Int Ophthalmol [JOURNAL]
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200 papers
Changing paediatric uveitis patterns in Italy: an eight-year experience from the Reggio Emilia Uveitis clinic.
Gentile P, Aldigeri R, Ceccarelli F … +15 more , Ragusa E, Li Calzi G, Bolletta E, De Simone L, Gozzi F, Adani C, Fastiggi M, Barchi L, Cappella M, De Fanti A, Neri A, Vecchi M, Nucci P, Nucci C, Cimino L
Int Ophthalmol · 2026 Feb · PMID 41636860 · Publisher ↗
PURPOSE: To determine the aetiological, clinical, and therapeutic features of children diagnosed with uveitis in a tertiary referral centre in Northern Italy. METHODS: Evaluation of medical data of all new paediatric (≤ ...
PURPOSE: To determine the aetiological, clinical, and therapeutic features of children diagnosed with uveitis in a tertiary referral centre in Northern Italy. METHODS: Evaluation of medical data of all new paediatric (≤ 16 years old) referrals to the Ocular Immunology Unit of Reggio Emilia (Northern Italy) between November 2015 and December 2023. An interdisciplinary diagnostic-therapeutic pathway-based approach was adopted for all patients. RESULTS: Among a pool of 263 patients, the male-to-female ratio was 1:1.32. Anterior uveitis was the most common diagnosis (45.2%), followed by pan-(23.6%), intermediate (16.7%), and posterior (14.5%) uveitis. The most identifiable specific diagnoses were juvenile idiopathic arthritis (JIA) (27.8%), Vogt-Koyanagi-Harada disease (8.7%), and toxoplasmosis (6.8%). Non-infectious systemic disease aetiologies were the most frequent (47.5%), followed by infectious uveitis (15.2%) and non-infectious ocular-specific conditions (2.7%). Idiopathic uveitis accounted for 34.6% of cases. Immunosuppressants were administered in 58.5% of patients. Antimetabolites, calcineurin inhibitors, and biologics were prescribed in 52.5%, 4.6% and 31.6% of cases, respectively. Methotrexate, adalimumab, and azathioprine were the most commonly prescribed immunosuppressants (29.3%, 26.6%, and 21.7% of patients, respectively). JIA-associated uveitis is the type most associated with surgical procedures (39.7%). CONCLUSIONS: The patterns of uveitis in children differ from those in adults, with infectious aetiologies being less common and idiopathic uveitis accounting for the majority of cases. However, the frequency of idiopathic uveitis in Italy is decreasing. Nowadays, a wide range of immunosuppressants are used for the treatment of paediatric uveitis.
Visual and anatomical outcomes of epiretinal membrane surgery across milder vs. severe stages: a retrospective longitudinal study.
Kunbaz A, Derin Sengun G, Sahin ZB … +7 more , Mahjoub AHM, Beyzade Z, Ucdag F, Durmus E, Esen F, Oguz H, Aykut V
Int Ophthalmol · 2026 Feb · PMID 41632388 · Publisher ↗
PURPOSE: Epiretinal membrane (ERM) is a common condition causing visual deterioration. However, the indication and timing for the surgical treatment of this condition have not been standardized. In this study we aimed to...
PURPOSE: Epiretinal membrane (ERM) is a common condition causing visual deterioration. However, the indication and timing for the surgical treatment of this condition have not been standardized. In this study we aimed to evaluate the anatomical and functional outcomes of mild vs severe epiretinal membrane surgery across different stages and determine the optimal timing for surgical intervention using Govetto's OCT-based classification. METHODS: This retrospective study included 46 eyes undergoing pars plana vitrectomy for ERM. Patients were stratified according to severity into Stage 2 (n = 10), Stage 3 (n = 25), and Stage 4 (n = 11) based on SD-OCT findings. Pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were analyzed. A short patient questionnaire was used to assess the subjective outcomes of the surgery. RESULTS: Stage 4 patients had significantly worse preoperative and postoperative BCVA compared to milder stages (p = 0.007). Structural OCT abnormalities such as ectopic inner foveal layers (EIFL), inner retinal irregularity (IRI), COST (cone outer segment tip) line defects and inner segment/outer segment (IS/OS) junction disruption were significantly more frequent in Stage 4. Stage 2 showed thinner CMT and significantly better visual outcomes postoperatively. Subjective visual improvement was most notable in Stage 3 (p = 0.032). CONCLUSIONS: ERM surgery in severe cases (stage 4) is associated with inferior anatomical and visual outcomes. Surgical intervention in milder cases particularly in stage 2, results in more favorable postoperative BCVA and reduced anatomical disruption. These findings support considering surgery in milder cases before the development of advanced OCT changes such as IS/OS disruption, EIFL and IRI.
Uveal melanoma survival prediction system: a multi-center database study.
Zhou CB, Zhu JY, Chen TT
Int Ophthalmol · 2026 Feb · PMID 41632384 · Publisher ↗
BACKGROUND: This study aimed to develop and validate a competing risk nomogram to predict overall survival (OS) in uveal Melanoma(UM) patients. METHODS: This study divided 14,688 UM patients from the SEER database from 2...
