevens Johnson Syndrome and chemical injury.
Epithelial cell proliferation on anterior surface of intraocular lens after Descemet stripping automated endothelial keratoplasty (DSAEK) surgery: a case report.
Zare A, Kanavi MR, Feizi S … +2 more , Pirsarabi F, Tajari F
BMC Ophthalmol · 2026 Jun · PMID 42310613 · Full text
BACKGROUND: We report a rare case of histopathologically confirmed epithelial cell proliferation on the anterior surface of an intraocular lens (IOL) following Descemet stripping automated endothelial keratoplasty (DSAEK...
BACKGROUND: We report a rare case of histopathologically confirmed epithelial cell proliferation on the anterior surface of an intraocular lens (IOL) following Descemet stripping automated endothelial keratoplasty (DSAEK). CASE PRESENTATION: A 61-year-old female with a history of multiple ocular surgeries, including phacoemulsification cataract extraction and DSAEK, was referred for progressive visual deterioration. Clinical examination revealed resistant deposits on the anterior surface of the posterior chamber IOL, confined to the pupillary zone. Despite repeated interventions-including Nd: YAG laser treatment and surgical polishing of the IOL surface-the opacities persisted, ultimately necessitating IOL explantation and histopathological analysis. Light microscopy confirmed epithelial cell proliferation on the IOL surface. Examination of the stained lens revealed a sheath of cellular imprints and ghost cells. Unlike previously reported cases of IOL opacification, von Kossa staining demonstrated no calcium phosphate deposits, suggesting a distinct pathological mechanism originating from epithelial cell proliferation, likely derived from the capsular bag. CONCLUSIONS: Epithelial cell proliferation should be considered in the differential diagnosis of unexplained, persistent IOL surface opacities following DSAEK. In this case, definitive diagnosis was established only through histopathological evaluation of the explanted lens.
Factors leading to high intraocular pressure in Intraocular Device-Associated Uveitis (IDAU): a retrospective nested case-control study from a tertiary uveitis cohort.
Juhong J, Somkijrungroj T, Kongwattananon W … +2 more , Ueathaweephol S, Pongpirul K
BMC Ophthalmol · 2026 Jun · PMID 42310605 · Full text
BACKGROUND: Intraocular device-associated uveitis (IDAU) - which we propose as a more precise alternative to the traditional term "uveitis-glaucoma-hyphema (UGH) syndrome" - is a rare but potentially sight-threatening co...
BACKGROUND: Intraocular device-associated uveitis (IDAU) - which we propose as a more precise alternative to the traditional term "uveitis-glaucoma-hyphema (UGH) syndrome" - is a rare but potentially sight-threatening complication of intraocular device implantation. Elevated intraocular pressure (IOP) is a major driver of visual morbidity in IDAU, but the risk factors that predispose affected patients to IOP elevation remain poorly characterised. We aimed to describe the clinical spectrum of IDAU and to identify independent risk factors for elevated IOP in this population, using the Chulalongkorn University Uveitis Cohort (CUC) database. METHODS: This first nested case-control study within the Chulalongkorn University Uveitis Cohort (CU²C) enrolled 375 subjects followed at a tertiary uveitis clinic in Thailand over 8 years (August 2014-June 2022). Cases (n = 30) were IDAU patients with elevated IOP (> 21 mmHg); controls (n = 60) were IDAU patients with normal IOP, sampled at a 1:2 ratio from the same cohort. Univariate and multivariate logistic regression were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for candidate risk factors. RESULTS: We retrospectively identified 90 subjects who developed IDAU. Following a one-to-two case-control ratio, 30 case subjects and 60 control subjects were included. Three factors were significantly associated with high intraocular pressure in IDAU. These included intraocular lens (IOL) malposition (AOR: 8.30, 95% CI 1.25 to 54.76), long eye (AOR: 8.08, 95% CI 1.18 to 55.16) and age (AOR: 1.18, 95% CI 1.07 to 1.31). There was no statistical evidence of effects of hypertension, ruptured posterior capsule, vitrectomized eye, transillumination iris defect (TID), pseudophacodonesis and single-piece IOL in sulcus on high IOP in IDAU. CONCLUSION: In this first nested case-control study of IDAU, IOL malposition, long axial length (> 25 mm), and older age were independently associated with elevated IOP. These findings should inform clinician awareness and post-operative monitoring strategies for high-risk IDAU patients.
Short-term visual acuity responder rates after full-thickness macular hole surgery stratified by hole size: a retrospective cohort study.
Timoceanu L, Lang C, Tschuppert S … +3 more , Guber J, Valmaggia C, Ebneter A
BMC Ophthalmol · 2026 Jun · PMID 42310594 · Full text
PURPOSE: To quantify early real-world visual acuity (VA) responder rates at 25-35 days after idiopathic full-thickness macular hole (FTMH) surgery and evaluate the influence of hole size, gas tamponade, and prescribed du...
