Int Ophthalmol [JOURNAL]
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200 papers
Results of adjunctive homogenate amniotic membrane eye drops in the management of refractory ocular surface disease with dry eye manifestations.
Bonacci E, Fasolo A, Biondan E … +6 more , Trojan D, Ferrari S, Montagner G, Barabino S, Di Zazzo A, Pedrotti E
Int Ophthalmol · 2026 Jun · PMID 42274910 · Publisher ↗
PURPOSE: To evaluate clinical outcomes of adjunctive treatment with homogenate human amniotic membrane eye drops (AMED) in patients with refractory ocular surface disease with dry eye (DE) manifestations. METHODS: We ret...
PURPOSE: To evaluate clinical outcomes of adjunctive treatment with homogenate human amniotic membrane eye drops (AMED) in patients with refractory ocular surface disease with dry eye (DE) manifestations. METHODS: We retrospectively reviewed patients' medical records, ocular surface images, and instrumental data related to Schirmer I test, Oxford and Efron grading, non-invasive tear break-up time, Ocular Surface Disease Index (OSDI), adverse events, and symptom recurrence after discontinuation. All patients were assessed for safety while the efficacy analysis included patients who completed 2-month uninterrupted AMED treatment, without modification of topical or systemic therapy in the previous two months or during the treatment period. RESULTS: A total of 160 patients were exposed to AMED. Twenty-three (14.4%) patients discontinued treatment and 25 (15.6%) showed adverse events. 112 (70%) patients [mean (SD) age 57 (16) years], 73.0% female, were included in the efficacy analysis. We observed improvement in corneal Oxford grading in graft-versus-host disease (GVHD) and limbal stem cell deficiency (LSCD) patients (P < 0.001 and P = 0.02, respectively) and conjunctival Oxford grading in GVHD, LSCD, Sjögren's syndrome (SS) and non-Sjögren's dry eye (NSDE) (P < 0.001); decreasing in Efron score in GVHD and SS (P < 0.001 and P = 0.03, respectively). Tear film stability improved across almost all groups and OSDI showed clinically modest changes. Symptoms recurrence was reported in 86.9% of patients within one month after AMED discontinuation without adverse events reported during 2-month continuous treatment. CONCLUSIONS: Adjunctive AMED treatment was associated with objective improvements of ocular surface, with limited effects on symptoms, likely reflecting the multifactorial nature of DE manifestations across clinically and pathophysiological distinct entities.
Evaluation of corneal morphology, pupillometry, and ocular surface parameters in Fabry disease patients: correlation with plasma Lyso-Gb3 levels.
Dal A, Kutluksaman B, Akikol T … +3 more , Erdağ M, Canleblebici M, Turgut FH
Int Ophthalmol · 2026 Jun · PMID 42274905 · Publisher ↗
BACKGROUND: Fabry disease is an X-linked lysosomal storage disorder characterized by systemic glycosphingolipid accumulation that may disrupt endothelial and neuronal integrity, leading to autonomic and ocular involvemen...
BACKGROUND: Fabry disease is an X-linked lysosomal storage disorder characterized by systemic glycosphingolipid accumulation that may disrupt endothelial and neuronal integrity, leading to autonomic and ocular involvement. Non-invasive ocular imaging may offer early diagnostic biomarkers reflecting systemic disease activity. This study aimed to evaluate autonomic, ocular surface, and corneal morphological parameters in patients with Fabry disease (FD) and explore their correlations with plasma Lyso-Gb3 concentrations. METHODS: In this prospective cross-sectional study, 25 eyes of genetically confirmed FD patients and 25 age-and sex-matched healthy controls were examined. All participants underwent dynamic pupillometry, non-contact tear break-up time, Schirmer I testing, meibography, and anterior-segment optical coherence tomography (AS-OCT) to quantify corneal epithelial thickness. Plasma Lyso-Gb3 levels were available for 14 patients. Group comparisons were performed using Mann-Whitney U and t-tests, and correlations were assessed via Spearman analysis. RESULTS: Static pupil diameters were wider in Fabry patients under all light conditions, though not significantly (p > 0.05). Maximal Redilation Velocity (MRV) was significantly reduced in patients with FD (p = 0.015), possibly indicating sympathetic dysfunction. Peripheral (5-7 mm) corneal epithelial thickness was significantly thinner in patients with FD (p = 0.031). Lyso-Gb3 concentrations exhibited moderate, statistically significant negative correlations with epithelial thickness across all zones (central r = - 0.659, paracentral r = - 0.638, peripheral r = - 0.607; all p < 0.05). No significant associations were found between Lyso-Gb3 and pupillometric or ocular-surface parameters (p > 0.05). CONCLUSION: Fabry disease involves subclinical ocular autonomic and structural alterations, reflected by reduced MRV and peripheral epithelial thinning correlated with biochemical disease load. Dynamic pupillometry and AS-OCT-based epithelial mapping may serve as complementary, non-invasive biomarkers for early diagnosis and monitoring of Fabry-related ocular involvement.
