BMC Ophthalmol [JOURNAL]
Sun
200 papers
Rapid resolution of submacular hemorrhage in neovascular age-related macular degeneration using pneumatic displacement and faricimab.
Ji PX, Herman JE, Sivachandran N
BMC Ophthalmol · 2026 May · PMID 42216114 · Full text
BACKGROUND: Submacular hemorrhage (SMH) is a rare but visually devastating complication of neovascular age-related macular degeneration (nAMD) associated with poor long-term prognosis due to photoreceptor iron toxicity,...
BACKGROUND: Submacular hemorrhage (SMH) is a rare but visually devastating complication of neovascular age-related macular degeneration (nAMD) associated with poor long-term prognosis due to photoreceptor iron toxicity, subretinal fibrosis, and retinal pigment epithelial (RPE) damage. Pneumatic displacement (PD) combined with anti-vascular endothelial growth factor (anti-VEGF) therapy is an established approach for managing acute SMH; however, the role of faricimab, a novel dual inhibitor of VEGF-A and angiopoietin-2 (Ang-2), in this context has not been previously evaluated. CASE PRESENTATION: This study reports the outcomes of PD combined with faricimab injection in a case of a 75-year-old female with acute SMH secondary to nAMD. The patient with dense SMH and a large PED secondary to presumed polypoidal choroidal vasculopathy (PCV) underwent PD with 0.40 mL of sulfur hexafluoride and intravitreal faricimab injection (50 µL, 6 mg) on the same day as presentation, followed by 5 days of face-down positioning with excellent patient compliance confirmed by verbal verification. Two additional faricimab injections were administered at 4 and 8 weeks, followed by treat-and-extend protocol. CONCLUSIONS: The use of timely PD with appropriate head positioning can effectively manage patients with acute large SMH and improve visual outcomes. While the combined approach with serial faricimab injections showed longer-term benefits, the immediate improvement was likely due to mechanical techniques. The potential added benefit of faricimab's dual inhibition mechanism over other anti-VEGF therapies in SMH remains to be investigated through larger, comparative trials.
Accommodation-induced biometric changes in ciliary muscle, trabecular meshwork, and Schlemm's canal: comparison of eyes in high myopia.
Shao Y, Li Z, Wu X … +12 more , Wu X, Wan N, Chen H, Zhe N, Wang J, Zhao Y, Zhou Y, Nie L, Wang Y, Shen M, Lu F, Li Z
BMC Ophthalmol · 2026 May · PMID 42215972 · Full text
PURPOSE: To evaluate accommodation-induced changes in the ciliary muscle (CM), Schlemm's canal (SC), and trabecular meshwork (TM) in eyes with and without high myopia, and to assess the associations among these structure...
PURPOSE: To evaluate accommodation-induced changes in the ciliary muscle (CM), Schlemm's canal (SC), and trabecular meshwork (TM) in eyes with and without high myopia, and to assess the associations among these structures during accommodation. METHODS: 116 eyes from 57 healthy control (HC) and 59 high myopia (HM) were assessed across two experiments. In the first experiment, pilocarpine-induced accommodation was applied to 78 eyes, while in the second, a -5 diopter (D) accommodative stimulus was used on 38 eyes. Anterior segment images were captured via swept-source optical coherence tomography before and after each accommodation stimulus. Measurements included the maximum thickness of CM and the anterior length of CM, the length of TM, and the area of SC. Statistical analyses evaluated group differences and correlations. RESULTS: Drug-induced and - 5D stimulation increased the maximum thickness of CM and the area of SC's levels while decreasing the anterior length of CM's levels. In the HC group, the length of TM was larger in the accommodative state, mediating the relationship between changes in the maximum thickness of CM and the area of SC. Conversely, these changes and correlations in the length of TM were insignificant in HM eyes. The length of TM increased with axial length and elongation in the anterior length of CM across all subjects; however, accommodation-related changes diminished as axial length (AL) and the anterior length of CM increased. Causal mediation analysis demonstrated that the anterior length of CM mediated the relationship between AL and the length of TM elongation. CONCLUSIONS: In two trials, accommodation-induced changes in the CM, TM, and SC were observed in eyes with or without HM, with reduced TM and SC response in HM. Differences in CM, TM, and SC behavior during accommodation between the HC and HM groups suggest that CM contraction may reshape the aqueous humor outflow channels.
Long non-coding RNA SNHG17 contributes to proliferation and migration of retinal vascular endothelial cell in diabetic retinopathy through miR-34a-5p/CDK6 axis.
Wei L, Song J, Han S … +2 more , Wu M, Liang H
BMC Ophthalmol · 2026 May · PMID 42215943 · Full text
BACKGROUND: Long non-coding RNAs (lncRNAs) emerge as crucial regulators in diabetic retinopathy (DR). OBJECTIVES: This study examined the expression profile of lncRNA SNHG17 in DR patients, and the underlying mechanism w...