BACKGROUND: This study aimed to develop and validate a competing risk nomogram to predict overall survival (OS) in uveal Melanoma(UM) patients. METHODS: This study divided 14,688 UM patients from the SEER database from 2000 to 2020 into training cohorts and internal test cohorts after excluding cases with incomplete information. Univariate and multivariate cox regression analyses were used to identify potential risk factors for UM and construct the clinical predictive model nomogram. The predictive capacity was evaluated using calibration curves, receiver operating characteristic curves (ROCs), and decision curve analysis (DCA). RESULTS: A total of 4184 eligible patients were included for analysis, with 2929 cases (70%) in the training group and 1255 cases (30%) in the internal test group. Multivariable cox regression analysis confirmed six independent risk factors (chemotherapy, radiation, total number of malignant tumors, pathological type, grade, diagnostic confirmation). The nomogram demonstrated excellent discriminative ability, with AUCs in the training and internal test groups at 1 year, 3 years, and 5 years being 0.89 and 0.88, 0.93 and 0.93, 0.91 and 0.9, respectively. The calibration plot indicated that predictions based on the nomogram were well-matched to actual clinical practice, and the DCA plot showed good clinical utility for the nomogram. Additionally, Kaplan-Meier curve analysis indicated that, in both the train set and the test set, the high score group had significantly poorer survival outcomes than the low score group (P < 0.001). CONCLUSION: Employing the nomogram method for survival prognosis assessment in UM patients yields high accuracy. This can further enhance the precise evaluation of UM patient survival prognosis, providing guidance for personalized treatment.
Comparative efficacy and safety of phacoemulsification with intraocular lens implantation combined with goniosynechialysis versus phaco-trabeculectomy in primary angle-closure glaucoma with extensive peripheral anterior synechiae and cataract: a retrospective study.
Liu K, Xu H
Int Ophthalmol · 2026 Feb · PMID 41632359 · Publisher ↗
OBJECTIVE: To compare the efficacy and safety of phacoemulsification combined with goniosynechialysis versus phaco-trabeculectomy in patients with PACG complicated by cataract. METHODS: We conducted a retrospective analy...
OBJECTIVE: To compare the efficacy and safety of phacoemulsification combined with goniosynechialysis versus phaco-trabeculectomy in patients with PACG complicated by cataract. METHODS: We conducted a retrospective analysis of clinical data from 80 eyes of patients with PACG and cataract, treated at Jianhu County People's Hospital between January 2023 and January 2025. P Patients underwent either phacoemulsification plus goniosynechialysis (n = 40) or phacoemulsification plus trabeculectomy (n = 40). We measured ACD, ACA, IOP, and corneal astigmatism both preoperatively and at 12 months postoperatively. We also evaluated visual acuity outcomes and the incidence of postoperative complications. RESULTS: Baseline characteristics were comparable between groups. At 12 months post-surgery, two groups showed marked improvements in ACD and ACA, with a significant reduction in IOP compared to baseline (all P < 0.05). The goniosynechialysis group demonstrated a significantly greater increase in ACA (38.43° vs. 33.13°, P < 0.001) and better control of corneal astigmatism (1.18D vs. 2.31D, P < 0.001). The visual improvement rates were similar between groups (82.5% vs. 67.5%, P = 0.126). The incidence of postoperative complications was significantly lower in the goniosynechialysis group (7.5% vs. 27.5%, P = 0.019). CONCLUSION: In PACG patients with cataract and extensive PAS, phacoemulsification combined with goniosynechialysis achieved better anterior chamber angle opening, less postoperative astigmatism, and fewer complications than phaco-trabeculectomy, while providing comparable improvements in ACD, IOP, and visual outcomes at 12 months.
Molecular landscape connecting complications of dry eye disease: mechanisms, therapeutic targets, biomarkers, and future innovations.
Sen H, Durgapal S, Jakhmola V
Int Ophthalmol · 2026 Feb · PMID 41627595 · Publisher ↗
PURPOSE: This review paper is a sightseeing on the molecular pathways of the DED, which culminate in the cascades of inflammatory cytokines, apoptosis, oxidative stress, as well as the breakdown of homeostasis of the ocu...
PURPOSE: This review paper is a sightseeing on the molecular pathways of the DED, which culminate in the cascades of inflammatory cytokines, apoptosis, oxidative stress, as well as the breakdown of homeostasis of the ocular surface. The article also discusses complications, and it explains the connection between conjunctivitis, keratitis, corneal ulcers, blepharitis, dysfunction of meibomian glands, recurrent corneal erosion, ocular neuropathic pain, and accentuating the systemic effects of conditions, such as Sjögren syndrome. Within the directions of such molecular pathways, the article analyzes diagnostic biomarkers, as HLA-DR, MMP-9, cytokine profile, and innovations in technologies testing. Associating clinical exercise with the molecular frontier will add a new dimension to how we style, achieve, and eventually treat complications associated with DED. METHODS: Using PubMed, Scopus, Web of Science, and SpringerLink, an extensive appraisal of recent experimental and clinical literature was carried out. To offer mechanistic and translational understanding, studies explaining inflammatory signaling cascades, oxidative and mitochondrial stress, extracellular matrix remodeling, neurosensory changes, and immune-epithelial interaction in DED were assessed. RESULTS: Pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), dysregulated matrix metalloproteinases (MMP-2/9), oxidative stress-induced epithelial damage, and abnormal neuro-immune signaling mediated by substance P and calcitonin gene-related peptide are all closely linked molecular pathways that contribute to DED complications. Corneal epithelial fragility, poor regeneration, neurotrophic keratopathy, ulceration, secondary infection, and visual impairment are the results of these processes. Refined illness categorization and risk prediction are made possible by developments in molecular diagnostics, such as tear osmolarity, MMP-9, neurosensory biomarkers, and lipidomic and proteomic signatures. CONCLUSION: With the passage of research and progress in diagnosis with biomolecular science and technology, biomarkers such as MMP-9, lactoferrin, interleukin, and HLA-DR have brought the possibility of following the evolution, subtyping, and diagnosis of diseases. The recent revelations of the molecular biology of dry eye diseases raise the concern for a specific therapeutic approach that not only brings symptomatic relief but modulates molecular expressions as well. A vibrant combination of ophthalmology, pharmacology, immunology, bioengineering, and material sciences with regard to new therapeutic strategies and more refined delivery platforms. Such leveraging of molecular insight to provide specific interventions is needed clinically.