Video-based evaluation of cataract surgery and intraoperative complications: a single surgeon's 12-year experience.
Akarsu Acar OP, Gonen T
Int Ophthalmol · 2026 Jun · PMID 42274844 · Publisher ↗
PURPOSE: To evaluate the intraoperative complications of cataract surgeries, identify their independent risk factors, and determine how complication rates evolve over time by reviewing surgical videos, considering both t...
PURPOSE: To evaluate the intraoperative complications of cataract surgeries, identify their independent risk factors, and determine how complication rates evolve over time by reviewing surgical videos, considering both the surgeon's experience and baseline patient characteristics. METHODS: This retrospective, cross-sectional study evaluated 523 high-quality cataract surgery videos (selected from 1770) performed by a single surgeon with over five years of baseline experience. Videos were divided into group 1 (2010-2017, n = 274) and group 2 (2018-2022, n = 249). Patient cooperation, intraoperative complications, and specific preceding surgical steps were analyzed via video. Cataract grading and pupil diameter were obtained from patient files and video recordings. Univariate and multivariate logistic regression analyses were performed. RESULTS: Univariate analysis showed complication rates (p = 0.026), cataract hardness (p = 0.002), and accompanying ocular findings (p = 0.009) were significantly higher in group 1. Patient cooperation was significantly lower in eyes with complications in group 1 (p = 0.003). Multivariate regression analysis revealed that only poor patient cooperation (OR = 4.862, 95% CI 741-13.579, p = 0.003) and higher nucleus grade (OR = 5.510, 95% CI 1.258-24.134, p = 0.024) were significant independent predictors of intraoperative complications. CONCLUSION: Patient cooperation and cataract hardness are the primary independent predictors of surgical safety. It is crucial that high-risk cases are carefully pre-assessed and operated on by experienced surgeons equipped with advanced crisis management strategies. High-quality surgical video recordings provide analytically indispensable insights, proving highly beneficial for both postoperative case review and the training of resident physicians.
Use of electronic health records to examine margin-to-reflex distance in patients without eyelid conditions affecting position.
Zhou JW, Kalaw FGP, Saseendrakumar BR … +4 more , Baxter SL, Liu CY, Korn BS, Kikkawa DO
Int Ophthalmol · 2026 Jun · PMID 42262631 · Full text
PURPOSE: To characterize reference margin-to-reflex distance 1 (MRD1) measurements across different demographic factors, age, sex, race, and ethnicity, using a large electronic health record-derived (EHR) dataset. METHOD...
PURPOSE: To characterize reference margin-to-reflex distance 1 (MRD1) measurements across different demographic factors, age, sex, race, and ethnicity, using a large electronic health record-derived (EHR) dataset. METHODS: This was a single-institution observational, cross-sectional study of adult patients seen in an academic oculoplastics division from October 2018 to June 2023. MRD1 values were extracted from structured data fields and free-text progress notes. Patients with diagnoses known to affect MRD1 (e.g. dermatochalasis, ptosis) were excluded from the study. Univariate analysis was conducted using one-way ANOVA and post hoc testing, while multivariable analysis testing was done through a linear mixed-effects regression model. RESULTS: A total of 6231 patients and 11,932 reference MRD1 values were analyzed. MRD1 decreased by approximately 0.2 mm (mm) per decade of life (p < 0.001). Female sex was associated with higher MRD1 measurements (3.38 vs 3.003, p < 0.001), while Asian race was associated with lower MRD1 values (2.99 vs 3.32, p < 0.001). CONCLUSIONS: MRD1 values vary significantly by age, sex, and race. These findings provide reference values for MRD1 within a clinical oculoplastics population accounting for demographic factors.