PURPOSE: To quantify early real-world visual acuity (VA) responder rates at 25-35 days after idiopathic full-thickness macular hole (FTMH) surgery and evaluate the influence of hole size, gas tamponade, and prescribed duration of face-down positioning. METHODS: In this retrospective cohort study, 193 eyes were analyzed after pars plana vitrectomy with internal limiting membrane peeling and SF6 20% or C3F8 12% gas tamponade. Routine Snellen (decimal) best-corrected VA was extracted from the medical record and converted to logarithm of the minimum angle of resolution (logMAR). Primary outcomes were mean VA change from the last preoperative assessment to the postoperative visit at 25-35 days and rates of two and three lines VA improvement (≥ 0.2 and ≥ 0.3 logMAR, respectively). Secondary outcomes were baseline-adjusted postoperative VA and anatomical closure. RESULTS: Overall, 66.8% of eyes improved by ≥ 0.2 logMAR and 52.3% by ≥ 0.3 logMAR. Mean VA improved from 0.774 ± 0.409 to 0.455 ± 0.346 logMAR (mean VA change - 0.318 logMAR; p < 0.001). VA change and responder rates did not differ significantly across International Vitreomacular Traction Study size groups (< 250 μm, 250-400 μm, > 400 μm), and no statistically significant association with gas choice or prescribed face-down positioning duration was detected within the limitations of this retrospective cohort. Baseline-adjusted postoperative VA differed by size, with large holes having worse early postoperative VA than small and medium holes, independent of prescribed face-down positioning duration or vitreomacular traction status. Anatomical closure differed by International Vitreomacular Traction Study size group (small 98.9%, medium 96.7%, large 78.0%; p < 0.001). CONCLUSIONS: In routine care, FTMH surgery results in clinically meaningful early VA improvement at 25-35 days, with approximately two-thirds of eyes gaining ≥ 0.2 logMAR and half gaining ≥ 0.3 logMAR. Although VA improvement was similar across size groups, large holes had lower closure rates and worse early postoperative BCVA. No statistically significant association between gas choice, prescribed face-down positioning duration, and the extent of VA improvement was detected in this retrospective cohort.
The effects of different forms of omega-3 polyunsaturated fatty acids on dry eye disease resulting from various etiologies: a meta-analysis and systematic review.
Chen G, Yan X, Yang S … +1 more , Li X
BMC Ophthalmol · 2026 Jun · PMID 42304315 · Full text
BACKGROUND: To compare the therapeutic effects of omega-3 polyunsaturated fatty acids (PUFAs) supplements across different formulations and dry eye disease (DED) etiologies. METHODS: Studies were systematically searched...
BACKGROUND: To compare the therapeutic effects of omega-3 polyunsaturated fatty acids (PUFAs) supplements across different formulations and dry eye disease (DED) etiologies. METHODS: Studies were systematically searched in six databases without language restrictions. Dry eye symptom scores, tear break-up time (TBUT), Schirmer test, corneal fluorescein staining (CFS), and meibomian gland dysfunction (MGD) scores were extracted as outcomes. Meta-regression, sensitivity and subgroup analyses were implemented to investigate significant heterogeneity. RESULTS: Twenty-seven randomized controlled trials (RCTs) were included. Systemic omega-3 supplementation appeared to improve all assessed outcomes in the overall pooled analysis; however, subgroup analyses revealed formulation- and etiology-dependent effects. Among systemic long-chain omega-3 formulations, efficacy was etiology-dependent: no significant benefits were observed in MGD-associated dry eye or in cases of unspecified etiology, whereas significant improvements were found in video display terminal-related dry eye and contact lens-associated dry eye. Given the limited evidence, findings were synthesized qualitatively: omega-3 supplements demonstrated beneficial effects in rosacea-associated and Sjögren's syndrome-related dry eye, whereas no clinically meaningful improvement was observed in LASIK-induced dry eye. In contrast, neither systemic short-chain fatty acids nor the combination of long- and short-chain omega-3 PUFAs achieved statistical significance. Furthermore, topical omega-3 delivery failed to demonstrate significant benefits compared with artificial tears. Meta-regression analysis revealed a significant association between omega-3 supplementation and several external factors, including mean age, geographic location, assessment methodologies, omega-3 dose, and publication year. CONCLUSIONS: Our research suggests that omega-3 supplements in different forms fail to demonstrate consistent effectiveness for DED of various etiological origins. Therefore, personalized guidance from healthcare providers regarding the application of omega-3 PUFAs for the management of ocular surface disorders is warranted. PROSPERO REGISTRATION: CRD42024623916.
Management of sliding suction loss during keratorefractive lenticule extraction performed with VisuMax 800 femtosecond laser using CIRCLE software: a case report.
Kim BK, Chung YT
BMC Ophthalmol · 2026 Jun · PMID 42304301 · Full text
BACKGROUND: Keratorefractive lenticule extraction (KLEx) is a widely used refractive procedure, but intraoperative suction loss remains a critical complication. While the faster laser frequency of the VisuMax 800 theoret...