Tobacco smoking is not associated with primary open-angle glaucoma: a systematic review and meta-analysis.
Ramji S, Daniel S, Ansari AS … +3 more , Jackson TL, Alsaif A, Kailani O
Int Ophthalmol · 2026 Feb · PMID 41627566 · Full text
PURPOSE: This systematic review explores the relationship between tobacco smoking and the development of primary open-angle glaucoma (POAG). Glaucoma is the leading cause of irreversible blindness worldwide. Prior litera...
PURPOSE: This systematic review explores the relationship between tobacco smoking and the development of primary open-angle glaucoma (POAG). Glaucoma is the leading cause of irreversible blindness worldwide. Prior literature investigating the link between tobacco smoking and glaucoma has reported contradictory findings on the association between tobacco smoking and POAG. METHODS: Systematically EMBASE, MEDLINE, and Web of Science were searched, encompassing articles published up until April 2025. The inclusion criteria comprised observational and randomised controlled studies that provided a statistical analysis exploring the association between tobacco smoking and POAG in adult populations. The ROBINS-E tool was utilised to assess the risk of bias of studies and meta-analyses were completed using RevMan software. The main outcomes were effect estimates that measured the association between tobacco smoking and POAG. RESULTS: Across 26 eligible studies and 289,930 participants, there was a prevalence of 6,454 cases of POAG. The meta-analyses revealed that current smokers (OR = 1.00, 95%CI 0.76-1.33, p = 0.97, n = 11), past smokers (OR = 0.92, 95%CI 0.75-1.11, p = 0.38, n = 6) as well as both current and past tobacco smoking combined (OR = 1.00, 95%CI 0.84-1.19, p = 1.00, n = 17) exhibited no statistically significant association with POAG when compared to individuals who had never smoked. Heterogeneity ranged from low to substantial across comparisons, and risk of bias was frequently rated as high among included observational studies. The lack of an associative effect was sustained, on exclusion of studies with a high risk of bias. CONCLUSION: Although the results suggest no significant statistical association between tobacco smoking and POAG, given the substantial morbidity and mortality associated with tobacco smoking and the detrimental impact on systemic and ocular health, tobacco smoking cessation should remain at the forefront of health promotion. PROSPERO registration ID: CRD42023409440.
Shared diagnostic biomarkers and diagnostic models of age-related macular degeneration and systemic lupus erythematosus.
Cheng X, Zeng X, Liu S … +3 more , Liu C, Liu Y, Xu G
Int Ophthalmol · 2026 Feb · PMID 41627545 · Publisher ↗
PURPOSE: This study aimed to investigate the potential link between age-related macular degeneration (AMD) and systemic lupus erythematosus (SLE), exploring whether AMD may share underlying autoimmune mechanisms with SLE...
PURPOSE: This study aimed to investigate the potential link between age-related macular degeneration (AMD) and systemic lupus erythematosus (SLE), exploring whether AMD may share underlying autoimmune mechanisms with SLE. The objective was to identify shared core genes and potential diagnostic biomarkers for both diseases. METHODS: We utilized GEO datasets to develop diagnostic models and performed differential gene expression analysis, weighted gene co-expression network analysis (WGCNA), and three machine learning techniques-LASSO regression, random forest (RF), and support vector machine recursive feature elimination (SVM-RFE)-to identify common key genes between AMD and SLE. Mendelian randomization analysis was conducted to validate the potential causal relationship between AMD and the identified essential genes. Single-cell RNA sequencing data were analyzed to explore the expression patterns of shared biomarkers at the cellular level. The expression level of the identified biomarker was validated using reverse transcription quantitative polymerase chain reaction and Western blotting. RESULTS: Several shared core genes were identified as associated with both AMD and SLE. The Mendelian randomization study confirmed a potential correlation between AMD and these essential genes. Single-cell transcriptomic analysis revealed distinct expression profiles of these markers across relevant cell types, supporting their role in disease pathology. CONCLUSION: Our findings suggest that AMD and SLE share key genetic features, supporting the hypothesis that AMD may have an autoimmune component. These shared genes hold promise as potential therapeutic targets and diagnostic biomarkers for both diseases.
