Eur J Ophthalmol [JOURNAL]
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200 papers
Investigating ocular ischemic events following pars plana vitrectomy.
Alshaikhsalama AM, Hashim H, Shieh D … +1 more , Wang AL
Eur J Ophthalmol · 2026 May · PMID 41379563 · Full text
ObjectiveTo assess the incidence of post-vitrectomy ocular ischemic events, including retinal artery occlusion (RAO), retinal vein occlusion (RVO), and non-arteritic ischemic optic neuropathy (NAION).MethodsThis retrospe...
ObjectiveTo assess the incidence of post-vitrectomy ocular ischemic events, including retinal artery occlusion (RAO), retinal vein occlusion (RVO), and non-arteritic ischemic optic neuropathy (NAION).MethodsThis retrospective cohort study examined 120,350 patients who underwent vitrectomy. Using a multicenter healthcare database, patients with a CPT code for any vitrectomy procedure were assessed for subsequent ocular ischemic events. A follow-up analysis of 510,915 patients was performed to determine the risk attributable to vitrectomy versus clinical characteristics. Exclusion criteria included history of prior ocular ischemic events and less than 6 months of follow up.ResultsThe first post-operative month had a significantly higher risk of vascular occlusions compared to the 6-12-month period, with incidence rate ratios (IRRs) of 9.69 (95% CI: 6.9-13.7) for RAO, 11.43 (95% CI: 9.3-14.1) for RVO, and 8.75 (95% CI: 5.2-14.7) for NAION. The IRR for overall ischemic events was also increased during the first month following vitrectomy at 10.7 (95% CI: 9.0-12.7) and remained elevated up to 6 months later with an IRR of 1.49 (95% CI: 1.2-1.8) for the 3-6-month period compared to 6-12-months postoperatively. A separate multivariate analysis revealed that the risk of overall ischemic events was most correlated to vitrectomy (hazard ratio [HR] 3.32, 95% CI: 3.10-3.57) over multiple variables including cataract surgery (HR 1.49, 95% CI: 1.42-1.56) and nicotine use (HR 1.15, 95% CI: 1.08-1.22).ConclusionsVitrectomy is correlated with significantly increased risk of ocular ischemic events, particularly within the first month following surgery. This risk gradually declines but remains elevated up to 6 months postoperatively.
A rare case of conjunctival hibernoma in a von Hippel-Lindau (VHL) patient: Possible association?
Kiristioglu MO, Baykara M, Balaban-Adim S
Eur J Ophthalmol · 2026 May · PMID 41379559 · Publisher ↗
PurposeOcular involvement is exceedingly uncommon, and to date, no conjunctival hibernoma has been reported in humans. We present the first such case in a patient with von Hippel-Lindau (VHL) syndrome.Case reportA 32-yea...
PurposeOcular involvement is exceedingly uncommon, and to date, no conjunctival hibernoma has been reported in humans. We present the first such case in a patient with von Hippel-Lindau (VHL) syndrome.Case reportA 32-year-old woman with genetically confirmed type 1 VHL disease presented with a long-standing, progressively enlarging, painless subconjunctival mass in her only functional eye. Systemic history included multiple cerebellar hemangioblastomas, bilateral nephrectomy for renal cell carcinoma, and an endolymphatic sac tumor. Ophthalmic examination revealed a firm, elevated, subepithelial nodular lesion on the bulbar conjunctiva of the left eye, partially prolapsing beyond the palpebral fissure. The lesion was non-tender, non-ulcerated, and showed no surface inflammation. The eye had phthisis bulbi and residual retinal hemangioblastoma. Orbital magnetic resonance imaging demonstrated a 1.2 × 0.9 × 0.7 cm homogeneous, well-circumscribed lesion, hyperintense on T2-weighted fat-suppressed images, confined to the conjunctiva without scleral, orbital, or bony involvement. Surgical excision revealed a cream-gray, lobulated mass composed of multivacuolated eosinophilic cells with granular cytoplasm. Immunohistochemistry showed strong S-100 positivity and low Ki-67, consistent with hibernoma. Despite a positive deep margin, the patient declined further surgery; no recurrence was observed at three months.ConclusionThis is the first documented case of conjunctival hibernoma in humans and the second reported association with VHL. Conjunctival hibernoma should be considered in the differential diagnosis of vascular conjunctival lesions, particularly in patients with VHL.