BACKGROUND: Long non-coding RNAs (lncRNAs) emerge as crucial regulators in diabetic retinopathy (DR). OBJECTIVES: This study examined the expression profile of lncRNA SNHG17 in DR patients, and the underlying mechanism was probed in human retinal microvascular endothelial cells (hRMECs). MATERIALS AND METHODS: 120 healthy controls (HC), 100 patients with T2DM, and 253 patients with DR were enrolled. hRMECs were treated with high glucose (HG) to mimic DR in vitro. qRT-PCR was performed for mRNA measurement. Cell viability and migration were detected under diverse conditions. Claudin-5 (CLDN5) concentration was detected via ELISA. The predicted targeting relationship was verified via luciferase reporter assay. RESULTS: SNHG17 was notably downregulated in patients' serum and linked to DR progression. Among these patients, serum SNHG17 was the lowest in those with proliferative DR (PDR). In vitro, SNHG17 overexpression significantly boosted proliferation, migration and CLDN5 expression of HG-exposed hRMECs while inhibiting their apoptosis. SNHG17 functioned as a sponge for miR-34a-5p, whose upregulation reversed SNHG17's effects on hRMECs. CDK6, a target of miR-34a-5p, was downregulated in HG-treated hRMECs, and its serum levels correlated negatively with miR-34a-5p across all participants. CONCLUSION: Downregulation of SNHG17 was linked to the onset and development of DR. Overexpression of SNHG17 can recover the proliferation and migration of hRMECs that were suppressed by HG through sponging miR-34a-5p, and CDK6 may be the target of the SNHG17/miR-34a-5p axis. CLINICAL TRIAL NUMBER: Not applicable.
Multimodal structure-function mapping of retinal sensitivity loss in pachychoroid spectrum diseases.
Kim S, Lee YE, Han YE … +1 more , Lee J
BMC Ophthalmol · 2026 May · PMID 42215920 · Full text
PURPOSE: Pachychoroid spectrum disease (PSD) is characterized by a thickened choroid and alterations of the retinal pigment epithelium (RPE). Although structural changes in PSD have been well described, the relationship...
PURPOSE: Pachychoroid spectrum disease (PSD) is characterized by a thickened choroid and alterations of the retinal pigment epithelium (RPE). Although structural changes in PSD have been well described, the relationship between RPE integrity and retinal function has not been fully clarified. This study investigated the characteristics of retinal sensitivity in eyes with inactive PSD using near-infrared autofluorescence (NIRAF) and microperimetry. METHODS: Twenty-six eyes without recent exudative activity were retrospectively analyzed. Hypoautofluorescent areas on NIRAF images were manually outlined to identify regions of RPE alteration, and mean retinal sensitivity (mRS) was compared between the inside and outside of these lesions. RESULTS: Thirteen eyes showed macular neovascularization (MNV-positive), while the remaining thirteen had no MNV. In MNV-positive eyes, mRS was significantly reduced within hypoautofluorescent lesions compared with surrounding areas (26.98 ± 7.14 vs. 29.11 ± 4.53 dB, p = 0.021). In MNV-negative eyes, a similar but nonsignificant trend was observed. In an exploratory adjusted linear regression model, MNV status was associated with greater lesion-associated retinal sensitivity reduction (B coefficient = 1.55, p = 0.032). Sublesional choroidal thickness and symptom duration were not significantly associated with ΔmRS. CONCLUSION: These results suggest that NIRAF-defined RPE alterations are topographically associated with localized retinal sensitivity reduction, particularly when MNV is present. The combined use of NIRAF, microperimetry, and OCT angiography may support topographic functional assessment in PSD, although prospective validation is required.
Visual and refractive outcomes of small incision lenticule extraction planned with a VISULYZE-generated nomogram for myopia and astigmatism: a retrospective comparative study.
Lin Y, Wei X, Su H … +3 more , Li Y, Huang B, Huang M
BMC Ophthalmol · 2026 May · PMID 42215913 · Full text
PURPOSE: Small-incision lenticule extraction (SMILE) is a widely used procedure for correcting myopia and myopic astigmatism. However, variability in refractive outcomes, particularly astigmatic correction, remains a con...
PURPOSE: Small-incision lenticule extraction (SMILE) is a widely used procedure for correcting myopia and myopic astigmatism. However, variability in refractive outcomes, particularly astigmatic correction, remains a concern. This study aimed to compare visual, refractive, and optical outcomes of SMILE planned with a VISULYZE-generated nomogram versus a conventional nomogram in patients with moderate myopia and astigmatism. METHODS: This retrospective comparative study included 120 eyes from 60 consecutive patients. Eyes were allocated to groups at the eye level, with both eyes from the same patient potentially included and independently assigned to either the VISULYZE-generated nomogram group (60 eyes) or the conventional nomogram group (60 eyes). Visual acuity, refractive outcomes, astigmatic axis deviation, and higher-order aberrations (HOAs) were evaluated preoperatively and at 3 months postoperatively. Statistical analyses accounted for inter-eye correlation using mixed-effects models to properly consider the independence of observations. RESULTS: Preoperative demographic and refractive characteristics were comparable between groups. At 3 months postoperatively, a higher proportion of eyes in the VISULYZE-generated nomogram group achieved uncorrected distance visual acuity (UDVA) of 20/20 or better than in the conventional group. With respect to astigmatic axis deviation and residual astigmatism, the VISULYZE group showed numerical trends toward closer alignment, although differences did not reach statistical significance. Postoperative increases in total HOAs and coma were observed in both groups, with smaller increases in the VISULYZE group. Changes in spherical aberration and trefoil were minimal and comparable between groups. CONCLUSION: SMILE planned with a VISULYZE-generated nomogram was associated with differences in early visual, refractive, and optical outcomes compared with conventional nomogram planning. VISULYZE-generated nomogram group has lower HOAS. Both groups' total HOAs and coma increases postoperatively, with smaller increases in the VISULYZE group.
Ray-tracing guided versus topography-guided FS-LASIK for myopia: a comparative study of relative peripheral refraction and visual quality.