BACKGROUND: Keratorefractive lenticule extraction (KLEx) is a widely used refractive procedure, but intraoperative suction loss remains a critical complication. While the faster laser frequency of the VisuMax 800 theoretically reduces this risk, it can still occur, occasionally presenting as sliding suction loss. In this phenomenon, the globe shifts while partial suction is maintained, resulting in a complete but decentered lamellar plane. This creates a surgical dilemma where standard re-docking protocols risk double cuts. In this report, we describe the first case of using the CIRCLE software as a rescue strategy specifically for sliding suction loss. CASE PRESENTATION: A 30-year-old male with - 4.25 diopter (D) myopia and - 0.25 D astigmatism underwent KLEx surgery using the VisuMax 800. During the peripheral cap cut, a sudden Bell's phenomenon caused the eye to shift, resulting in a sliding suction loss. The cap cut was completed in an inferiorly decentered position, while the subsequent incision was interrupted at 48.5%. To avoid corneal irregularities from standard re-initiation, the procedure was aborted. The following day, a rescue procedure was performed using CIRCLE software. By creating a junction (5.5 mm diameter, with a vertical offset of ± 5 μm) that precisely integrated with the existing decentered cap plane, the surgeon successfully bypassed the irregular incision and extracted the lenticule uneventfully. One month postoperatively, the patient achieved an uncorrected distance visual acuity of -0.04 logMAR, with stable refraction and a well-centered treatment zone confirmed by tomography. CONCLUSION: Sliding suction loss represents a specific intraoperative challenge that can occur even with high-speed laser systems. This case demonstrates that the CIRCLE software is a highly effective rescue tool for managing such complex interfaces. By enabling safe access to existing lamellar planes, CIRCLE software extends its utility from refractive enhancement to a vital intraoperative rescue strategy, preventing permanent corneal irregularities and ensuring excellent visual outcomes.
Clinical efficacy of intrastromal voriconazole injection in fungal keratitis involving different corneal stromal depths.
Huang H, Mo C, Zhou Z … +15 more , Jiang L, Chen G, Li Y, Chen B, Li Y, Tang F, Shen C, Lv M, Su N, Li F, Cui L, Xu F, Chen Q, Zhong H, Lan Q
BMC Ophthalmol · 2026 Jun · PMID 42304296 · Full text
PURPOSE: To evaluate the clinical efficacy of intrastromal injection of 0.5% (5 mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths. METHODS: This was a non-randomized, retrospective s...
PURPOSE: To evaluate the clinical efficacy of intrastromal injection of 0.5% (5 mg/mL) voriconazole in fungal keratitis (FK) involving different corneal stromal depths. METHODS: This was a non-randomized, retrospective study based on patient treatment preferences. A total of 53 patients (53 eyes) with confirmed fungal keratitis treated between March 2021 and December 2023 were enrolled. Based on anterior segment optical coherence tomography (AS-OCT) findings, lesions were stratified by depth into superficial stromal involvement (Group A, n = 29) and deep stromal involvement (Group B, n = 24). Each group was further subdivided according to treatment modality: non-injection group (conventional antifungal therapy) (subgroups A1 and B1) versus injection group (conventional antifungal therapy combined with intrastromal voriconazole injection) (subgroups A2 and B2). The following clinical parameters were compared among the four subgroups: reduction ratio of corneal epithelial staining area at 7 days post-treatment initiation, best-corrected visual acuity (BCVA), corneal epithelial healing time, clinical cure time, and final clinical outcomes. RESULTS: All groups demonstrated significant reduction in ulcer area after 7 days of treatment (P < 0.05). In superficial stromal fungal keratitis, ulcer improvement rates were comparable between groups A1 (37.19%) and A2 (36.11%) (P = 0.838). In deep stromal fungal keratitis, group B2 (41.30%) showed significantly greater improvement compared to B1 (14.95%) (P < 0.0001). Final BCVA improved significantly in all groups, with no significant intergroup differences. Epithelial healing time and clinical cure time showed no significant differences across groups. The overall clinical cure rate was 98.1%, achieved through the non-injection group in 79.2% of cases and the injection group in 18.9% of cases. Treatment failure occurred in one case (1.9%). CONCLUSIONS: Intrastromal voriconazole injection provides no additional benefit for superficial stromal fungal keratitis compared with conventional topical therapy and is therefore not recommended as routine treatment given its invasive nature. For deep stromal fungal keratitis, intrastromal injection demonstrates superior early lesion control but does not reduce overall disease duration or improve final visual outcomes. Further large-scale prospective studies are warranted to establish its optimal indications and clinical value.
Bilateral microsporidial keratoconjunctivitis in an orthokeratology lens wearer: a case report and literature review.
Liang R, Zhang B
BMC Ophthalmol · 2026 Jun · PMID 42298529 · Full text
BACKGROUND: Microsporidial keratoconjunctivitis is a rare but serious ocular infection that can occur in contact lens wearers, particularly in individuals exposed to certain environmental or behavioral risk factors. Earl...