Comment on "A comparison of general anesthesia versus local anesthesia in open globe injuries: A systematic review and meta-analysis".
Rani T, Chanu TZ, Babu L
Eur J Ophthalmol · 2026 Jul · PMID 41379557 · Publisher ↗
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Re: "Hypermucoviscous Klebsiella corneal abscess: Infection from inside out".
Rattanapitoon SK, La N, Rattanapitoon NK
Eur J Ophthalmol · 2026 Jul · PMID 41379549 · Publisher ↗
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Comparative diagnostic accuracy of photographic methods for detecting diabetic retinopathy: A systematic review and meta-analysis.
Dattilo V, Polito MS, Parravano M … +5 more , Donati MC, Peto T, Orso M, Virgili G, Cushley L
Eur J Ophthalmol · 2026 Mar · PMID 41362080 · Full text
Diabetic retinopathy (DR) remains a leading cause of vision loss globally. Timely detection through photographic screening is key to prevention, yet considerable variability exists across imaging protocols. This systemat...
Diabetic retinopathy (DR) remains a leading cause of vision loss globally. Timely detection through photographic screening is key to prevention, yet considerable variability exists across imaging protocols. This systematic review and meta-analysis evaluates the diagnostic accuracy of various photographic strategies for DR detection to inform evidence-based screening practices. We systematically searched six databases and trial registries up to June 2023. Eligible studies included adults (≥18 years) with type 1 or 2 diabetes undergoing DR screening using fundus photography, compared against a reference standard (7-field ETDRS or dilated ophthalmoscopy). We performed bivariate meta-analyses for direct comparisons (e.g., mydriatic vs. non-mydriatic), and indirect armbased meta-analyses. Eighty studies (over 50,000 participants) were included. Direct comparisons including 8 studies (16 arms, 2967 participants), found that the sensitivity for detecting any DR was comparable between mydriatic and non-mydriatic imaging (90% vs. 89%), though specificity was lower without dilation (85% vs. 90%). Sensitivity improved with the number of fields (from 0.82 with 1-field to 0.98 with ≥4-fields), particularly in nonmydriatic settings. Results also showed an observed heterogeneity in accuracy of screening across settings showing the need for continuous auditing of screening performance. Photographic screening for DR was effective across multiple configurations. Two-field mydriatic protocols offer high diagnostic accuracy, while trained graders and portable devices can enhance scalability. Findings support the design of structured screening programs adapted to local resources and clinical priorities.
Utility of an LLM-powered experts-in-the-loop chatbot for pre- and post-operative care of cataract surgery patients.
Sachdeva B, Ramjee P, Sharma R … +5 more , Thulasidas M, Raveendra Murthy S, Fulari G, Murali K, Jain M
Eur J Ophthalmol · 2026 May · PMID 41358933 · Publisher ↗
PurposeTo evaluate the utility of , an LLM (Large Language Model)-powered chatbot that provides doctor-verified answers to patient questions about cataract surgery. We examine its use by both end-users (patients and atte...
PurposeTo evaluate the utility of , an LLM (Large Language Model)-powered chatbot that provides doctor-verified answers to patient questions about cataract surgery. We examine its use by both end-users (patients and attendants) and medical experts.MethodsA 24-week study was conducted to evaluate among patients, their attendants, doctors, and patient coordinators. The bot responded instantly to questions by querying a knowledge base curated by medical professionals. Each response was asynchronously verified by an ophthalmologist (for medical questions) or a patient coordinator (for logistical questions), and their edits contributed to updating the knowledge base, thereby minimizing future expert intervention. A mixed-methods analysis was conducted on interaction logs, including patient and attendant questions, chatbot answers, and expert verifications.ResultsA total of 318 patients and attendants sent 1,992 messages, and LLM-generated answers were verified by five doctors and two coordinators. Questions asked pre-surgery were significantly more than post-surgery . Participants asked significantly more medical than logistical questions . Doctors rated 84.5% of 's answers to medical questions as accurate and complete. Their edits, which mainly involved adding information, increased the acceptance of the bot's answers by 19.0% over time.Conclusion was predominantly used to address medical questions. It incorporated expert corrections to improve its answers and reduce the experts' bot-related workload over time. This study highlights the potential of LLM-powered chatbots to support patient-provider communication in ophthalmology.