Ao D, Wu J, Zhang B … +2 more , Xiong L, Wang Z
BMC Ophthalmol · 2026 May · PMID 42215905 · Full text
PURPOSE: To compare the distribution of relative peripheral refraction (RPR) and higher-order aberrations (HOAs) following ray-tracing-guided (RG) and topography-guided (TG) femtosecond laser-assisted in situ keratomileu...
PURPOSE: To compare the distribution of relative peripheral refraction (RPR) and higher-order aberrations (HOAs) following ray-tracing-guided (RG) and topography-guided (TG) femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and to investigate their associations with postoperative visual symptoms. METHODS: This study compared the clinical outcomes of RG FS-LASIK and TG FS-LASIK, with 50 eyes from 50 patients prospectively enrolled in each group. Evaluations preoperatively and 3 months postoperatively included visual acuity, manifest refraction, HOAs, RPR, and the quality of vision questionnaire. RPR was assessed via wide-field peripheral refraction and analyzed across eccentricities (5°, 12.5°, 25°, and >25°) within the superior, inferior, nasal, and temporal quadrants. RESULTS: The RG and TG groups showed comparable visual outcomes, with no significant differences in efficacy index (1.16 ± 0.22 vs. 1.14 ± 0.21, p = 0.755) and safety index (1.21 ± 0.22 vs. 1.24 ± 0.21, p = 0.816). Both platforms induced changes in HOAs and coma, whereas reduced spherical aberration was found in the RG group. Both procedures led to a reduction in RPR, a trend that became increasingly prominent in the peripheral region. However, the TG group showed relatively uniform RPR changes across the visual field, whereas the RG group exhibited a significant increase in superior-inferior RPR asymmetry after FS-LASIK. RPR was regionally associated with HOAs, with >25° RPR mainly correlated with spherical aberration (r = -0.458, p < 0.001) and HOAs (r = -0.265, p = 0.008), and superior-inferior asymmetry was negatively correlated with spherical aberration (r = -0.357, p = 0.001). Regression analysis indicated that superior RPR (coef = -0.601, p = 0.001) and superior-inferior (S - I) symmetry (coef = 0.652, p = 0.004) were significantly associated with glare, and a negative shift in spherical aberration (coef = 0.917, p = 0.007) was associated with fewer starburst symptoms. CONCLUSION: Both RG and TG FS-LASIK provide comparable central visual correction, but they exert distinct effects on RPR profiles and HOAs. Postoperative glare was associated with RPR asymmetry, whereas the negative spherical aberration appeared to alleviate starburst symptoms. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500106477), retrospectively registered on July 24, 2025.
Efficacy comparison of moderate to severe astigmatism: implantable collamer lens combined with paired opposite clear corneal incisions versus toric implantable collamer lens.
Zhang X, Wan Y, Wang W
BMC Ophthalmol · 2026 May · PMID 42215893 · Full text
PURPOSE: To compare the efficacy of Implantable Collamer Lens (ICL) combined with paired opposite clear corneal incisions (OCCI) versus Toric Implantable Collamer Lens (TICL) for moderate to severe astigmatism. METHODS:...
PURPOSE: To compare the efficacy of Implantable Collamer Lens (ICL) combined with paired opposite clear corneal incisions (OCCI) versus Toric Implantable Collamer Lens (TICL) for moderate to severe astigmatism. METHODS: This retrospective comparative study included 40 patients with moderate to severe astigmatism (cylinder 1·5D-3·0D). Based on patient preference, 20 eyes underwent TICL implantation (TICL group) and 20 eyes underwent ICL with OCCI (OCCI group). Preoperative and 6-month postoperative data were analyzed, including uncorrected and corrected distance visual acuity (UDVA, CDVA), refraction, higher-order aberrations (HOAs), and Alpins vector parameters (target-induced astigmatism [TIA], surgically induced astigmatism [SIA], difference vector [DV], correction index [CI], angle of error [AE]). RESULTS: At 6 months postoperatively, both groups showed significant visual improvement. The proportion achieving UDVA ≥ 20/20 was 100% in TICL group and 95% in OCCI group. Residual astigmatism ≤ 1·0D was achieved in 95% (TICL) and 90% (OCCI). Spherical equivalent within ±1·0D was 95% and 90%, respectively. OCCI induced significantly more HOAs, horizontal coma, and horizontal trefoil postoperatively compared to TICL (all p < 0.05). Vector analysis showed no significant between-group differences in TIA, SIA, DV, CI, or AE (all p > 0.05). CONCLUSIONS: ICL combined with OCCI yields acceptable visual and refractive outcomes for moderate to severe astigmatism, though slightly inferior to TICL in accuracy and HOAs. It represents a viable alternative when TICL is unavailable or contraindicated.
Air/gas migration after descemet membrane endothelial keratoplasty (DMEK): the impact of scleral-fixated versus posterior chamber intraocular lenses.
Aydin E, Aydin B, Ozmen MC … +4 more , Yavuz VC, Boluk CE, Göktaş E, Akata RF
BMC Ophthalmol · 2026 May · PMID 42210210 · Full text
BACKGROUND: To evaluate factors associated with posterior migration of intracameral air/gas into the vitreous cavity following Descemet membrane endothelial keratoplasty (DMEK). METHODS: This retrospective case series in...