BACKGROUND: Microsporidial keratoconjunctivitis is a rare but serious ocular infection that can occur in contact lens wearers, particularly in individuals exposed to certain environmental or behavioral risk factors. Early and accurate diagnosis is crucial to ensure effective treatment and prevent long-term complications. This report presents a case of bilateral microsporidial keratoconjunctivitis in a pediatric patient who wore orthokeratology lenses, accompanied by a review of relevant literature. CASE PRESENTATION: A 9-year-old female presented with bilateral eye redness and a persistent foreign body sensation lasting for 3 weeks. The patient had recently started raising a pet parrot at home. Upon examination, conjunctival congestion was observed, along with papillary and follicular hypertrophy and diffuse punctate staining of the corneal epithelium. Corneal scraping and gene sequencing confirmed the diagnosis of Encephalitozoon hellem infection. CONCLUSION: This case underscores the rare occurrence of bilateral microsporidial keratoconjunctivitis in an immunocompetent child wearing orthokeratology lenses. Environmental exposure and lens wear may have contributed to infection. Clinicians should consider microsporidiosis in the differential diagnosis of persistent keratoconjunctivitis that does not respond to conventional therapies.
Regenerative effects of RKI-1447 on human corneal endothelial cells: a comparative study.
Akkaya HS, Kilic-Toprak E, Cort A … +2 more , Parca O, Toprak I
BMC Ophthalmol · 2026 Jun · PMID 42298479 · Full text
BACKGROUND: To evaluate and compare the effects of two Rho-associated protein kinase (ROCK) inhibitors (Y-27632 and RKI-1447) on human corneal endothelial cell (HCEC) proliferation and wound healing. METHODS: Using a com...
BACKGROUND: To evaluate and compare the effects of two Rho-associated protein kinase (ROCK) inhibitors (Y-27632 and RKI-1447) on human corneal endothelial cell (HCEC) proliferation and wound healing. METHODS: Using a commercial primary HCEC line, three groups of HCECs were created; control (no treatment), Y-27,632-treated, and RKI-1447-treated. The control, Y-27,632, and RKI-1447 groups were compared regarding cell proliferation (5-bromo-2-deoxyuridine [BrdU] incorporation), wound healing (ImageJ analysis), and ROCK activity (enzyme-linked immunosorbent assay [ELISA]). RESULTS: Both RKI-1447 (1 µM) and Y-27,632 (10 µM) significantly enhanced HCEC proliferation when compared to the control group (p < 0.05). However, RKI-1447 showed a more potent effect than Y-27,632 in terms of stimulating cell proliferation under the experimental conditions tested (p < 0.05). Furthermore, endothelial wound healing was faster in the RKI-1447 group compared to the control and Y-27,632 groups (p < 0.05). Y-27,632 was found to stimulate wound healing more than the control group only in the first 24 h (p < 0.05). CONCLUSION: This pilot study demonstrated that RKI-1447 was more potent than Y-27,632 regarding HCEC proliferation, endothelial wound healing and suppressing ROCK activity. However, further in vitro and in vivo preclinical studies are required to validate the efficacy and ocular safety profile of RKI-1447 before any consideration of clinical translation.
Three-year outcomes of customized transepithelial corneal cross-linking with oxygen supplementation in keratoconus.
Kojima T, Lin Y, Hishida A … +1 more , Nakamura T
BMC Ophthalmol · 2026 Jun · PMID 42298463 · Full text
BACKGROUND: Customized corneal cross-linking (CXL) has primarily been performed using the epithelium-off technique. Evidence on epithelium-preserving (transepithelial or epi-on) customized procedures remains limited, par...
BACKGROUND: Customized corneal cross-linking (CXL) has primarily been performed using the epithelium-off technique. Evidence on epithelium-preserving (transepithelial or epi-on) customized procedures remains limited, particularly with high oxygen concentrations (> 90%) beyond 1 year. We evaluated the 3-year clinical outcome and safety of customized transepithelial CXL (custom TE-CXL) with oxygen supplementation in patients with progressive keratoconus. METHODS: This retrospective study included 74 individuals (90 eyes) with progressive keratoconus who underwent custom TE-CXL with oxygen supplementation and were followed for at least 3 years. Outcomes included visual acuity, keratometric parameters, corneal thickness, and total corneal higher-order aberrations (HOAs). Examinations were performed at baseline and at 1, 2, and 3 years postoperatively. Longitudinal changes were analyzed using a linear mixed-effects model adjusted for baseline values. RESULTS: From 1 year onward, uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) showed significant improvement compared with preoperative values. Least squares mean (LSMean) Kmax values decreased from 56.2 D at baseline to 54.9 D, 54.4 D, and 54.2 D at 1, 2, and 3 years, respectively (all P < 0.01). UCVA improved at 1 year and remained stable thereafter, whereas corrected distance visual acuity (CDVA) showed no significant changes. Total HOAs, including coma and spherical aberration, decreased progressively over time. Apical corneal thickness decreased gradually, and thinnest corneal thickness showed significant reductions from 1 year onward. No adverse events, such as infection or corneal haze, were observed during follow-up. CONCLUSIONS: This descriptive, non-comparative analysis showed that custom TE-CXL with oxygen supplementation may be associated with stabilization of keratoconus over a 3-year period without observed adverse events. Further randomized controlled studies are warranted to evaluate its comparative effectiveness.