Conjunctival Microbiota in retinal diseases requiring anti-VEGF therapy: Age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion.
Cakici O, Yilmaz OF, Karaca S … +5 more , Sarmis A, Mutlu MA, Sahin ZB, Borucu B, Oguz H
Eur J Ophthalmol · 2026 May · PMID 41342744 · Publisher ↗
PurposeThis study aimed to investigate the conjunctival microbiota of patients requiring intravitreal injections due to diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO)....
PurposeThis study aimed to investigate the conjunctival microbiota of patients requiring intravitreal injections due to diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO).MethodsA total of 182 participants (46 DR, 71 AMD, 16 RVO, and 49 controls) were enrolled between August and November 2024. Conjunctival swabs were collected from both eyes under sterile conditions prior to injection and cultured on 5% sheep blood and chocolate agar. Microorganisms were identified using Vitek MS.ResultsNo significant differences were observed among the groups in overall microbial growth frequency (all > 0.05). Gram-negative bacteria, fungi, and polymicrobial growth were more frequently detected in DR and AMD patients, suggesting a trend toward greater microbial diversity, although these differences were not statistically significant.ConclusionDR and AMD patients exhibited higher prevalence of gram-negative, fungal, and polymicrobial colonization. These findings underscore the importance of strict aseptic preparation, povidone-iodine disinfection, and targeted prophylactic strategies to minimize post-injection infection risk in high-risk populations.
Six-Year outcome of ultrathin femtosecond Laser-assisted descemet stripping automated endothelial keratoplasty.
Alburayk K, Al Somali A, Aljindan M … +2 more , Alshaibani AK, Alkharashi M
Eur J Ophthalmol · 2026 May · PMID 41334754 · Publisher ↗
PurposeThe present study aims to evaluate the survival rate outcomes of The Femtosecond laser assisted Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (FS-UT-DSAEK) over a 6-year period in addition to oth...
PurposeThe present study aims to evaluate the survival rate outcomes of The Femtosecond laser assisted Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (FS-UT-DSAEK) over a 6-year period in addition to other outcome measures.Material and methodsA retrospective study of 100 eyes with endothelial decompensation from various causes was studied. The Femtosecond laser assisted technique was used to prepare donor tissue with a graft thickness of 100 μm. We evaluated the rate of graft loss, best corrected visual acuity (BCVA), graft survival rate, immunologic rejection rates and any intra or postoperative complications.ResultsThe mean age of the participants was 63.86 years, the sex distribution showed that 61.9% of the participants were females, and 38% were males. The highest proportion of cases (56.5%) was associated with PBK. Most of eyes underwent the DSAEK procedure alone, accounting for 86%. Kaplan-Meier graft survival probability at 1 and 6 years was 93.1% and 86.9%, respectively. Statistical analysis using t-tests revealed that all comparisons between the pre- and subsequent BCVA measurements were statistically significant. Primary graft failure was observed in 8% and the most common complication was graft detachment, which was observed in 10%.ConclusionUp to our knowledge, we reported the longest follow up of FS-UT-DSAEK in the literature. Our data showed an excellent survival rate and complication profile with no clear harmful effect on the endothelium from laser preparation. However, the visual outcomes in comparison to MK-UT-DSAEK still is questionable and needs to be addressed with randomized trials.
Evaluating choroidal biomarkers for cardiovascular risk prediction using the American Heart Associatiońs PREVENT score.
Remolí-Sargues L, Monferrer-Adsuara C, López-Salvador B … +3 more , López-Sánchez E, Francés-Muñoz E, Castro-Navarro V
Eur J Ophthalmol · 2026 May · PMID 41324978 · Publisher ↗
PurposeTo investigate the association between PREVENT, a cardiovascular disease (CVD) risk estimation model, and quantitative parameters derived from choroidal vascular imaging.MethodsWe conducted a retrospective study i...