BACKGROUND: To evaluate factors associated with posterior migration of intracameral air/gas into the vitreous cavity following Descemet membrane endothelial keratoplasty (DMEK). METHODS: This retrospective case series included 30 eyes of patients with posterior chamber intraocular lenses (PCIOLs) and 11 eyes of patients with scleral-fixated intraocular lenses (SFIOLs) who underwent DMEK surgery. Preoperative variables potentially associated with posterior air/gas migration were recorded, including the type of intraocular lens, anterior chamber depth (ACD), pupil diameter, intraocular pressure (IOP), history of pars plana vitrectomy (PPV), and presence of iris defects. Preoperative and postoperative corrected and uncorrected visual acuity levels were assessed for all patients. Graft detachment and subsequent rebubbling were documented. RESULTS: Age, ACD, IOP, and preoperative and postoperative best-corrected visual acuity (BCVA) were similar between the groups (p > 0.05). The mean pupil diameter was significantly larger in the SFIOL group than in the PCIOL group (P < 0.001). Overall, 9 eyes (22%) developed posterior air/gas migration, which occurred more frequently in the SFIOL group than in the PCIOL group (63.7% vs. 6.7%, p < 0.001). Air/gas migration was significantly associated with larger pupil diameter and prior PPV (p = 0.013 and p = 0.014, respectively). CONCLUSION: Posterior air/gas migration into the vitreous cavity appears to be an important contributor to graft detachment following DMEK. In this cohort, SFIOL implantation was strongly associated with postoperative air/gas migration. Larger pupil diameter and prior PPV were also significantly associated with air/gas migration.
Influences of myopic residual refractions on uncorrected distance visual acuity in eyes with conventional and enhanced monofocal intraocular lenses.
Yokogawa T, Takada K, Tokuda S … +4 more , Mori Y, Minami K, Shoji N, Miyata K
BMC Ophthalmol · 2026 May · PMID 42210187 · Full text
BACKGROUND: In eyes with conventional monofocal intraocular lenses (IOLs), uncorrected distance visual acuity (UDVA) deteriorates as myopic refraction error increases. This retrospective study aimed to evaluate tolerance...
BACKGROUND: In eyes with conventional monofocal intraocular lenses (IOLs), uncorrected distance visual acuity (UDVA) deteriorates as myopic refraction error increases. This retrospective study aimed to evaluate tolerance to myopic residual refraction in eyes with conventional and enhanced monofocal IOLs. METHODS: Clinical records of 166 eyes from 135 patients with conventional monofocal IOLs (XY1, Hoya) and 55 eyes from 28 patients with enhanced monofocal IOLs (XY1-EM, Hoya) were reviewed. Associations between UDVA and refractive error spherical equivalent (SE) were evaluated using two analyses. The influences of UDVA on SE (0.0 logMAR or less, 0.1 logMAR, and 0.2 logMAR or higher) and the influence of SE on UDVA (within ± 0.50 D, between - 1.00 and 0.0 D, and - 1.00 D or less) were evaluated. In addition, changes in UDVA with SE were evaluated using segmented regression analysis, and SE break points were compared between IOL types. RESULTS: In the influences of UDVA on SE, the mean SE of eyes with XY1-EM was - 0.61 D for the range of UDVA of 0.1 logMAR, which was twice that of eyes with XY1 (P = 0.0025). In the influence of SE on UDVA, no differences were found. Segmented regression analysis resulted in the break point at -1.075 D in eyes with enhanced XY1-EM IOLs, whereas the break point was at -0.45 D in eyes with conventional XY1 IOLs. Both evaluation results showed the improvement of myopic refractive tolerances in the use of enhanced IOLs. CONCLUSIONS: The influence of myopic residual refractions on UDVA in eyes with conventional and enhanced monofocal IOLs was investigated. The quantitative evaluations revealed the improvement of refractive tolerance up to approximately - 1.00 D of myopia in eyes with enhanced monofocal IOLs. In addition, segmented regression analysis between UDVA and refractive error proved effective for evaluating refractive tolerance.
Anterior chamber temperature rise during torsional versus longitudinal phacoemulsification: an experimental porcine eye study.
Suzuki H
BMC Ophthalmol · 2026 May · PMID 42210159 · Full text
BACKGROUND: Previous studies have reported lower thermal profiles with torsional ultrasound than with longitudinal ultrasound; however, the mechanical determinants underlying this difference remain incompletely understoo...
BACKGROUND: Previous studies have reported lower thermal profiles with torsional ultrasound than with longitudinal ultrasound; however, the mechanical determinants underlying this difference remain incompletely understood. In particular, the mechanical determinants of intraocular temperature behavior under controlled experimental conditions remain unclear. Therefore, this study aimed to compare anterior chamber temperature behavior between longitudinal and torsional ultrasound under standardized experimental conditions, including settings with nominally comparable tip-excursion parameters. METHODS: Anterior chamber temperature changes were evaluated using porcine eyes under standardized experimental conditions. Continuous longitudinal and torsional ultrasound were applied with controlled irrigation and aspiration settings. Ultrasound power settings were adjusted to create nominally comparable tip-excursion conditions between the two modalities. Temperature was continuously recorded, and temporal temperature profiles were analyzed. RESULTS: Under identical machine settings, torsional ultrasound produced a significantly smaller increase in anterior chamber temperature than longitudinal ultrasound. However, when nominally comparable tip-excursion settings were used, temperature rise did not differ significantly between the two modalities. In both ultrasound modes, anterior chamber temperature increased rapidly after activation and reached a plateau within approximately 20 s. CONCLUSIONS: Under controlled low-flow experimental conditions, torsional ultrasound produced a smaller increase in anterior chamber temperature than longitudinal ultrasound. However, this difference was not observed under nominally comparable machine-level tip-excursion settings. These findings suggest that tip-motion characteristics may contribute to intraocular temperature behavior during ultrasound activation.
Long-term impact of scleral contact lens use on endothelial cell density in patients with moderate to advanced keratoconus.