Effectiveness of orthokeratology in controlling myopia in adolescents aged 6-18 years: a systematic review and meta-analysis.
Dong X, Li W, Liu H
Int Ophthalmol · 2026 Jan · PMID 41619099 · Publisher ↗
BACKGROUND: Global childhood myopia is rising, with longer axial length increasing ocular risks. Orthokeratology corrects vision and may slow axial elongation via peripheral defocus, but the efficacy of newer OK lens des...
BACKGROUND: Global childhood myopia is rising, with longer axial length increasing ocular risks. Orthokeratology corrects vision and may slow axial elongation via peripheral defocus, but the efficacy of newer OK lens designs and long-term persistence of effect remain to be comprehensively evaluated. METHODS: Adhering to PROSPERO and PRISMA 2020, PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched through 18 April 2025. Included studies prospectively compared axial-length changes in children (6-18 years) with OK versus single-vision spectacles, soft contact lenses, or conventional OK. Hartung-Knapp-adjusted random-effects meta-analyses were performed, with subgroup, sensitivity, and leave-one-out analyses addressing heterogeneity. RESULTS: Fifteen trials (1,065 participants) met inclusion criteria. At 12 ± 2 months, OK slowed axial elongation by a pooled mean difference (MD) of - 0.15 mm (95% CI - 0.20 to - 0.10; I2 = 90.8%). Five studies with ≥ 24-month follow-up showed a sustained benefit (MD - 0.19 mm, - 0.32 to - 0.06; I2 = 79%). Four head-to-head trials suggested modified OK designs (e.g., smaller optical zones, higher compression factors) provided an additional - 0.12 mm (- 0.23 to - 0.01) at one year, after excluding one discordant soft-lens study. Funnel plots and Egger's tests indicated no small-study bias. Most studies had low risk of bias; limitations included lack of masking and predominantly East-Asian samples. CONCLUSIONS: Axial elongation in myopic children is reduced by approximately 0.15 mm in the first year with OK, and this effect persists for up to three years. Modified lens designs may offer additional benefit. Larger, multi-ethnic trials with long-term follow-up and standardised safety reporting are needed.
Safety and efficacy of various topical anesthesia for intravitreal injection: a randomized controlled trial.
Yahalomi T, Achiron A, Moscovici D … +7 more , Plopsky G, Cohen R, Braudo S, Kaplanov I, Katz M, Arnon R, Pikkel J
Int Ophthalmol · 2026 Jan · PMID 41619065 · Publisher ↗
PURPOSE: This study aimed to determine the efficacy of various types of topical anesthesia prior intravitreal injection in an effort to lessen adverse effects such as pain and subconjunctival bleeding. METHODS: This rand...
PURPOSE: This study aimed to determine the efficacy of various types of topical anesthesia prior intravitreal injection in an effort to lessen adverse effects such as pain and subconjunctival bleeding. METHODS: This randomized controlled study included 239 patients. All patients were randomly assigned to either receive: (1) Lidocaine gel 3% (Anaesthetic BL 3% gel), (2) Lidocaine gel 10% (Anaesthetic BL 10% gel), (3) Oxybuprocaine 0.4% eye drops (Localin), (4) Tetracaine HCl 1%, eye drops (Tetracaine) (5) A combined Oxybuprocaine 0.4% eye drops (Localin) and an ice patch. Patients' discomfort, itching, burning and pain (using Visual Analog Scale), and bleeding size (using images) were measured one and ten minutes post-injection. Tolerability was calculated by averaging patients' pain, discomfort, itching, and burning scores. RESULTS: In the one- and ten-minute post-injection analyses, the groups receiving Tetracaine (0.60 ± 0.63, 0.50 ± 0.61) and the combined Oxybuprocaine and ice patch anesthesia (0.55 ± 0.66, 0.38 ± 0.58) had the lowest mean tolerability scores. In most parameters (discomfort burning, and pain scores) the Tetracaine and the combined Oxybuprocaine and ice patch anesthesia demonstrated the lowest mean scores. All subjective criteria assessed by the surgeon immediately following the injection were not found to be significantly different at any group, such as movements during injection (p = 0.19), complaints during injection (p = 0.56), complaints following injection (p = 0.21). Bleeding size (area or circumference) was not statistical different between groups. CONCLUSION: This study demonstrated a considerable reduction in pain and overall tolerability with Tetracaine or a combination of ice patch and Oxybuprocaine anesthesia. These findings may lessen patients' discomfort and improve their tolerance.
GDPooled transformer: glaucoma detection using pooled attention based transformer with attention mechanism.
Bharathi VC, Shaik S
Int Ophthalmol · 2026 Jan · PMID 41619064 · Publisher ↗
Glaucoma is a common eye disease affecting several people worldwide. Blindness can be avoided with proper treatment and regular examination. Delayed diagnosis of eye disease causes serious damage to the optic nerve, resu...