PurposeTo investigate the association between PREVENT, a cardiovascular disease (CVD) risk estimation model, and quantitative parameters derived from choroidal vascular imaging.MethodsWe conducted a retrospective study including 82 eyes from 82 patients aged 30 to 79 years who attended a standard ophthalmologic evaluation. Choroidal vascularity index (CVI), total choroidal area (TCA), luminal choroidal area (LCA), stromal choroidal area (SCA), and vessel density (VD) in the choriocapillaris (CC) and mid choroid, measured using swept-source optical coherence tomography angiography (SS-OCTA), were recorded.ResultsTCA, LCA, and SCA were significantly lower in the high-risk group compared to the low-risk group ( value <0.001). Correlation analysis revealed a significant negative association between 10-year PREVENT scores and TCA, LCA, and SCA (r ≈ -0.350, value <0.001), and between the 30-year PREVENT score and VD in the CC (r = -0.370, value = 0.037).ConclusionThis study provides initial evidence that choroidal structural and vascular parameters are inversely associated with long-term cardiovascular risk, suggesting their potential utility in the primary prevention of CVD. Further longitudinal studies with larger sample sizes are warranted to confirm these findings.
Relationship between monocyte-to-lymphocyte ratio and age-related macular degeneration: Findings from a national cross-sectional study.
Cheng X, Lohmann T, Johnen S … +2 more , Walter P, Baumgarten S
Eur J Ophthalmol · 2026 May · PMID 41313467 · Full text
BackgroundRecent advances have revealed the important role of the immune system in the progression of age-related macular degeneration (AMD). Monocyte-to-lymphocyte ratio (MLR) is a combined marker reflecting inflammatio...
BackgroundRecent advances have revealed the important role of the immune system in the progression of age-related macular degeneration (AMD). Monocyte-to-lymphocyte ratio (MLR) is a combined marker reflecting inflammation status. However, research on the correlation between MLR and AMD is limited.MethodsIn this cross-sectional analysis, weighted multivariable logistic regression, multinomial logistic regression, subgroup analysis, smoothed curve fitting and threshold effect analysis were used to investigate the relationship between MLR and AMD based on data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES).ResultsThis study included data of 4,655 participants. The proportions of no AMD, early AMD and late AMD were 92.27%, 6.79% and 0.95%, respectively. After adjusting for covariates, weighted multivariable logistic regression analysis revealed that MLR was positively associated with AMD ( = 3.22, 95%CI 1.32-7.82). Threshold effect analysis revealed that higher MLR associated with prevalence of AMD after MLR was greater than 0.37 (OR = 8.93, 95%CI 2.53-31.60). The diagnostic performance of MLR > 0.37 for AMD was assessed using ROC curve analysis. In addition, MLR was proven to have a significant positive correlation with early AMD (OR = 1.20, 95%CI 1.19-1.21) and late AMD (OR = 9.21, 95%CI 9.10-9.31) through weighted multinomial logistic regression.ConclusionsOur study demonstrates that an elevated MLR is independently associated with the prevalence of AMD.
Clinical and pathological predictors of high risk histopathological features in retinoblastoma: Analysis of 236 eyes.
Naseripour M, Naseripour M, Fazel M … +5 more , Mansouri S, Fallahtafti P, Fadakar K, Faranoush M, Mirshahi R
Eur J Ophthalmol · 2026 May · PMID 41295972 · Publisher ↗
PurposeTo investigate the association between high-risk histopathological features (HRHFs) and clinical indicators in advanced retinoblastoma and to identify independent predictors of high-risk disease.MethodsThis single...
PurposeTo investigate the association between high-risk histopathological features (HRHFs) and clinical indicators in advanced retinoblastoma and to identify independent predictors of high-risk disease.MethodsThis single-center retrospective cohort study analyzed 236 enucleated eyes from patients with retinoblastoma treated at a tertiary referral center in Tehran, between 2001 and 2024. Clinical data and histopathological features were extracted. Eyes were classified into low-risk and high-risk groups based on HRHFs. Statistical analyses included univariate and multivariate logistic regression to identify factors independently associated with HRHFs.ResultsOf the 236 eyes, 58 (24.6%) demonstrated HRHFs. Patients with high-risk tumors were significantly older at diagnosis (31.9 ± 19.2 vs. 22.3 ± 18.9 months, p = 0.017) and enucleation (37.3 ± 24.8 vs. 26.6 ± 23.3 months, p = 0.009). In multivariate analysis, four variables remained independently associated with HRHFs: increasing age at enucleation (OR = 1.015; 95% CI: 1.001-1.029; p = 0.038), higher tumor height (OR = 1.171; 95% CI: 1.073-1.279; p < 0.001), iris neovascularization (OR = 60.12; 95% CI: 6.93-521; p < 0.001), and both exophytic endophytic growth pattern (OR = 11.92; 95% CI: 2.04-70.28; p = 0.006). Rosette subtype, growth pattern, and tumor necrosis were not independently predictive after adjustment.ConclusionsOlder age at enucleation, iris neovascularization, tumor height, and a combined exophytic endophytic tumor growth patterns are strong independent predictors of high-risk histopathologic features in retinoblastoma. Recognizing these indicators preoperatively may assist in risk stratification and guide treatment choices to enhance outcomes.