Uveitis-glaucoma-hyphema syndrome after secondary intraocular lens implantation: incidence and clinical features in a real-world cohort.
Calleja-Casado F, Ruiz Del Río N, García-Ibor F … +3 more , Hernández Pérez D, Obiol Ferrando S, Samper AD
Int Ophthalmol · 2026 Jun · PMID 42258065 · Publisher ↗
PURPOSE: To evaluate the incidence and clinical characteristics of uveitis-glaucoma-hyphema (UGH) syndrome after secondary intraocular lens (IOL) implantation and to assess its distribution according to fixation approach...
PURPOSE: To evaluate the incidence and clinical characteristics of uveitis-glaucoma-hyphema (UGH) syndrome after secondary intraocular lens (IOL) implantation and to assess its distribution according to fixation approach. METHODS: This retrospective cohort study included patients undergoing secondary IOL implantation without capsular support between May 2018 and February 2025 at a tertiary referral centre. 0000-0002-0367-1446 Eyes received scleral-sutured posterior chamber IOLs (n = 33) or retropupillary iris-claw IOLs (n = 44), with technique selection based on ocular anatomy. Eyes with pre-existing uveitis were excluded. UGH syndrome diagnosis required imaging confirmation of IOL-uveal contact by anterior segment OCT (Anterion®, Heidelberg Engineering), performed as part of the institutional protocol in all suspected cases. UGH syndrome was classified as complete or incomplete using predefined clinical criteria. Analyses were descriptive and unadjusted. RESULTS: UGH developed in 14 of 77 eyes (18.2%). Incidence was higher in the scleral-sutured group (12/33, 36.4%) than in the iris-claw group (2/44, 4.5%) (Fisher exact test, p = 0.0006), with an unadjusted risk ratio of 8.0 (95% CI 1.9-33.3). Most cases were managed medically; two required surgical intervention: one IOL exchange and one IOL removal leaving the eye aphakic due to extensive macular atrophy. No eye suffered permanent vision loss directly attributable to UGH syndrome. Thirteen of 14 cases occurred in left eyes. CONCLUSIONS: In this real-world cohort, UGH occurred predominantly in anatomically high-risk eyes undergoing scleral-sutured fixation. These findings suggest a potential interaction between baseline ocular vulnerability and fixation technique, underscoring the importance of individualized surgical planning and postoperative monitoring.
A randomized controlled trial comparing limbal-conjunctival autograft with conjunctival autograft in recurrent pterygium surgery with intraoperative application of 0.02% mitomycin C.
Peng W, Wang C, Gong X … +5 more , Zheng Z, Yu K, Zhou T, Pi J, Zhou S
Int Ophthalmol · 2026 Jun · PMID 42257741 · Publisher ↗
OBJECTIVES: To compare the outcomes of conjunctival graft (CAG) versus limbal-conjunctival autograft (LCAG) in preventing recurrence after surgery for recurrent pterygium with intraoperative application of 0.02% mitomyci...