Doğan C, Kılıçarslan O, Özdemir FB … +2 more , Atakan D, Mergen B
BMC Ophthalmol · 2026 May · PMID 42210145 · Full text
BACKGROUND: We investigated the effect of long-term use of scleral contact lens (SL) on corneal endothelial parameters in patients with keratoconus (KC). METHODS: Specular microscopy (Konan Cell Check SL, Hyogo, Japan) i...
BACKGROUND: We investigated the effect of long-term use of scleral contact lens (SL) on corneal endothelial parameters in patients with keratoconus (KC). METHODS: Specular microscopy (Konan Cell Check SL, Hyogo, Japan) imaging was performed on healthy subjects (control group) and patients with KC (KC group) who were long-term SL wearers using the center method. Specular microscopy measurements were taken for both the groups before and after SL use. RESULTS: The mean duration of SL use in the KC group was 5 ± 2 years. No significant differences in specular microscopy parameters were noted between the first and last examinations of the control and KC groups. CONCLUSION: Corneal endothelial parameters were not affected in long-term SL wearers when the recommended fitting and usage practices were followed, suggesting that SL use is well tolerated by the corneal endothelium. However, further research involving larger cohorts is essential to confirm the long-term safety of SL use.
Gender-based analysis of visual and refractive characteristics in exotropia.
Khorrami-Nejad M, Akbari MR, Masoomian B … +3 more , Mirmohammadsadeghi A, Hussein HR, Narooie-Noori F
BMC Ophthalmol · 2026 May · PMID 42204682 · Full text
PURPOSE: To analyze gender-based differences in visual acuity, refractive error, angle of deviation, and amblyopia in patients with alternate exotropia (Alt XT) and intermittent exotropia (IXT). METHOD: A retrospective s...
PURPOSE: To analyze gender-based differences in visual acuity, refractive error, angle of deviation, and amblyopia in patients with alternate exotropia (Alt XT) and intermittent exotropia (IXT). METHOD: A retrospective study of 4,417 surgical exotropia patients (2,970 Alt XT; 1,447 IXT) compared sex-based differences in CDVA, refraction, deviation angles, and amblyopia within each subtype. Alongside unadjusted tests, subtype-specific multivariable models were used: linear regression for right-eye logMAR CDVA (adjusting for age, near/distance deviation, spherical equivalent, and astigmatism), linear regression for distance deviation angle (adjusting for age, spherical refractive error, astigmatism, and amblyopia status), and binary logistic regression for amblyopia (yes/no) (adjusting for age, distance deviation, spherical refractive error, and astigmatism). An ordinal model for amblyopia severity was explored but interpreted cautiously due to sparse data. RESULTS: In Alt XT, females had higher mean cylindrical error (0.86 ± 1.23 D vs. 0.76 ± 1.07 D; p = 0.024), while males had larger horizontal deviations at near (37.2 ± 16.6Δ vs. 35.0 ± 16.6Δ; p < 0.001) and distance (35.9 ± 16.0Δ vs. 34.3 ± 15.8Δ; p = 0.008) and a higher prevalence of severe amblyopia (12.2% vs. 7.8%; p < 0.001). In IXT, females were younger (16.7 ± 11.6 vs. 18.8 ± 11.9 years; p = 0.001), whereas males had larger deviations at near (28.1 ± 11.7Δ vs. 26.2 ± 10.0Δ; p = 0.001) and distance (28.4 ± 11.4Δ vs. 27.2 ± 9.8Δ; p = 0.025) and higher overall amblyopia prevalence (13.0% vs. 8.7%; p = 0.010), mainly mild (10.4% vs. 7.0%; p = 0.031). CDVA and spherical equivalent did not differ by sex in either subtype. In adjusted models, sex was not associated with right-eye logMAR CDVA in Alt XT (B = 0.005; p = 0.814) or IXT (B = 0.005; p = 0.506). Sex was associated with a small difference in distance deviation magnitude in Alt XT (B = 1.33 prism diopters; p = 0.018) but not in IXT (p = 0.114). In adjusted logistic regression, sex was not associated with amblyopia prevalence in Alt XT (OR = 1.12; p = 0.159) but was associated in IXT (OR = 1.51; p = 0.025). CONCLUSION: Gender-specific differences were observed in astigmatism, deviation magnitude, age at surgery, and amblyopia patterns across exotropia subtypes. After adjustment, sex remained associated with distance deviation in Alt XT and amblyopia prevalence in IXT, but not with CDVA in either subtype. Overall, sex appears to be a relevant clinical variable in exotropia and should be considered in assessment and future research.
Association of systemic inflammatory indices and body mass index with diabetic macular edema in non-proliferative diabetic retinopathy.
Harley O, Amelia YS, Gustianty E … +2 more , Soetedjo NNM, Kartasasmita AS
BMC Ophthalmol · 2026 May · PMID 42204503 · Full text
PURPOSE: To evaluate the association between systemic biomarkers and the presence of diabetic macular edema (DME) with non-proliferative diabetic retinopathy (NPDR), and to assess the discriminative ability of these mark...