Glaucoma is a common eye disease affecting several people worldwide. Blindness can be avoided with proper treatment and regular examination. Delayed diagnosis of eye disease causes serious damage to the optic nerve, resulting in loss of vision and blindness. As a result, early disease detection is crucial, and the current research has employed time-consuming machine-learning techniques. It is also difficult to detect eye diseases using computer-aided diagnostic systems because they rely on manually designed features to assess the disease. In order to detect glaucoma, the proposed work presented a novel hybrid deep learning-based GD Pooled Attention assisted Transformer model. The initial step in the proposed detection method is to remove noise and enhance the contrast of the fundus image from the databases using a cross-guided bilateral filter (Cr-GBF). The glaucoma-affected images are collected from ORIGA and RIMONE datasets. Glaucoma is primarily identified by structural deformation in the optic disc region. Thus, significant features are extracted from the images using improved channel spatial attention with AlterNet-K (Im-ChspAN), and disease detection is performed using the proposed Optimized hybrid GD pooled attention former (OpHGpoTr) model. The proposed model's performance is evaluated using the following metrics: accuracy of 98.68%, precision of 97.06%, sensitivity of 97.07%, specificity of 98.57%, and f-score of 98.31%. The classifier showed better performance than the existing studies.
Drug strategies for the treatment and prevention of proliferative vitreoretinopathy: an overview of innovative treatment concepts.
Luyken AK, Junge V, Schulz A … +2 more , Fuchsluger TA, Schaub F
Int Ophthalmol · 2026 Jan · PMID 41619046 · Full text
PURPOSE: To present an overview of emerging pharmacological strategies for the prevention and treatment of proliferative vitreoretinopathy (PVR). METHODS: This review critically examines recent experimental and clinical...
PURPOSE: To present an overview of emerging pharmacological strategies for the prevention and treatment of proliferative vitreoretinopathy (PVR). METHODS: This review critically examines recent experimental and clinical evidence on pharmacological agents targeting key pathogenic mechanisms of PVR, including epithelial-mesenchymal transition, profibrotic cytokine signaling (TGF-β, PDGF, VEGF), and inflammation-driven tissue remodeling. Investigated compounds include clinically tested substances such as daunorubicin, 5-fluorouracil, corticosteroids, anti-VEGF agents, methotrexate, isotretinoin, decorin and infliximab, as well as newer experimental approaches including Topotecan, Melphalan, ROCK-Inhibitors and gene-regulated therapies. Mechanistic insights into receptor crosstalk, intracellular signaling cascades, and cell survival pathways are integrated with findings from preclinical models and clinical studies. RESULTS: Several agents have shown anti-proliferative and anti-inflammatory effects in vitro and in vivo, with methotrexate and infliximab emerging as particularly promising candidates. However, clinical data remain heterogeneous, and no pharmacological agent has yet received regulatory approval for PVR treatment. Risk stratification based on preoperative PVR, vitreous hemorrhage, or ocular trauma may help optimize patient selection in future trials. CONCLUSION: Pharmacological modulation of PVR is conceptually well supported by preclinical data, but clinical translation remains limited. Well-designed randomized trials in clearly defined high-risk populations are needed to validate efficacy, determine optimal treatment windows, and develop standardized protocols for both prophylaxis and therapy.
Sustainability in vitreoretinal surgery: environmental impact and carbon emission reduction strategies.
Kiyat P, Degirmenci C, Nalcaci S … +1 more , Palamar M
Int Ophthalmol · 2026 Jan · PMID 41619024 · Publisher ↗
PURPOSE: To analyze environmental sustainability in vitreoretinal surgery and evaluate evidence-based strategies for reducing carbon footprint while maintaining optimal patient outcomes. METHODS: Literature review using...
PURPOSE: To analyze environmental sustainability in vitreoretinal surgery and evaluate evidence-based strategies for reducing carbon footprint while maintaining optimal patient outcomes. METHODS: Literature review using PubMed and Google Scholar databases focusing on vitreoretinal surgery's environmental impact and sustainable practices. RESULTS: Vitreoretinal surgery generates significant carbon emissions through disposable equipment, building energy consumption, and tamponade gas utilization. Fluorinated gases represent the most environmentally damaging component, with SF₆ demonstrating 22,800 times greater global warming potential than CO₂. Despite being used in only 38.6% of procedures, SF₆ was responsible for 68.8% of total emissions in vitreoretinal surgery, demonstrating a 4.4-fold greater environmental impact compared to C₂F₆. Air tamponade offers up to 47% emission reductions for appropriate cases, while alternative gas selection achieves 50% reductions when longer-acting tamponades are necessary. Energy optimization protocols, waste segregation improvements, and packaging modifications provide additional reduction opportunities. CONCLUSION: Sustainable vitreoretinal surgery is feasible through evidence-based strategies that significantly reduce environmental impact without compromising patient safety. Key interventions include implementing air tamponade for appropriate cases and selecting alternative fluorinated gases with lower environmental impact. Implementation requires addressing regulatory barriers and cultural resistance through education programs and policy reform. The specialty should adopt the "5 R" framework for sustainable practice.
Visual rehabilitation with scleral lenses after open globe injury repair.
Biberoğlu Çelik E, Ozkan G, Şahin Ö … +1 more , Akkaya Turhan S
Int Ophthalmol · 2026 Jan · PMID 41615530 · Publisher ↗
PURPOSE: To evaluate the visual outcomes with scleral lens (SL) wear in patients who have undergone surgical repair for open globe injuries (OGI). METHODS: The medical records of patients with a history of OGI at the Dep...