OBJECTIVES: To compare the outcomes of conjunctival graft (CAG) versus limbal-conjunctival autograft (LCAG) in preventing recurrence after surgery for recurrent pterygium with intraoperative application of 0.02% mitomycin C(MMC). METHODS: This prospective randomized controlled trial included one hundred thirty-two participants with recurrent pterygium who underwent either LCAG or CAG following pterygium excision, with intraoperative application of 0.02% MMC for 5 min (66 eyes in each group). Patients were followed for 12 months. The primary outcomes were recurrence and postoperative complications. RESULTS: A total of 126 patients completed the 12-month follow-up, including 63 eyes in the LCAG group and 63 eyes in the CAG group. Recurrence occurred in 6 eyes (9.52%) in the LCAG group and 3 eyes (4.76%) in the CAG group. The absolute risk difference was - 4.76% (95% CI, - 13.1-3.6%), the relative risk was 0.50 (95% CI, 0.13-1.92), and the odds ratio was 0.48 (95% CI, 0.11-1.99), with no statistically significant difference between groups (χ = 1.077, P = 0.299). No significant association was found between recurrence and surgical method, age, sex, number of previous excisions, size of pterygium or autograft, or degree of vascularization. Localized donor-site pannus formation was observed in 19 eyes (30.16%) in the LCAG group. No scleral or corneal melting was observed during follow-up. Limbal stem cell function was not objectively assessed. CONCLUSIONS: In this prospective randomized superiority trial,no statistically significant difference was detected in recurrence rates of recurrent pterygium after surgery with mitomycin C application between the LCAG and CAG groups during the 12-month follow-up period. Localized donor-site pannus formation was seen in some eyes with LCAG.
A systems approach to the diagnosis and management of vision‑threatening ocular changes in midface trauma: a narrative review and proposed practical framework.
Khikmatov MN, Agzamova SS
Int Ophthalmol · 2026 Jun · PMID 42250051 · Publisher ↗
PURPOSE: To summarize current evidence regarding vision-threatening ocular complications associated with midface trauma and to propose a practical systems-oriented framework for their early recognition, evaluation, and m...
PURPOSE: To summarize current evidence regarding vision-threatening ocular complications associated with midface trauma and to propose a practical systems-oriented framework for their early recognition, evaluation, and management. METHODS: A narrative review of the literature was conducted focusing on ocular injuries associated with midface trauma, including orbital compartment syndrome, open-globe injury, extraocular muscle entrapment, hyphema, posterior segment trauma, and traumatic optic neuropathy. Evidence was synthesized to develop a clinically applicable framework for multidisciplinary trauma care. RESULTS: Vision-threatening ocular injuries following midface trauma require rapid identification and timely escalation. Key components include bedside ocular screening, recognition of red-flag findings, appropriate imaging, early ophthalmology consultation, and coordinated communication between emergency, maxillofacial, ophthalmology, and trauma teams. Evidence strongly supports urgent intervention for orbital compartment syndrome and does not support routine high-dose corticosteroid therapy for traumatic optic neuropathy. Additional recommendations include standardized checklists, structured handover processes, and local quality-improvement measures. CONCLUSIONS: A systems-based approach may improve the early detection and management of vision-threatening ocular injuries in patients with midface trauma. The proposed framework aims to reduce preventable visual loss, standardize multidisciplinary care pathways, and support future prospective evaluation of clinical outcomes.
The effect of topical Ankaferd use on the recovery of wound healing in experimentally formed corneal perforations.
Değirmenci G, Aritürk N, Güvenç T
Int Ophthalmol · 2026 Jun · PMID 42250026 · Publisher ↗
PURPOSE: To compare the clinical and histopathological outcomes of topical Ankaferd Blood Stopper (ABS) combined with autologous blood versus N-butyl-2-cyanoacrylate (NBCA) in the management of experimentally induced cor...
PURPOSE: To compare the clinical and histopathological outcomes of topical Ankaferd Blood Stopper (ABS) combined with autologous blood versus N-butyl-2-cyanoacrylate (NBCA) in the management of experimentally induced corneal perforations with tissue loss. METHODS: Thirty-four eyes of 29 New Zealand white rabbits were randomly assigned to four groups: ABS combined with autologous blood (n = 10), autologous blood alone (n = 9), NBCA (n = 10), and untreated controls (n = 5). A standardized 1-mm full-thickness central corneal perforation was created using a biopsy punch to simulate tissue loss. Clinical examinations were performed on postoperative days 1, 2, 3, 7, 14, and 21 to assess wound leakage, anterior chamber depth, corneal edema, and inflammation. On day 21, corneal transparency and histopathological findings (stromal fibrosis and inflammatory infiltration) were evaluated. RESULTS: During the first postoperative week, the ABS group showed significantly less wound leakage and anterior chamber shallowing compared to the other groups (p < 0.05). Adhesive dislodgement requiring reapplication was significantly more frequent in the NBCA group (p = 0.012). At the end of the follow-up (day 21), the ABS group demonstrated significantly better corneal transparency (p = 0.027). Histopathologically, stromal fibrosis and inflammatory cell infiltration were significantly reduced in the ABS-treated eyes (p < 0.05). CONCLUSION: Topical ABS combined with autologous blood provides better clinical stability and more favorable biological healing than NBCA. These findings suggest that ABS may serve as a biologically advantageous alternative for the temporary management of corneal perforations.