Influence of angle kappa and angle alpha on visual outcomes after implantation of a nondiffractive extended-depth-of-focus intraocular lens: a prospective observation study.
Wu N, Yao Y, Zhou B … +3 more , Liu S, Zhang Y, Wang X
BMC Ophthalmol · 2026 Jun · PMID 42289663 · Full text
BACKGROUND: While large angle kappa (chord µ) and angle alpha (chord α) have been reported to adversely affect visual quality with diffractive multifocal intraocular lenses (MIOLs), their impact on the postoperative visu...
BACKGROUND: While large angle kappa (chord µ) and angle alpha (chord α) have been reported to adversely affect visual quality with diffractive multifocal intraocular lenses (MIOLs), their impact on the postoperative visual outcomes of nondiffractive extended depth of focus (EDOF) IOLs remains unclear. This study aimed to evaluate the influence of postoperative angle kappa and angle alpha on visual and optical outcomes following implantation of a nondiffractive EDOF IOL. METHODS: This prospective observational study included 115 cataract patients (115 eyes) who underwent implantation of the AcrySof IQ Vivity nondiffractive wavefront-shaping EDOF IOL. At 3 months postoperatively, photopic and mesopic angle kappa and angle alpha were measured using the OPD-Scan III. Visual outcomes included uncorrected visual acuity at different distances, objective optical quality parameters, contrast threshold, and patient-reported subjective visual disturbance scores. We performed partial correlation analyses to examine the relationships of angle kappa and angle alpha with postoperative visual outcomes, while controlling for potential confounding variables. Subgroup analyses based on clinically relevant offset thresholds were additionally conducted. RESULTS: At 3 months postoperatively, most postoperative angle kappa and angle alpha values were within physiological ranges, with only a small number of eyes having values ≥ 0.5 mm (photopic angle kappa: n = 7; mesopic angle kappa: n = 10; angle alpha: n = 29). Partial correlation analyses demonstrated no significant associations between photopic or mesopic angle kappa and postoperative visual acuity, objective optical quality metrics, or subjective visual disturbance scores (all P > 0.05). Angle alpha showed weak but statistically significant positive correlations with uncorrected distance visual acuity and contrast threshold (P < 0.05), indicating slightly better visual performance with larger angle alpha values. No significant differences in visual outcomes were observed among angle kappa and angle alpha subgroups. CONCLUSIONS: Within the observed postoperative range, angle kappa and angle alpha were not associated with clinically meaningful deterioration in visual performance following implantation of a nondiffractive EDOF IOL. These findings suggest that wavefront-shaping EDOF designs may be tolerant to moderate angular offsets in routine clinical practice.
Monofocal intraocular lens based on the Bessel principle for improved intermediate vision: a comparative assessment.
Kremser F, Yan W, Khoramnia R … +2 more , Auffarth GU, Łabuz G
BMC Ophthalmol · 2026 Jun · PMID 42288831 · Full text
BACKGROUND: To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL) - Extend (Hanita), against a well-established IOL - Eyhance (ICB00, J&J Vision) - through in vitro benchmarking. METHODS:...
BACKGROUND: To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL) - Extend (Hanita), against a well-established IOL - Eyhance (ICB00, J&J Vision) - through in vitro benchmarking. METHODS: Optical benchmarking was conducted using the OptiSpheric IOL PRO2 device in compliance with International Organization for Standardization (ISO) guidelines. Optical quality was assessed using the modulation transfer function (MTF), point spread function (PSF), area under the MTF (MTFa), and 1951 USAF test charts. Measurements were taken at 3.0 mm and 4.5 mm apertures using a model cornea that induced 0.13 μm of spherical aberration to simulate clinical performance. RESULTS: Both IOLs demonstrated comparable optical performance. At a 3 mm aperture, the Extend produced an average MTF at 50 lp/mm of 0.38 ± 0.01, while the ICB00 produced 0.36 ± 0.01. The MTFa and derived logMAR visual acuity (VA) curves showed nearly complete overlap for defocus levels less than - 1.25 D, with both lenses yielding identical VA at far focus (-0.09 logMAR). At higher defocus levels, the observed difference between the models accounted for < 0.02 logMAR, which is small and below the resolution threshold of standard VA testing. Point spread function assessments revealed comparable light distribution for both IOLs. CONCLUSION: Under laboratory conditions, the Hanita Extend IOL shows comparable results to the Eyhance ICB00 regarding MTF function, USAF-Chart images, and PSF assessment.
Targeted CYP27A1 gene analysis for early identification of cerebrotendinous xanthomatosis in juvenile cataract patients: report of a novel variant.
Ceylan A, Güler S, Aydin FO … +3 more , Akbas YB, Yildiz BK, Yildirim Y
BMC Ophthalmol · 2026 Jun · PMID 42288808 · Full text
BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early...
BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early diagnosis. This study evaluated the prevalence of CYP27A1 variants in patients with bilateral juvenile cataracts and described related clinical findings. METHODS: This single-center retrospective study was conducted between May 2022 and April 2025 at Başakşehir Çam and Sakura City Hospital, Istanbul. Patients aged 6 months to 21 years with bilateral juvenile cataracts of undetermined etiology were included. Those with congenital, traumatic, or defined metabolic cataracts were excluded. All underwent ophthalmic evaluation and targeted CYP27A1 sequencing (exons 1-9, exon-intron boundaries) with confirmatory Sanger sequencing. Variants were classified per ACMG/AMP guidelines using ClinVar, HGMD, VarSome, and Franklin databases. RESULTS: Among 128 patients (42.2% male, 57.8% female; mean age 10.9 ± 9.4 years), two (1.5%, 95% CI: 0.2-5.4) carried a novel homozygous CYP27A1 c.398G > A (p.W133*) pathogenic variant, and three (2.4%, 95% CI: 0.5-6.9) had a heterozygous c.884 C > T (p.A295V) variant of uncertain significance. Both families had parental consanguinity. Both patients with homozygous pathogenic variants presented with bilateral cerulean cataracts. DISCUSSION: The absence of systemic symptoms at diagnosis highlights the feasibility of ophthalmology-based genetic screening for CTX. Identifying affected individuals before neurological onset enables timely initiation of oral chenodeoxycholic acid replacement therapy, which may reduce cholestanol and bile alcohol accumulation and help prevent irreversible complications. CONCLUSION: Incorporating CYP27A1 sequencing into the evaluation of bilateral juvenile cataracts may facilitate earlier detection of CTX and timely referral for appropriate management, especially in high-consanguinity regions.
Comparative outcomes of endoscopic dacryocystorhinostomy under local versus general anesthesia in elderly patients.
Chang YH, Liao YL, Tsai YJ … +1 more , Chu YC
BMC Ophthalmol · 2026 Jun · PMID 42288789 · Full text
BACKGROUND: Endoscopic dacryocystorhinostomy (DCR) is a common procedure, typically performed under general anesthesia (GA), while performing it under local anesthesia (LA) may offer benefits to elderly or high-risk pati...
BACKGROUND: Endoscopic dacryocystorhinostomy (DCR) is a common procedure, typically performed under general anesthesia (GA), while performing it under local anesthesia (LA) may offer benefits to elderly or high-risk patients. This study evaluates the feasibility and surgical outcomes of endoscopic DCR under LA, with comparison to GA. METHODS: This retrospective cohort study included patients aged 18 years or older with acquired nasolacrimal duct obstruction who underwent Endoscopic DCR at a tertiary referral center between January 2019 and December 2024. Surgical outcomes were evaluated using multivariable Cox proportional hazards models adjusted for age and sex, with propensity score-matched analyses as sensitivity analyses. Secondary outcomes included operative time, intraoperative bleeding, complications, predictors of failure and revision surgery. Furthermore, potential predictors were screened by univariable analyses, and variables with P < 0.15 were entered into multivariable models. RESULTS: The study enrolled 210 eyes of 162 patients, with 117 patients (159 eyes) in the GA group, and 45 patients (51 eyes) in the LA group. The mean age was 61.7 ± 12.2 years in the GA group, and 72.3 ± 12.7 years in the LA groups. Surgical success was comparable between groups, with the LA group exhibiting a shorter operative time (P < 0.001). No major adverse events were reported. Small lacrimal sac size was identified as an independent associated factor of surgical failure (P < 0.001). CONCLUSIONS: LA offers a feasible alternative to GA for endoscopic DCR, particularly in elderly patient. Potential drawbacks include patient discomfort and an uncontrollable surgical field, which can be mitigated with appropriate patient selection.
Elevated serum high-density lipoprotein is positively associated with incident glaucoma among middle-aged and older adults: a national cohort in China.
Chen Z, Lin H, Zheng X … +4 more , Song X, Feng H, Guo H, Yu X
BMC Ophthalmol · 2026 Jun · PMID 42288781 · Full text
PURPOSE: Emerging evidence challenges the traditional view of high-density lipoprotein (HDL) as uniformly protective in ocular health. This study aimed to evaluate the association between serum HDL levels and glaucoma in...
PURPOSE: Emerging evidence challenges the traditional view of high-density lipoprotein (HDL) as uniformly protective in ocular health. This study aimed to evaluate the association between serum HDL levels and glaucoma in a middle-aged and older Chinese population. METHODS: We conducted a retrospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 7,510 participants aged over 45 years without baseline glaucoma were included. Serum HDL was measured at baseline (2011), and incident glaucoma was ascertained via self-report during follow-up (2013-2018). Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to assess the association, with adjustment for demographic and clinical covariates. RESULTS: Over a 7 years' follow-up, 224 participants (2.98%) developed glaucoma. After multivariable adjustment, each 1 mmol/L increase in HDL was associated with a 57% higher risk of glaucoma (HR = 1.57; 95% CI: 1.10-2.26; p = 0.014). Participants with low HDL level (< 1.0 mmol/L) had a significantly lower glaucoma risk compared to those with normal HDL level (HR = 0.63; 95% CI: 0.38-0.89; p = 0.012). RCS analysis indicated a steeper increase in risk at serum HDL ≤ 1.501 mmol/L. Subgroup analyses revealed consistency across most strata, with a stronger association observed in participants with liver disease (p for interaction = 0.035). CONCLUSION: Elevated serum HDL levels were associated with an increased risk of glaucoma in Chinese middle-aged and older adults, particularly at lower HDL concentrations. These findings challenge the conventional "good cholesterol" paradigm in glaucoma and underscore the need for further research into lipid-related pathways in its pathogenesis.