PURPOSE: To evaluate the visual outcomes with scleral lens (SL) wear in patients who have undergone surgical repair for open globe injuries (OGI). METHODS: The medical records of patients with a history of OGI at the Department of Ophthalmology, Marmara University School of Medicine, between 2017 and 2023 were retrospectively reviewed. Eleven patients (8 male, 3 female) with corneal scar and/or irregular corneal astigmatism, and intolerance to corneal rigid lenses (CRLs) were included in the study. Demographics, type and extent of injury were assessed. Best corrected visual acuity (BCVA) before SL trial and with SLs wear were measured. RESULTS: The median age of the patients was 40.0 years (IQR, 24-42). The patients were followed up for a median duration of 22.0 months (IQR, 17-59) months. Central scarring was observed in 45.5% of cases, and paracentral scarring in 54.5% of cases. Aphakic correction was performed in one patient. The median BCVA improved from 0.50 (logMAR) to 0.10 (logMAR) after SL wear (p = 0.003). CONCLUSIONS: The significant improvement in BCVA observed after SL wear indicates that SLs are an effective option for visual rehabilitation in patients with corneal scarring and irregular astigmatism following OGI repair.
Bilateral implantation of extended depth of focus intraocular lens in patients with early or intermediate age-related macular degeneration.
Ciarmatori N, Cartabellotta A, Adamo GG … +4 more , Biffi C, Talli PM, Pellegrini M, Mura M
Int Ophthalmol · 2026 Jan · PMID 41615526 · Full text
PURPOSE: To evaluate the visual outcomes, dysphotopsia profile, and patient satisfaction following bilateral implantation of the AcrySof IQ Vivity intraocular lens (IOL) in patients with early or intermediate age-related...
PURPOSE: To evaluate the visual outcomes, dysphotopsia profile, and patient satisfaction following bilateral implantation of the AcrySof IQ Vivity intraocular lens (IOL) in patients with early or intermediate age-related macular degeneration (AMD). METHODS: Prospective, single-center study. 24 patients (48 eyes) with bilateral cataract and early or intermediate AMD who underwent bilateral implantation of the AcrySof IQ Vivity IOL. The primary outcome was monocular corrected distance visual acuity (mCDVA). Secondary endpoints were distance-corrected and unaided monocular and binocular visual acuity at 4 m, 66 cm, and 40 cm, monocular defocus curve, subjective dysphotopsia (McAlinden QoV questionnaire) and haloes perception (Aston Halometer), visual function (Catquest-9SF), and spectacle independence (IOLSAT). RESULTS: At 3 months postoperatively, mCDVA improved significantly from 0.30 to 0.00 logMAR (p < 0.001). Binocular uncorrected distance and intermediate visual acuities of ≤ 0.2 logMAR were achieved by 23 (95.8%) and 17 (70.8%) patients, respectively. The defocus curve showed visual acuity of 0.2 logMAR across a range of + 1.40 D to -1.72 D. Bothersome dysphotopsias significantly decreased, with QoV scores improving from 58.5 (IQR: 26.1-66.5) to 0.00 (IQR: 0.00-14.3) (p < 0.05). The mean halo eccentricity was 0.50 ± 0.08 degrees. Spectacle independence was reported by 22 (91.7%), 20 (83.3%), and 13 (54.2%) patients for distance, intermediate, and near tasks, respectively. Overall, 22 (91.7%) patients reported postoperative satisfaction. CONCLUSION: The AcrySof IQ Vivity IOL demonstrated favourable outcomes in patients with early or intermediate AMD, offering a meaningful range of spectacle-free vision with minimal photic phenomena.
Effects on anterior chamber stability during the capsulorhexis using utrata forceps vs. a bent 26G cannula.
Handzel DM, Sekundo W, Abdallah CB … +1 more , Ladewig MS
Int Ophthalmol · 2026 Jan · PMID 41615516 · Publisher ↗
PURPOSE: Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the ant...
PURPOSE: Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the anterior chamber using intraoperative rebound tonometry. METHODS: The study included 261 eyes allocated to six groups according to three ophthalmic viscoelastic device (OVD) conditions-hyaluronic acid (HA), hydroxypropylmethylcellulose (HPMC), and their combination via the soft-shell technique (SST)-and two instruments (Utrata forceps UF and a 26-G cystotome RN). Intraocular pressure (IOP) was measured before and after CCC using rebound tonometry with sterilized probes. RESULTS: IOP reached 78.6 mmHg in the RN group and 76.5 mmHg in the UF group after OVD instillation and after the creation of the CCC. The mean IOP drop during capsulorhexis was significantly greater with UF (67.1 ± 12.3 mmHg; n = 117) compared to RN (56.5 ± 11.6 mmHg; n = 144) (P < 0.001). CONCLUSION: The results of this study showed a statistically significant difference in the stability of the anterior chamber depending on the instrument used. The use of different OVDs had no statistically significant influence on anterior chamber stability. Maintaining a more stable IOP with a 26-gauge cystotome may be advantageous in complex cases, such as increased posterior vitreous pressure, zonular weakness or heightened intracapsular pressure.
The impact of obstructive sleep apnea syndrome on corneal sensitivity and dry eye parameters: a comprehensive analysis.