Pathological mechanisms of Sjögren's disease-related dry eye: from multiglandular dysfunction to ocular surface inflammation.
Gao T, Ding G, Gong J … +1 more , Wang X
Int Ophthalmol · 2026 Jun · PMID 42247167 · Full text
Sjögren's disease-related dry eye (SjD‑DE) refers to a form of dry eye disease driven by autoimmune dysregulation in Sjögren's disease (SjD). Compared with primary dry eye, patients with SjD-DE typically present with mor...
Sjögren's disease-related dry eye (SjD‑DE) refers to a form of dry eye disease driven by autoimmune dysregulation in Sjögren's disease (SjD). Compared with primary dry eye, patients with SjD-DE typically present with more pronounced symptoms and signs, along with persistent and refractory disease courses that markedly impair daily functioning and quality of life. Although the precise mechanisms underlying SjD-DE have not been fully elucidated, accumulating evidence indicates that SjD affects not only lacrimal secretion but also multiple components of the ocular surface. In this context, we review recent pathological studies focusing on glandular dysfunction, goblet cell loss, tear film hyperosmolarity, ocular surface inflammation, and corneal nerve pathology in SjD-DE. These pathological alterations are highly interconnected and mutually reinforcing, ultimately driving the "vicious cycle" of ocular surface damage. This review aims to provide insights to support the development of novel non-invasive diagnostic criteria and future therapeutic strategies for SjD-DE.
Decoding visual pathway damage in pituitary macroadenomas: insights from retinal nerve fiber layer and visual field analysis.
Tongal S, Poslu Karademir F, Cakir I … +2 more , Ozcelik F, Inal A
Int Ophthalmol · 2026 Jun · PMID 42247165 · Publisher ↗
PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness and visual field (VF) defects in patients with pituitary macroadenomas to assess the utility of these parameters in monitoring visual pathway involvement. M...
PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness and visual field (VF) defects in patients with pituitary macroadenomas to assess the utility of these parameters in monitoring visual pathway involvement. METHODS: A retrospective study was conducted on patients diagnosed with PMA at Beyoglu Eye Hospital between September 2023 and July 2024. Comprehensive ophthalmological examinations were performed, including VF testing and RNFL thickness measurement via optical coherence tomography (OCT), and compared with healthy controls. RESULTS: The study included 62 eyes from 31 PMA patients (19 males, 12 females; mean age 53.50 ± 18.84 years) and 62 eyes from 31 healthy individuals. Among patients, 25 had prior surgery, 4 underwent gamma knife treatment, 2 had scheduled surgery, and 2 were under observation. Visual acuity (VA) in PMA patients was no light perception in 6 eyes, counting fingers at 10 cm in 1 eye, 50 cm in 1 eye, and a mean VA of 0.12 logMAR in 54 eyes. Optic disc exams revealed normal appearance in 33 eyes, temporal pallor in 13, and diffuse pallor in 16. The mean Visual Field Index was 77.34%, and mean deviation was - 7.43 dB (p < 0.05). Mean RNFL thickness was significantly lower in PMA patients, especially in nasal (49.80 ± 22.1 µm) and temporal (54.93 ± 19.4 µm) quadrants compared to superior (78.85 ± 38.58 µm) and inferior (118.08 ± 31 µm) quadrants (p < 0.05). Nasal fibers showed the most pronounced thinning, followed by superior, temporal, and inferior fibers. CONCLUSIONS: Visual field testing is the primary method for assessing chiasmal involvement in pituitary macroadenoma. RNFL analysis offers complementary structural information on axonal damage, and evaluating both together improves the clinical assessment and follow-up of visual pathway involvement.