PURPOSE: To evaluate the association between systemic biomarkers and the presence of diabetic macular edema (DME) with non-proliferative diabetic retinopathy (NPDR), and to assess the discriminative ability of these markers for identifying DME. METHODS: A cross-sectional study was conducted among 80 patients with type 2 diabetes mellitus and NPDR. Participants were categorized into DME and non-DME groups based on spectral-domain optical coherence tomography (OCT), with a central macular thickness ≥ 300 μm defining DME. Hematological parameters were analyzed from complete blood counts. Statistical analysis was performed using SPSS 23.0. RESULTS: A total of 80 eyes (40 with DME and 40 without DME) were analyzed. Significant elevation of neutrophil counts was observed in the DME group (p = 0.006). Similarly, NLR and SII values were higher in the DME group (p = 0.075 and p = 0.048, respectively). The combined model of NLR, SII, and BMI showed moderate discriminatory ability (AUC 0.706, p = 0.002). NPDR severity was significantly associated with DME in the univariate and multivariate analyses of the initial model (OR 3.023, p = 0.049). This association lost statistical significance after adjustment for age and BMI. Systemic inflammatory markers (NLR, MLR, PLR, and SII) were not significantly associated with DME. CONCLUSIONS: SII and NLR demonstrated moderate discriminatory ability for identifying DME in patients with NPDR, particularly when integrated with the metabolic parameter BMI. These findings provide foundational evidence for the potential of using an accessible, cost-effective marker in diabetic retinal disease.
High-performance proteomics reveals immune, epithelial, and vascular dysregulation underlying lacrimal fluid defects in patients with aniridia.
Willems M, Vialaret J, Girard M … +12 more , Feret N, Bremond-Gignac D, Chassaing N, Kindermans J, Fichter L, Hirtz C, Mollevi C, Crowdy H, Pequignot M, Delettre C, Daien V, Michon F
BMC Ophthalmol · 2026 May · PMID 42204496 · Full text
BACKGROUND: Congenital aniridia is a rare disorder presenting as a panocular malformation with variable severity, often complicated by progressive keratopathy. The purpose of this study was to characterise the tear-film...
BACKGROUND: Congenital aniridia is a rare disorder presenting as a panocular malformation with variable severity, often complicated by progressive keratopathy. The purpose of this study was to characterise the tear-film proteome in adults with PAX6-related congenital aniridia and to identify dysregulated pathways linked to aniridia associated keratopathy (AAK). METHODS: Tears were obtained with Schirmer strips from four genetically confirmed patients and four age- and sex-matched healthy volunteers. Peptides prepared with the single-pot, solid-phase-enhanced (SP3) protocol were analysed by data-independent nanoLC-MS/MS. Proteins were identified with a false discovery rate (FDR) <1% during DIA data processing. Differential abundance between controls and patients samples was assessed using an adjusted p-value < 0.05. Proteins with |log₂-fold change| ≥1 were considered significantly expressed. Functional enrichment was evaluated with Enrichr (Gene Ontology, Reactome, JensenExp, Orphanet, TissueExp). RESULTS: A total of 3 162 proteins were detected; 2 633 showed a valid intensity in every sample of at least one group and were retained for statistical testing. Seventy-three (2.8%) were differentially expressed: 33 were over-expressed and 40 under-expressed in aniridia tears. Down-regulated proteins clustered in lipid homeostasis, epithelial junction integrity and wound-healing modules and included lacritin, secretoglobins and cytoskeletal adaptors, indicating a fragile, poorly repaired surface. Up-regulated species were dominated by neutrophil effectors (CD177 ≈ 50-fold) and reflected heightened innate immunity and abnormal epithelial maturation. Anti-angiogenic processes were significantly over-represented in both under and over-expressed protein sets. CONCLUSION: Our workflow proved highly sensitive, capturing more than 3 000 tear proteins and thus underscoring the robustness of our proteomic approach. The tear film in aniridia reflects dysregulation of various processes, including immunity, lipid and epithelial homeostasis, and vascular remodelling. Our approach highlights novel biomarkers critical for developing targeted therapeutic strategies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05562115. Registered on 29 September 2022.
The prevalence and association between electronic cigarette use and dry eye symptom severity among Palestinian university students: a cross-sectional study.
Sawaftah Z, Sawafta A, Odah AB … +2 more , Zant MA, Abualhasan H
BMC Ophthalmol · 2026 May · PMID 42204489 · Full text
BACKGROUND: Dry eye symptoms are common and can negatively affect visual function and quality of life, particularly among young adults. Electronic cigarette use has increased markedly in this age group; however, evidence...
BACKGROUND: Dry eye symptoms are common and can negatively affect visual function and quality of life, particularly among young adults. Electronic cigarette use has increased markedly in this age group; however, evidence regarding its association with dry eye symptoms, especially in Middle Eastern populations, remains limited. METHODS: A cross-sectional study was conducted among undergraduate students enrolled at multiple Palestinian universities in the West Bank between January and May 2025. Data were collected using a structured self-administered questionnaire assessing sociodemographic characteristics, smoking status, and dry eye symptoms measured by the Ocular Surface Disease Index (OSDI). Smoking status was categorized as non-smoking, exclusive e-cigarette use, exclusive traditional cigarette smoking, or dual use of e-cigarettes and traditional cigarettes. Dry eye symptom severity was classified using established OSDI cutoffs. Crude and adjusted associations between smoking status and dry eye symptom severity were evaluated using ordinal logistic regression, adjusting for age, sex, and academic year. RESULTS: A total of 450 participants were included in the analysis, of whom 58.2% of participants had dry eye symptoms defined as an OSDI score > 12 (mild, moderate, or severe categories). In adjusted analyses, Dual use of e-cigarettes and traditional cigarettes was significantly associated with higher odds of more severe dry eye symptoms compared with non-smoking (OR = 2.35; 95% CI 1.23-4.49; p = 0.010). Exclusive e-cigarette use was associated with higher odds of dry eye symptom severity (OR = 1.64; 95% CI 0.89-3.02; p = 0.113), although this association did not reach statistical significance. Traditional cigarette smoking demonstrated an inverse association with dry eye symptom severity in crude analysis (OR = 0.49; 95% CI 0.25-0.96; p = 0.038), which was no longer significant after adjustment (OR = 0.90; 95% CI 0.43-1.90; p = 0.789). The proportional odds assumption was not violated. CONCLUSIONS: Dual use of e-cigarettes and traditional cigarettes is independently associated with increased severity of dry eye symptoms among Palestinian undergraduate students. These findings suggest that combined smoking behaviors may pose additional ocular health risks and highlight the need for targeted awareness and preventive strategies addressing smoking-related ocular surface symptoms among young adults. CLINICAL TRIAL NUMBER: Not applicable.