The effect of latanoprostene bunod on retinal vessel density in patients with primary open-angle glaucoma.
Ertan E, Aksöz P, Ermiş S … +2 more , Akbaş YB, Yıldırım Y
Eur J Ophthalmol · 2026 May · PMID 41236873 · Publisher ↗
PurposeThis study evaluates the efficacy of once-daily administration of 0.024% topical latanoprostene bunod (LBN) ophthalmic solution and its effects on macular vessel density (VD) in patients with primary open-angle gl...
PurposeThis study evaluates the efficacy of once-daily administration of 0.024% topical latanoprostene bunod (LBN) ophthalmic solution and its effects on macular vessel density (VD) in patients with primary open-angle glaucoma (POAG).MethodsA total of 86 eyes from 43 newly diagnosed POAG patients who had not received prior antiglaucoma treatment were included in this prospective study. Optical coherence tomography angiography (OCTA) was used to assess macular VD before and after LBN treatment. Changes in IOP and VD in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed.ResultsThe study included 43 patients (20 males, 23 females) with a mean age of 58.34 ± 15.28 years. After one month of LBN treatment, the mean IOP reduction was 8.3 mmHg, representing a 32.7% decrease. LBN significantly increased VD in both SCP and DCP, especially in the foveal and superior regions ( < 0.05). A positive correlation was observed between intraocular pressure (IOP) reduction and VD increase in these regions. No significant changes were noted in the temporal, inferior, or nasal regions.ConclusionLBN is an effective and well-tolerated treatment for IOP reduction in treatment-naïve POAG patients. It significantly increases macular VD, particularly in the foveal and superior regions, with VD changes correlating with IOP reduction. These vascular benefits likely result from nitric oxide (NO)-mediated microcirculatory improvements. Larger, long-term multicenter studies are needed to explore LBN's sustained vascular effects in glaucoma management.
The use of Delta wave hypnosis for reducing perioperative anxiety in cataract surgery: A prospective randomized controlled trial.
Haythem E, Eslem B, Imen N … +5 more , Eya BA, Asma K, Yassin O, Afef M, Iheb L
Eur J Ophthalmol · 2026 May · PMID 41217980 · Publisher ↗
PurposeTo evaluate the efficacy of delta-wave auditory hypnoanalgesia as an adjunct to regional anesthesia in reducing perioperative anxiety during cataract surgery.MethodsThis prospective, single-blind randomized contro...
PurposeTo evaluate the efficacy of delta-wave auditory hypnoanalgesia as an adjunct to regional anesthesia in reducing perioperative anxiety during cataract surgery.MethodsThis prospective, single-blind randomized controlled trial included 198 participants undergoing cataract surgery under locoregional anesthesia. Patients were randomized into a hypnoanalgesia group (H), which received delta-wave binaural beats, and a control group (T), which received no auditory intervention. Primary outcomes were changes in mean heart rate (HR), blood pressure, and anxiety levels. Secondary outcomes included pain perception (Numeric Rating Scale, NRS), bispectral index, and postoperative satisfaction.ResultsH group demonstrated significantly lower HR, systolic blood pressure (SBP), and mean arterial pressure (MAP), with a peak effect observed 20-25 min after device placement (SBP: = 0.041; MAP: < 0.001). APAIS anxiety scores were halved in the H group ( < 0.001). Pain scores were significantly lower in H group ( < 0.001 and = 0.018, respectively). Postoperative satisfaction scores were higher among patients, surgeons, and anesthesiologists in H group ( = 0.003, < 0.001, and < 0.001, respectively).ConclusionDelta-wave auditory hypnoanalgesia may be a potential non-pharmacological adjunct in ophthalmic surgery reducing perioperative anxiety, and enhancing patient satisfaction.