The role of STAT3-targeted therapy created with COLIVELIN in the cross-talk between IL6/JAK2/STAT3 and TGF-β/SMAD2/SMAD3 signaling in a hyperinflammation and ROS-induced in vitro AMD model and its effect on retinal apoptosis.
Güçlü H, Doğanlar Z, Şambel Aykutlu M … +2 more , Köse G, Doğanlar O
Int Ophthalmol · 2026 Jun · PMID 42240907 · Publisher ↗
This study aimed to investigate the therapeutic potential of Colivelin in modulating the cross-talk between the IL-6/JAK2/STAT3 and TGF-β/SMAD2/SMAD3 signaling pathways and its downstream effects on retinal apoptosis in...
This study aimed to investigate the therapeutic potential of Colivelin in modulating the cross-talk between the IL-6/JAK2/STAT3 and TGF-β/SMAD2/SMAD3 signaling pathways and its downstream effects on retinal apoptosis in an in vitro AMD model. An in vitro AMD model was established in ARPE-19 human RPE cells using a sublethal combination of lipopolysaccharide and hydrogen peroxide. Apoptosis was quantified via Tali® image cytometry. Gene expression profiling was performed by qRT- PCR. Protein expressions were assessed by Western blot. Formal mediation analysis was employed to quantify pathway-specific mechanistic contributions. The AMD model exhibited significant upregulation of hypoxia-related genes (HIF-1α, VEGF, MMP3, MMP9), pro-inflammatory cytokines (IL-6, TNF-α), and pro-apoptotic markers (BAX, p53, Caspase- 3), accompanied by markedly elevated ROS levels and reduced cell viability. Low-dose Colivelin (1 µM) significantly enhanced STAT3 phosphorylation, restored antioxidant gene expression (GSS, CAT, SOD2), suppressed hypoxia-associated gene expression, and substantially reduced TGF-β receptor, SMAD2, and SMAD3 expression at both transcriptional and protein levels. Formal mediation analysis revealed that 91-98% of Colivelin's anti-apoptotic effect at the therapeutic dose was mediated through STAT3-driven suppression of TGF-β/SMAD2/3 signaling, rather than through direct STAT3 transcriptional activity on apoptotic target genes. Conversely, high-dose Colivelin (10 µM) paradoxically activated SMAD2/3-independent pro-apoptotic cascades, demonstrating a dose- dependent biphasic response. This study provides the first formal mechanistic evidence that Colivelin exerts its cytoprotective effects in AMD primarily through a STAT3 → SMAD2/3 suppression axis. Low-dose (1 µM) Colivelin demonstrated superior and broader therapeutic efficacy compared to Bevacizumab by simultaneously modulating oxidative stress, hypoxia, angiogenesis, and apoptotic signaling pathways. These findings establish Colivelin as a promising multi-target therapeutic candidate for AMD, with its therapeutic window defined by the capacity of STAT3 activation to selectively suppress TGF-β/SMAD-driven apoptotic signaling without engaging compensatory pro-death mechanisms. Rigorous pharmacokinetic optimization and in vivo validation are warranted to advance Colivelin toward clinical translation.
Ocular toxicity associated with Ethambutol in the South-East Asia Region.
Suresh J, Kumar R, Hissar S … +2 more , Shukla S, Vivekanandan K
Int Ophthalmol · 2026 Jun · PMID 42240730 · Publisher ↗
INTRODUCTION: Ethambutol-induced optic neuropathy is a well-documented adverse reaction, the severity of which depends on drug serum concentration in the body. The recent dose-frequency modification for ethambutol from t...