Cataract after electrical injury: clinical characteristics and surgical management outcomes, a case report of three cases.
Wang Y, Chang X, Li L
BMC Ophthalmol · 2026 Jun · PMID 42288764 · Full text
BACKGROUND: Electric cataract, a rare and vision-threatening complication, is frequently observed in patients following electrical injuries. Current knowledge of its clinical characteristics and treatment is largely deri...
BACKGROUND: Electric cataract, a rare and vision-threatening complication, is frequently observed in patients following electrical injuries. Current knowledge of its clinical characteristics and treatment is largely derived from a limited number of case reports. This report presents three cases of distinct types of electric cataract, with detailed documentation of disease progression, clinical features, individualized surgical management, and corresponding outcomes. CASE PRESENTATION: This case series included three patients: a 30-year-old female with indirect lightning-induced cataract (onset at 2 years), a 64-year-old male with cataract following domestic low-voltage electrical injury (onset at 50 years), and a 54-year-old male with high-voltage electric cataract (onset at 3 months). All three cases presented with characteristic anterior subcapsular opacities (snowflake, sunflower, or moss-like patterns), anterior subcapsular cortical opacities, and posterior subcapsular opacities. Intraoperative zonular laxity was observed in all three cases. Two patients had unilateral involvement, while one had bilateral cataracts. The young patient received implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL), and the middle-aged patient received implantation of a toric monofocal IOL. The patient with bilateral cataracts also had simultaneous macular damage, as well as corneal leukoma; a monofocal IOL was implanted in one eye, while the fellow eye ultimately progressed to a mature cataract. Postoperative corrected distance visual acuity improved to 0.8 in two cases and 0.4 in the third. No significant postoperative complications were observed. CONCLUSION: Cataracts following electrical injury may be insidious at onset and can exhibit progressive worsening. Pupillary dilation examination is essential, and regular follow-up is required. Attention should be paid to concomitant injuries of the cornea, fundus, zonules, and corneal endothelium to guide individualized surgical planning, thereby maximizing patient benefits.
Chronic oculomotor nerve palsy secondary to a sphenoid-cavernous sinus lesion in an adolescent: a case report and literature review.
Alawaz RA, Taishan SS, Alhaimi F
BMC Ophthalmol · 2026 Jun · PMID 42288741 · Full text
BACKGROUND: Oculomotor nerve (cranial nerve III) palsy in children and adolescents is uncommon and typically suggests an underlying structural lesion rather than microvascular ischemia. Sphenoid sinus disease represents...
BACKGROUND: Oculomotor nerve (cranial nerve III) palsy in children and adolescents is uncommon and typically suggests an underlying structural lesion rather than microvascular ischemia. Sphenoid sinus disease represents a rare cause of ocular cranial neuropathies and most frequently affects the abducens nerve. Consequently, isolated chronic oculomotor nerve palsy secondary to sphenoid sinus pathology is an unusual clinical presentation. CASE PRESENTATION: We report a 16-year-old male who presented with long-standing right ocular deviation and progressive limitation of eye movements beginning in early childhood. Neuro-ophthalmic examination demonstrated severe limitation of adduction, elevation, and depression of the right eye associated with a large-angle exotropia and a fixed dilated pupil, consistent with chronic oculomotor nerve palsy. Notably, no ptosis of the right upper eyelid was observed despite the severity of the motor deficit, a finding that is discussed in the context of divisional and fascicular nerve involvement. The patient had a prior history of a sphenoid sinus lesion treated with functional endoscopic sinus surgery and partial resection. Histopathological examination revealed a histiocyte-rich lesion with surrounding fibrosis. Magnetic resonance imaging obtained during the current evaluation demonstrated postoperative changes with arrested pneumatization of the right sphenoid sinus, with no evidence of residual or recurrent mass lesion, and diffuse fatty atrophy of the right medial and inferior rectus muscles consistent with long-standing denervation. CONCLUSION: This case highlights a rare presentation of chronic isolated oculomotor nerve palsy associated with sphenoid-cavernous sinus pathology in an adolescent. The close anatomical relationship between the sphenoid sinus and the cavernous sinus provides a plausible mechanism for selective involvement of the oculomotor nerve. Early recognition of sphenoid sinus lesions in pediatric patients presenting with unexplained strabismus or cranial nerve deficits is essential to prevent irreversible neuro-ophthalmic sequelae.
Operationalizing a minimal-metric school screening pathway: using non-cycloplegic spherical equivalent as a first-stage triage metric for hyperopia-reserve insufficiency in Chinese schoolchildren.