Clinical outcomes of bilateral implantation of a new non-diffractive extended-vision intraocular lens (AcrySof IQ vivity).
Costa C, Cortinhal T, Figueiredo I … +4 more , Silva M, Raimundo M, Quadrado MJ, Murta J
Eur J Ophthalmol · 2026 May · PMID 41212744 · Publisher ↗
PurposeTo report clinical (visual and refractive), spectacle independence, patient-reported outcomes following bilateral sequential implantation of a non-diffractive extended-vision intraocular lens (IOL): AcrySof IQ Viv...
PurposeTo report clinical (visual and refractive), spectacle independence, patient-reported outcomes following bilateral sequential implantation of a non-diffractive extended-vision intraocular lens (IOL): AcrySof IQ Vivity (DFT015 and DFTx15) in cataract surgery. This IOL provides continuous range of focus from distance to near, offering monofocal quality distance image and visual disturbances profile.MethodsRetrospective unmasked nonrandomized case series. Patients who underwent phacoemulsification and bilateral sequential implantation of AcrySof IQ Vivity, targeting minimonovision (nondominant eye targeted for between -0.25D and -0.50D). Clinical post-operative outcome measures were assessed 1-2 months postoperatively - binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity - 66 cm (UIVA), binocular uncorrected near visual acuity - 40 cm (UNVA), refraction, spherical equivalent (SE) and residual astigmatism (toric group). Spectacle independence and satisfaction systematic questionnaires (IOLSAT and Catquest-9SF) were performed. Visual disturbances were analyzed.Results181 patients were enrolled. 78 eyes were implanted with the DFTx15 (toric version). Binocular mean UDVA was -0.01 logMAR (± 0.05), binocular mean UIVA was 0.09 logMAR (± 0.08), binocular mean UNVA was 0.16 logMAR (± 0.12) and mean SE was -0.27D (± 0.36D). Mean residual astigmatism (toric group) was 0.3D (± 0.42D). Patient-reported outcomes for satisfaction and spectacle independence were excellent. Visual disturbances were rarely reported.ConclusionsImplanting this IOL using minimonovision strategy provides excellent binocular UDVA and UIVA, and good UNVA. It provides high patient satisfaction, spectacle independence (demonstrated excellent performance in systematic evaluations) and minimizes unwanted visual effects. Controlled designs and longer follow-ups are needed to confirm these findings.
Diagnostic accuracy of the non-compliance of the ISNT rule in glaucoma: Systematic review and meta-analysis.
Tello A, Vazquez E, Villamizar SJ … +4 more , Mejía-Salgado G, Duarte-Bueno LM, Acuña MF, Galvis V
Eur J Ophthalmol · 2026 Mar · PMID 41212675 · Publisher ↗
PurposeThis systematic review and meta-analysis evaluated the pooled diagnostic accuracy of the ISNT rule non-compliance in detecting glaucoma, considering diverse technique approaches.MethodsA comprehensive literature s...
PurposeThis systematic review and meta-analysis evaluated the pooled diagnostic accuracy of the ISNT rule non-compliance in detecting glaucoma, considering diverse technique approaches.MethodsA comprehensive literature search was conducted. The primary outcome was the pooled diagnostic accuracy of ISNT rule non-compliance, quantified through various tools. Secondary outcomes included subgroup comparisons based on approach type (neuroretinal rim [NRR] width versus recently described approaches), analysis method (original versus modified), measuring tool, anatomical site evaluated, ISNT rule definition, and the continent where the study was conducted. Risk of bias was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool.ResultsA total of twenty-two results derived from six distinct measurement approaches across eighteen studies were included. The pooled diagnostic accuracy estimates were for sensitivity, 0.83 (confidence interval [CI]:0.77-0.88); specificity, 0.49 (CI:0.35-0.63); positive likelihood ratio, 1.60 (CI:1.30-2.15); negative likelihood ratio, 0.37 (CI:0.27-0.49); and diagnostic odds ratio, 4.55 (CI:2.76-7.50). No statistically significant differences were found between subgroup comparisons, except for the specificity of the original method (0.72 [CI:0.67-0.77]), sensitivity of the modified method (0.85 [CI:0.78-0.90]), and sensitivity of the NRR (0.86 [CI:0.79-0.91]).ConclusionsThe ISNT rule presented a low specificity but a high sensitivity for glaucoma diagnosis and may be a useful tool for screening.