Early-onset dead bag syndrome following cataract surgery: a case report with clinical and histopathological findings.
Jiang Y, Zhao H, Hong X … +4 more , Xu Z, Lin J, Lin Y, Xu W
BMC Ophthalmol · 2026 May · PMID 42192517 · Full text
BACKGROUND: In the present study, we aimed to comprehensively describe the full clinical course of dead bag syndrome (DBS) presenting 17 months after cataract surgery, and to elucidate its clinical characteristics, histo...
BACKGROUND: In the present study, we aimed to comprehensively describe the full clinical course of dead bag syndrome (DBS) presenting 17 months after cataract surgery, and to elucidate its clinical characteristics, histopathological features. CASE PRESENTATION: A 55-year-old man presented with progressive blurred vision in his left eye 17 months following an uncomplicated cataract extraction. Ophthalmic examination revealed a lax, translucent capsular bag accompanied by partial dislocation of the intraocular lens (IOL)-capsular bag complex. Histopathological analysis showed extensive depletion of lens epithelial cells (LECs), multilayer delamination of the capsular bag, and markedly reduced fibronectin expression. The patient subsequently underwent removal of the displaced IOL and scleral-sutured implantation of a new IOL, which led to substantial postoperative visual recovery. CONCLUSION: This case indicated that DBS could manifest within a relatively short postoperative interval. Histopathological analysis showed structural alterations of the capsular bag consistent with DBS following cataract surgery. Accordingly, DBS should be recognized as a potential complication and carefully considered during routine postoperative surveillance following cataract surgery.
Clinical outcomes of 27-gauge needle-guided flanged intrascleral haptic fixation using the yamane technique in various indications.
Yilmaz AC, Yilmaz M
BMC Ophthalmol · 2026 May · PMID 42192507 · Full text
PURPOSE: To describe the clinical outcomes and complications of intrascleral haptic fixation using the Yamane technique in patients with aphakia and intraocular lens (IOL) dislocation. METHODS: This study retrospectively...
PURPOSE: To describe the clinical outcomes and complications of intrascleral haptic fixation using the Yamane technique in patients with aphakia and intraocular lens (IOL) dislocation. METHODS: This study retrospectively examined 37 eyes of 37 patients who underwent Yamane surgery for aphakia or a dislocated IOL at a tertiary teaching hospital and had a follow-up period longer than 6 months. Demographic data, Yamane indication, ocular comorbidities, and additional surgical procedures performed were recorded. Preoperative and postoperative distance visual acuity (VA), refractive results, intraocular pressure (IOP), central macular thickness measurements, and postoperative complications were recorded. RESULTS: The mean age of the patients was 68.5 ± 13.1 years, and the mean follow-up period was 9.05 ± 3.36 months. The Yamane indication was aphakia in 24 (64.9%) patients and IOL dislocation in 13 (35.1%) patients. Anterior vitrectomy was performed in 19 patients (51.4%), capsular tension ring extraction in 2 patients (5.4%), IOL extraction in 7 patients (19.0%), and pars plana vitrectomy in 8 patients (21.6%). The mean subjective refraction improved from 8.70 ± 4.83 to -1.36 ± 0.41 diopter (D) at the final visit (p = 0.001). The mean cylindrical refraction was - 1.41 ± 1.05 D in the postoperative period. The mean best corrected VA improved from 0.53 ± 0.22 to 0.15 ± 0.09 logMAR (p = 0.001). Postoperatively, corneal edema was observed in two patients (5.4%), cystoid macular edema in two patients (5.4%), epiretinal membrane in two patients (5.4%), hypotony in one patient (2.7%), elevated IOP in two patients (5.4%), and iris capture of IOL in one patient (2.7%). CONCLUSION: The Yamane technique has provided favorable visual and refractive outcomes with manageable postoperative complications in patients with aphakia and IOL dislocation, including complex cases requiring additional intervention such as vitreoretinal surgery.
Multifocal toric IOL implantation in a patient with Alport syndrome, anterior lenticonus, and intermittent exotropia: a case report.
Bicaklioglu G, Karadag E
BMC Ophthalmol · 2026 May · PMID 42192496 · Full text
BACKGROUND: Alport syndrome is a hereditary disorder characterized by renal failure, sensorineural hearing loss, and ocular manifestations. Anterior lenticonus is the most pathognomonic ocular feature, whereas strabismus...