Durmuş E, Ersoy EE, Güneş MÇ … +4 more , Davas M, Beyca CC, İçten S, Oğuz H
Int Ophthalmol · 2026 Jan · PMID 41609935 · Publisher ↗
PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder involving recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, oxidative stress, and systemic inflammation. Althoug...
PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder involving recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, oxidative stress, and systemic inflammation. Although OSAS has been linked to several ocular disorders, its specific impact on ocular surface health, particularly in relation to dry eye disease (DED) and corneal sensitivity, is not fully understood. This study aimed to assess how OSAS severity influences dry eye parameters and corneal sensitivity, and to explore associations with systemic and demographic factors. METHODS: In this cross-sectional study, 174 patients diagnosed with OSAS via overnight polysomnography were divided into normal-mild OSAS and moderate-severe OSAS groups. Ocular surface assessments included non-invasive tear break-up time (NIBUT), Schirmer II test (ST), Ocular Surface Disease Index (OSDI), and corneal sensitivity measured in five corneal regions using a Cochet-Bonnet esthesiometer. Statistical analyses involved group comparisons, correlation assessments, and multivariable linear regression to identify predictors of dry eye parameters. RESULTS: Moderate-severe OSAS (AHI ≥ 15; n = 85) patients were older, had higher BMI, and lower minimum oxygen saturation (p < 0.001). No significant differences were observed between groups in NIBUT, ST, or regional corneal sensitivity. Interestingly, OSDI scores were lower in the moderate-severe group, nearing statistical significance (p = 0.055). ST was positively correlated with corneal sensitivity (r = 0.22-0.26), whereas OSDI was negatively correlated (r = - 0.14- - 0.18). Regression analyses identified age and smoking as significant predictors of NIBUT, and gender and oxygen saturation as predictors of OSDI. CONCLUSIONS: Although OSAS severity did not significantly affect objective dry eye measures or corneal sensitivity, subtle associations between tear production and corneal nerve function suggest possible subclinical ocular changes. Routine eye evaluations may benefit OSAS patients, especially those with risk factors like aging, smoking, and hypoxemia.
Awareness and care journey of Glaucoma patients attending three referral hospitals in South-East Nigeria: Implications for public health intervention.
Onyia O, Achigbu E, Ejiakor I … +7 more , Uche N, Onyia K, Emeonye A, Ogbonnaya C, Chuka-Okosa CM, Bunce C, Bascaran C
Int Ophthalmol · 2026 Jan · PMID 41609923 · Publisher ↗
INTRODUCTION: Glaucoma, the primary cause of permanent blindness, occurs frequently, progresses aggressively, and more challenging to treat among Blacks. In South-East Nigeria, Igbos who have ancestral ties to blacks in...
INTRODUCTION: Glaucoma, the primary cause of permanent blindness, occurs frequently, progresses aggressively, and more challenging to treat among Blacks. In South-East Nigeria, Igbos who have ancestral ties to blacks in the Barbados eye study are more likely to have primary open-angle glaucoma and are at risk of blindness. This study aims to evaluate glaucoma patients' awareness, care-seeking pathway and identify policy areas for planning and advocacy. METHOD: This cross-sectional survey was performed at three referral ophthalmology facilities. 303 eligible and consented participants were enrolled. Data collected with semi-structured researcher-administered questionnaire were imported into Stata v15.0. Charts and maps were used for descriptive percentages and proportions. At p-value < 0.05, statistically significant risks were determined using multiple logistic regression models. RESULTS: Over half of the participants (56.6%; 87/151) who had heard of glaucoma before diagnosis were early presenters. Social interactions between friends and family (57%), mass media-radio, television and print (31%) and internet (4%) were the three most common ways that participants learned about glaucoma. Fifty-one percent who presented late had been previously screened for glaucoma; a greater percentage of them spent more time visiting a spiritual home, optical store, or traditional healer compared to those who presented earlier. Basic literacy (0.18: CI 0.07-0.47) and the ability to pay rent (0.52: CI 0.31 - 0.91) were socio-economic factors independently associated with lower odds of presenting late to the glaucoma referral facility. CONCLUSION: Glaucoma awareness was linked to early presentation, although delays persist due to reliance on non-medical providers. Predictors of timely presentation suggest that socioeconomic empowerment may be a crucial lever for improving glaucoma health-seeking behaviour.
The existence of puckering in the retina beyond the macula: a prospective analysis.
Mukhtar A, Gad RE, Syrrou A … +5 more , Owda A, Karani R, Lin JM, İnam O, Tezel TH
Int Ophthalmol · 2026 Jan · PMID 41609905 · Publisher ↗
PURPOSE: To examine the existence of idiopathic epiretinal membranes (ERM) in the peripheral retina in patients with or without macular pucker. METHODS: The presence of the peripheral idiopathic epiretinal membranes was...