Sequential multimodal imaging of varicella-zoster virus-associated acute retinal necrosis: Insights supporting a neurotropic hypothesis.
Steptoe PJ, Ramalingam S, Dhillon B
Eur J Ophthalmol · 2026 Mar · PMID 41185897 · Full text
PurposeTo characterise the sequential macular changes using spectral-domain optical coherence tomography (SD-OCT) in acute retinal necrosis (ARN) and compare these with the von Szily model of neuronally transmitted herpe...
PurposeTo characterise the sequential macular changes using spectral-domain optical coherence tomography (SD-OCT) in acute retinal necrosis (ARN) and compare these with the von Szily model of neuronally transmitted herpetic retinitis.MethodsSingle-patient case study with serial SD-OCT imaging and analysis of aqueous humour varicella zoster virus (VZV) levels.ResultsA 30-year-old immunocompetent woman presented with 360° confluent peripheral retinal necrosis and scattered multifocal lesions in the right eye. VZV DNA was detected in the aqueous humour by polymerase chain reaction (PCR). At baseline, multiple radial retinal folds around the fovea were visible, appearing as sharp inner retinal undulations on SD-OCT. Numerous continuous and beaded vertical hyperreflective strips (VHRS) were present within the outer nuclear layer; in the parafovea, these followed the oblique course of the Henle fibre layer. By days 4-5, neurosensory detachments developed beneath VHRS, with subfoveal choroidal thickness peaking at day 9. Despite systemic and intravitreal antivirals, the right eye deteriorated to light perception, hypotony, and phthisis.ConclusionSequential macular SD-OCT in VZV-associated ARN revealed inner retinal undulations and vertical hyperreflective strips in the outer nuclear layer preceding neurosensory detachments. These observations may correspond to viral dissemination along neuronal pathways from the inner to outer retina, consistent with mechanisms described in animal models. Recognition of these imaging biomarkers could support early detection of macular involvement and improve understanding of ARN pathogenesis in humans.
Evaluating anxiety and depression levels in patients undergoing intravitreal injections and investigation of contributing factors.
Akçay G, Kutlutürk Karagöz I, Doğan Gökçe G
Eur J Ophthalmol · 2026 May · PMID 41182913 · Publisher ↗
PurposeTo evaluate anxiety and depression levels in patients receiving intravitreal injections for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO), and their associa...
PurposeTo evaluate anxiety and depression levels in patients receiving intravitreal injections for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO), and their associations with visual acuity, disease type, and demographic factors.MethodsThe study included 90 patients (43 males and 47 females) mean age 73.9 ± 12.4 years; (range: 22-92 years). Anxiety levels were assessed using the state anxiety form of the State-Trait Anxiety Inventory (STAI-S), and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Best-corrected visual acuity (BCVA) was recorded, and patients were evaluated according to disease type, severity of visual impairment, and number of injections.ResultsThe mean STAI-S score was 36.2 ± 8.9, and that of HADS was 13.9 ± 12.6. There were no significant differences in STAI-S scores between the disease groups ( = 0.17). However, HADS scores were significantly lower in the RVO group than in the DME and AMD groups ( = 0.02, = 0.04). A significant association was observed between severity of visual impairment and STAI-S scores ( = 0.016), with moderate visual impairment showing higher anxiety levels than mild and severe impairment ( = 0.07, = 0.02). However, HADS scores were not significantly associated with visual acuity ( = 0.058). Women exhibited higher HADS scores ( = 0.036). Neither injection frequency nor waiting time significantly affected STAI-S or HADS scores ( > 0.05).ConclusionPatients receiving intravitreal injections have varying levels of anxiety and depression, considering disease type, sex, and severity of visual impairment affecting these psychological parameters. These findings provide invaluable insights into the importance of psychological support in ophthalmic care.
Evaluation of conjunctival autograft reperfusion in pterygium surgery using anterior segment optical coherence tomography angiography (OCT-A).