Chen W, Chen F, Xie L … +3 more , Wu C, Ding S, Xiang D
BMC Ophthalmol · 2026 Jun · PMID 42286519 · Full text
BACKGROUND: School-based myopia screening commonly relies on non-cycloplegic refraction because cycloplegic refraction is difficult to implement universally at scale. This study evaluated whether non-cycloplegic spherica...
BACKGROUND: School-based myopia screening commonly relies on non-cycloplegic refraction because cycloplegic refraction is difficult to implement universally at scale. This study evaluated whether non-cycloplegic spherical equivalent (NC-SE) could serve as a low-burden first-stage triage metric to identify children who warrant cycloplegic assessment for possible hyperopia reserve insufficiency (HRI). METHODS: This cross-sectional school-based study included 1,650 children aged 6-15 years from Zengcheng District, Guangzhou, China. All participants underwent non-cycloplegic autorefraction, UCVA assessment, and cycloplegic autorefraction. Cycloplegic spherical equivalent (Cyclo-SE) was used as the reference standard for defining HRI, cycloplegic myopia, and pseudomyopia. HRI was operationally defined as preserved UCVA with low cycloplegic hyperopic reserve: Cyclo-SE from 0 to + 1.25 D in children aged 6-8 years and from 0 to + 1.00 D in children aged 9-15 years. Diagnostic performance of NC-SE for identifying HRI was assessed using receiver operating characteristic (ROC) analysis. RESULTS: The prevalence of HRI was 14.1%, 10.5%, and 3.9% in the 6-8, 9-11, and 12-15-year-old groups, respectively. Correlation between NC-SE and Cyclo-SE strengthened with age (Spearman's rho: 0.641, 0.675, and 0.813; all p < 0.001). For detecting HRI, NC-SE achieved an AUC of 0.661 (95% CI: 0.618-0.704). A pragmatic cutoff of -0.50 D yielded a sensitivity of 0.824 (95% CI: 0.765-0.870), specificity of 0.550 (95% CI: 0.524-0.575), PPV of 20.5% (95% CI: 17.9-23.4), and NPV of 95.7% (95% CI: 94.1-96.9). Among children with normal visual acuity, 24.1% had pseudomyopia. CONCLUSION: NC-SE may serve as a low-burden first-stage triage metric in school-based screening to identify children who warrant cycloplegic assessment for possible HRI. However, its moderate AUC and low PPV indicate that NC-SE should not be interpreted as a stand-alone diagnostic test. Cycloplegic refraction remains necessary for confirming hyperopic reserve status. Further longitudinal studies incorporating axial length, accommodative measurements, and external validation are needed to determine its prognostic value for incident myopia. CLINICAL TRIAL NUMBER: Not applicable.
Selective laser trabeculoplasty is effective in controlling steroid-induced OHT after 0.19 µg Fluocinolone acetonide implant, a long-term outcome of 15 eyes.
Chacun S, Billant J, Goissaud A … +8 more , Chirpaz N, Elbany S, Rocher A, Gilli C, Fenniri I, Burillon C, Matagrin B, Dot C
BMC Ophthalmol · 2026 Jun · PMID 42286485 · Full text
OBJECTIVE: To evaluate the long-term effectiveness and safety of selective laser trabeculoplasty (SLT) for controlling intraocular pressure (IOP) in patients with steroid-induced ocular hypertension (OHT) treated with fl...
OBJECTIVE: To evaluate the long-term effectiveness and safety of selective laser trabeculoplasty (SLT) for controlling intraocular pressure (IOP) in patients with steroid-induced ocular hypertension (OHT) treated with fluocinolone acetonide (FAc) intravitreal implants. METHODS: This was a single-center retrospective case series of patients with steroid-induced OHT. Eligibility required prior to exposure to ≥ 3 sustained-release dexamethasone intravitreal implants per eye. SLT was performed in all eyes either before (group 1, n = 6), after (group 2, n = 6), or both before and after (group 3, n = 3) the FAc implantation. IOP was analysed with linear mixed-effects models (random intercept for eye). The mean IOP and within-eye variability (SD-IOP) were summarized for the pre-SLT and post-SLT periods. RESULTS: Fifteen eyes from thirteen patients treated for macular edema were followed for 32 ± 17.7 months after SLT. The mean IOP decreased by 14.2 mmHg across the cohort (p < 0,001). In group 1, which was treated with SLT before FAc implantation, the mean IOP decreased from 16.5 ± 4.8 mmHg to 13.7 ± 2.1 mmHg (p < 0.001) with significantly reduced IOP variability (-2.1 mmHg, p < 0.001). No eye required filtering surgery. Steroid-induced OHT resolved in all eyes within ≤ 4 months after the last dexamethasone implant and ≤ 36 months after the FAc implant. CONCLUSION: SLT is a safe, effective, and repeatable intervention for preventing or controlling IOP elevation in OHT responders' eyes receiving FAc implants. Performing SLT prior to FAc injection may offer better IOP control and reduce variability in such patients.
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