PURPOSE: To examine the existence of idiopathic epiretinal membranes (ERM) in the peripheral retina in patients with or without macular pucker. METHODS: The presence of the peripheral idiopathic epiretinal membranes was sought using 200-degree widefield OCT (OPTOS Silverstone Swept source-OCT (SS-OCT) in two age, sex, and ocular comorbidities-matched groups consisting of 38 patients (24 with macular ERM and 14 without macular ERM). The significance of the correlation between the presence of macular and peripheral ERM was determined using Fisher's exact test and unpaired t-test. RESULTS: Seven out of 24 patients (29%) with idiopathic macular ERM had a peripheral ERM. In contrast, none of the patients without macular ERM had a peripheral ERM. Individuals with a history of idiopathic macular ERM showed a significantly higher incidence of idiopathic peripheral ERM (p = 0.03). CONCLUSIONS: Peripheral idiopathic ERM can be found in patients with macular ERM. All eyes with peripheral ERM were found in eyes with macular ERM. No patient was found to have a peripheral ERM unless a macular ERM was present. The macula seems more predisposed to developing an epiretinal membrane than the peripheral retina. A relatively higher density of Müller cells and tighter vitreoretinal attachments may predispose the posterior pole to idiopathic ERM development.
Critical limits for early detection of glaucoma, the Uppsala Glaucoma Detection Study (UGDS).
Kisonaite K, Tümer T, Alm A … +2 more , Nuija E, Yu Z
Int Ophthalmol · 2026 Jan · PMID 41609881 · Full text
The current study aimed to optimize the measurement design for each quantity of interest, determine critical limits for clinically distinguishing glaucoma-suspect eyes from non-suspect eyes in the UGDS using the optimize...
The current study aimed to optimize the measurement design for each quantity of interest, determine critical limits for clinically distinguishing glaucoma-suspect eyes from non-suspect eyes in the UGDS using the optimized design, and compare the efficiency of the measured quantities in estimating sensitivity METHODS: Data from non-glaucoma suspect eyes in the UGDS were analyzed for age and sex dependence, sources of variation, frequency distribution, and assessment of critical limits for glaucoma detection. Critical limit was defined as the extreme 95% confidence limit for the 95% one-sided tolerance. Intraocular pressure (IOP) and visual field contract sensitivity (Mean Deviation, MD), linear cup-to-disc ratio (C/D-linear), neuro-retinal rim area (NRA), nerve fiber layer thickness (cpRNFLT-Global and GDx-TSNIT) were examined RESULTS: Analysis revealed no significant age or sex dependence for the measured quantities. Variability among subjects was found to dominate, affecting the precision of measurements. Frequency distributions approximated normal distributions, enabling the estimation of tolerance limits for critical assessment. The critical limits to distinguish pathological from non-pathological were estimated as 22 mmHg, -3.7 dB, 0.84, 0.6 mm, 56 µm and 33 µm for IOP, MD, C/D-linear, NRA, cpRNFLT-Global and GDx-TSNIT respectively CONCLUSION: It appears preferable to estimate critical limits for small samples using the extreme confidence limit of the tolerance limit. The critical limits obtained here are consistent with previously reported values for the same device models. C/D-linear and NRA-Global metrics estimated with HRT show lower sensitivity-estimation efficiency compared with the other parameters assessed. Individualized intra-patient critical limits require a small increase of the measured quantity to identify glaucoma in the patient who has the disease.
Peripapillary intervortex venous anastomoses in central serous chorioretinopathy.
Maltsev DS, Kulikov AN, Kalinicheva YA … +1 more , Chhablani J
Int Ophthalmol · 2026 Jan · PMID 41609874 · Publisher ↗
AIM: To assess peripapillary intervortex venous anastomoses in patients with central serous chorioretinopathy (CSCR) and in healthy individuals and its association with the clinical characteristics of CSCR. METHODS: All...
AIM: To assess peripapillary intervortex venous anastomoses in patients with central serous chorioretinopathy (CSCR) and in healthy individuals and its association with the clinical characteristics of CSCR. METHODS: All participants received multimodal imaging, including a 12-mm optical coherence tomography angiography (OCTA) scan pattern centered on the optic disc for assessment of intervortex venous anastomoses in en face mode. Index of Vortex Anastomoses Number (IVAN) was defined as the number of quadrants of the peripapillary area with apparent vascular connectivity between neighboring quadrants of the eye fundus. IVAN was assessed in accordance with conventional and multimodal-based classifications of CSCR, as well as with laterality of the disease, its course, best-corrected visual acuity, subfoveal choroidal thickness, and central retinal thickness. RESULTS: One hundred twenty eyes of 60 CSCR patients (46 males (76.7%), 41.7 ± 7.9 years) and 47 eyes of 47 healthy individuals (36 males (76.6%), 42.2 ± 11.8 years) were included. IVAN was higher in chronic CSCR (median 4.0) compared to acute CSCR (median 2.0), and in chronic and acute CSCR compared to healthy eyes (median 1.0) (p < 0.001). IVAN was higher in the eyes of patients with bilateral CSCR (median 4.0), than in the active eye of unilateral CSCR patients (median 2.0) (p = 0.0002). The area of retinal pigment epithelium alteration and subfoveal choroidal thickness showed a statistically significant correlation with IVAN (r = 0.45, p < 0.001 and r = 0.35, p = 0.006). CONCLUSION: Semiquantitative analysis of intervortex venous anastomoses in peripapillary area based on en face OCTA showed their variable prevalence in eyes with CSCR, which correlates with clinical classifications of CSCR.
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