Latifi G, Ghanbari H, Ghafarian S … +3 more , Masoumi A, Beheshtnejad AH, Pirzadeh M
Eur J Ophthalmol · 2026 May · PMID 41160502 · Publisher ↗
Purposeto sequentially study the healing response of conjunctival autografts (CAGs) using optical coherence tomography angiography (OCTA) in patients undergoing pterygium surgeryMethodsseventeen eyes of seventeen patient...
Purposeto sequentially study the healing response of conjunctival autografts (CAGs) using optical coherence tomography angiography (OCTA) in patients undergoing pterygium surgeryMethodsseventeen eyes of seventeen patients who underwent pterygium excision with CAG were included. OCTA was performed at 1 week, 2 weeks, and 4 weeks post-operatively. The vessels were assessed at two different depths: 1. From conjunctival epithelium to a depth of 200 µm 2. From a depth of 200 µm to a depth of 1000 µm.ResultsAll CAGs demonstrated swelling during the first week. Intragraft hemorrhage was observed in 15 eyes (88.2%). CAG vessels showed variable dilation and tortuosity at this time. Under-perfusion of the scleral bed was noted in areas that showed a gap between CAG and the edges of the conjunctiva. During the second week after surgery, fine vessels formed connections between CAG and conjunctiva. Early evidence of vascular remodeling of marginal corneal arcades (MCAs) was visible at this time point. In the fourth post-operative week, CAG vessels were more complex and homogenous. Reconstruction of MCAs occurred in 15 patients (88.2%). Vessels of the conjunctival bed were dragged toward the autograft.ConclusionOCTA of the anterior segment can be used reliably to assess healing response following pterygium excision with CAG. Episcleral vessels play a major role in the re-vascularization of CAG. The use of mitomycin C with conjunctival autografting does not significantly interfere with the natural reperfusion of the graft. Failure of MCA reconstruction might contribute to the recurrence of pterygium.
Ocular hypertension and glaucoma after penetrating keratoplasty.
Aygoren B, Yuksel B, Tuncay K … +2 more , Cikmazkara I, Icel E
Eur J Ophthalmol · 2026 May · PMID 41148177 · Publisher ↗
PurposeTo report the incidence of glaucoma or ocular hypertension after PK and to determine the risk factors and treatment outcomes.MethodsThe medical records of 381 eyes of 365 patients who underwent penetrating keratop...
PurposeTo report the incidence of glaucoma or ocular hypertension after PK and to determine the risk factors and treatment outcomes.MethodsThe medical records of 381 eyes of 365 patients who underwent penetrating keratoplasty were retrospectively reviewed. The recorded IOP values of the patients during the follow-up period were analyzed. Trabeculectomy was performed in cases of elevated IOP despite maximum medical treatment, and AGV implantation was performed in refractory cases.Results381 eyes of 365 patients, 223 (58.5%) male and 158 (41.5%) female, aged between 18-86 (mean 56.0 ± 18.0) were included in the study. The mean follow-up period was 12-126 months (mean 46.3 ± 28.6). During the follow-up period, post-PK OHT/glaucoma developed after PK in 179 eyes (47.0%). The mean development of OHT/glaucoma after PK was 6.3 ± 11.0 months. Postoperative follow-up IOP > 21 mmHg eye count was 177. The mean postoperative IOP values of these eyes were 27.0 ± 5.9 mmHg. Older recipient age (>50years), elevated preoperative IOP, history of glaucoma in the fellow eye,previous cataract surgery, donor-recipient trephine diameter mismatch otherthan 0.25 mm, larger donor trephine diameter, and additional intraoperative procedures-such as scleral fixation, intraocular lens implantation, anterior vitrectomy,and goniosynechiolysis-were identified as risk factors associated with glaucoma after penetrating keratoplasty.ConclusionsDetermining the risk factors that play a role in the development of OHT/glaucoma after PK, close follow-up of postoperative IOP elevations, and treatment if necessary can preserve visual function and graft transparency for a longer period of time.
Turning diabetic retinopathy telescreening into a multi-telescreening.
Perilli R, Mastropasqua R, Mastropasqua L
Eur J Ophthalmol · 2026 Mar · PMID 41144243 · Publisher ↗
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