BACKGROUND: Alport syndrome is a hereditary disorder characterized by renal failure, sensorineural hearing loss, and ocular manifestations. Anterior lenticonus is the most pathognomonic ocular feature, whereas strabismus is rarely reported. Intraocular lens (IOL) implantation in such patients can be challenging due to lens capsule fragility and coexisting visual problems. CASE PRESENTATION: We report a patient with Alport syndrome presenting with anterior lenticonus and intermittent exotropia, who underwent sequential bilateral phacoemulsification with multifocal toric IOL implantation. Preoperative examination revealed high myopic astigmatism and reduced visual acuity. Strabismus evaluation showed intermittent exotropia with greater deviation at near. Surgery was performed with meticulous hydrodelineation and careful capsulorrhexis. A multifocal toric IOL was successfully implanted and oriented along the intended axis. At the 6-month postoperative follow-up, uncorrected distance visual acuity was maintained at 0.05 LogMAR (Snellen 20/22) and uncorrected near visual acuity was N5 at 40 cm in both eyes; no severe visual disturbances were detected, and no complications such as capsular contraction or IOL decentration were observed. CONCLUSION: Bilateral trifocal toric intraocular lens implantation may provide satisfactory visual rehabilitation in selected patients with Alport syndrome and anterior lenticonus, even in the presence of coexisting intermittent exotropia.
Comparison of ocular biometric parameters between nanophthalmos and primary angle closure disease: a cross-sectional comparative study.
Rajendrababu S, Berendschot TT, Senthilkumar VA … +4 more , Maghalakshmi U, Rao MK, Sundar B, Webers CAB
BMC Ophthalmol · 2026 May · PMID 42186044 · Full text
PURPOSE: To compare the ocular biometric parameters between eyes with nanophthalmos and primary angle closure disease (PACD). METHODS: This was a cross-sectional, comparative hospital-based study. A total of 144 subjects...
PURPOSE: To compare the ocular biometric parameters between eyes with nanophthalmos and primary angle closure disease (PACD). METHODS: This was a cross-sectional, comparative hospital-based study. A total of 144 subjects (144 eyes) including 58 nanophthalmos patients and 86 primary angle closure disease (26 primary angle closure and 60 primary angle closure glaucoma) patients were included in the study. The parameters studied were central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500 &AOD750), lens vault (LV), lens thickness (LT), axial length (AL), lens axial factor (LAF), relative lens position (RLP), and retinochoroido-scleral (RCS) thickness. All measurements were obtained prior to any laser or surgical intervention. RESULTS: The mean ± SD age was comparable without any statistically significant difference across all the groups (57.3 ± 11 years in the nanopthalmos group,56.7 ± 9.3 years in the PAC group,56.1 ± 9.2 in the PACG group).The median IOP was highest in PAC eyes (17mmHg) followed by PACG eyes (16mmHg) and nanophthalmic eyes (14mmHg) (p = 0.003). A significant difference was found in ACA among the three groups (p = 0.003), PAC and PACG eyes exhibited wider angles (median 26 for each) whereas nanophthalmic eyes showed narrower angle (median 20.5). The median AL was highest in PACG eyes, intermediate in PAC eyes and shortest in nanophthalmic eyes (p < 0.001). Similarly, median ACD was shallower in nanophthalmic eyes compared with PAC and PACG eyes(p = 0.0001). RCS thickness was significantly greater in nanophthalmos (~ 2.0 mm) compared to PAC and PACG (~ 1.5 mm), highlighting its diagnostic value. No difference was found in LT(p = 0.879) or CCT(p = 0.434) between the groups. Nanophthalmic eyes had higher LV, greater RCS thickness, higher LAF and normal RLP, compared to PAC and PACG. CONCLUSION: Nanophthalmos represents a more anatomically crowded and complex entity compared to PACD, characterized by critical biometric alterations that predispose to severe angle closure. Comprehensive biometric evaluation is essential for early diagnosis, risk stratification, and individualized management planning in these eyes.
A novel NYX gene mutation identified in a Chinese Northeast Han family with high myopia and night blindness.
Xu X, Zhang L, Li Y … +3 more , Dai L, Xiao Z, Yao D
BMC Ophthalmol · 2026 May · PMID 42186038 · Full text
OBJECTIVE: This study aimed to investigate the pathogenic gene mutation associated with high myopia and congenital stationary night blindness (CSNB) in a family from Northeast China. The objective was to clarify the unde...
OBJECTIVE: This study aimed to investigate the pathogenic gene mutation associated with high myopia and congenital stationary night blindness (CSNB) in a family from Northeast China. The objective was to clarify the underlying genetic basis and to determine the inheritance pattern of these ocular disorders. METHODS: Whole-exome sequencing was performed on the proband using the NovaSeq 6000 platform. Variants were filtered based on an allele frequency of less than 0.5% in the gnomAD database. Their pathogenic was evaluated using multiple in silico prediction tools, including CADD, REVEL, SpliceAI, SIFT, MutationTaster, PolyPhen-2, and AlphaMissense. The identified NYX mutation was subsequently validated through Sanger sequencing in the proband and six additional family members. In addition, comprehensive clinical evaluations were conducted. These included detailed ophthalmic examinations, assessment of refractive status, and fundus imaging. These investigations were performed to characterize the phenotypic features and to establish correlations with the genetic findings. RESULTS: A novel frameshift mutation, c.264dup p. (Arf89Alafs *26), was identified in exon 3 of the NYX gene. The proband exhibited extremely high myopia, with a spherical equivalent of less than - 23.00D. This condition was accompanied by typical clinical features of CSNB. Structural analysis indicated significant conformational changes in the mutant protein. Pedigree analysis supported an X-linked recessive mode of inheritance. This pattern was consistent with both the clinical presentation and the genetic findings observed in the affected family. CONCLUSION: This study is the first to identify the NYX c.264dup mutation as a causative variant of complete CSNB (cCSNB) accompanied by extreme high myopia. This finding expands the known mutational spectrum of the NYX gene. These results provide valuable evidence for improving molecular diagnostic strategies. They also offer important support for more accurate genetic counseling in affected individuals and their families.
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