INTRODUCTION: Ethambutol-induced optic neuropathy is a well-documented adverse reaction, the severity of which depends on drug serum concentration in the body. The recent dose-frequency modification for ethambutol from thrice-weekly regimen to daily-dose regimen might have opened doors for increased drug toxicity, resulting in increasing incidence of ocular toxicity. METHODOLOGY: A retrospective, post-market observational study was conducted using data collected from VigiBase® until Jan 2026, using mapped terms under Medical Dictionary for Regulatory Activities (MedDRA). RESULTS: Of 49,327 ethambutol-suspected adverse event cases reported globally, 4,748 cases were reported under the system organ class (SOC) eye disorders, of which 220 blindness cases were reported globally. Within South-East Asia Region (SEAR), India (n = 820, 79.8%), Thailand (n = 148, 14.4%) and Indonesia (n = 59, 5.7%) reported cases of ethambutol-related eye disorders. Commonly reported preferred terms in SEAR include vision blurred (n = 425, 41.3%), visual impairment (n = 263, 25.6%), optic neuropathy (n = 68, 6.6%), blindness (n = 66, 6.4%) and eye pain (n = 20, 1.9%), with more cases being observed in adults within the age group of 18-64 years. India alone reported 65 cases of blindness followed by Indonesia with 1 case reported. CONCLUSION: The increased cases of ethambutol-related ocular toxicity specifically blindness warrants periodic monitoring, dose adjustments and exploring newer, safer antibiotics.
Intraoperative pain sensitivity and aqueous humor inflammatory cytokine profiles in hepatitis C virus antibody-positive cataract patients.
Zhang JS, Wang JD, Li M … +4 more , Mao YY, Liu JY, Xu J, Wan XH
Int Ophthalmol · 2026 Jun · PMID 42223790 · Full text
PURPOSE: To investigate the differences in intraoperative pain sensitivity between cataract patients with and without hepatitis C virus (HCV) antibody-positivity, and to compare the expression levels of inflammatory cyto...
PURPOSE: To investigate the differences in intraoperative pain sensitivity between cataract patients with and without hepatitis C virus (HCV) antibody-positivity, and to compare the expression levels of inflammatory cytokines in aqueous humor. METHODS: This was a case-control study that enrolled a total of 17 HCV antibody-positive cataract patients and 17 HCV antibody-negative cataract patients. Aqueous humor samples were collected during cataract surgery, and 40 cytokines were detected and analyzed. The intraoperative pain levels were evaluated using three subjective questionnaires consisting of two components: the first component was a blinded assessment performed by the same chief surgeon during the operation, and the second component was a patient self-assessment of pain completed 1 h after surgery. Age and the parameters of liver and kidney function, which were approximately normally distributed continuous variables, were presented as Mean ± SD, and between-group comparisons were performed using the independent-samples t-test. Pain scores and inflammatory cytokines levels, which were non-normally distributed continuous variables, were expressed as "median [Q1, Q3]", and between-group comparisons were conducted using the Mann‑Whitney U test. Categorical variables including gender and laterality of the affected eye were compared using the chi‑square test. Correlation analysis was performed using Spearman's correlation coefficient. RESULTS: Intraoperative cooperation scores were 2 [2, 3] in HCV antibody-positive patients and 1 [1, 2] in HCV antibody-negative patients, with a significant difference (P = 0.01). Intraoperative pain expression scores were 2 [2, 3] and 1 [1, 2], respectively (P < 0.01). Intraoperative pain self-assessment scores were 4 [2, 6] and 2 [1, 2], respectively (P < 0.01). Aqueous humor levels of TNF‑β were 0.12 [0.11, 0.19] ng/L in HCV antibody-positive patients and 3.77 [1.97, 4.68] ng/L in HCV antibody-negative patients (P < 0.01). M‑CSF levels were 0.27 [0.19, 0.40] ng/L and 0.09 [0.08, 0.12] ng/L, respectively (P < 0.01). I‑309 levels were 2.83 [1.73, 3.37] ng/L and 1.37 [0.71, 1.85] ng/L, respectively (P = 0.01). MCP‑1 levels were 786.04 [667.62, 963.99] ng/L and 657.12 [636.74, 694.78] ng/L, respectively (P = 0.01). Furthermore, pain scores were negatively correlated with TNF‑β levels, and all correlations were statistically significant (all P < 0.01). CONCLUSION: HCV antibody-positive cataract patients demonstrated significantly higher pain sensitivity during phacoemulsification surgery compared with HCV antibody-negative patients. HCV antibody-positivity may represent one of the contributing factors for increased intraoperative pain in cataract patients, which may be associated with abnormal expression of inflammatory cytokines in the aqueous humor.
Extracellular vesicles as therapeutic agents for retinal ganglion cell degeneration: current challenges and future prospects.
Shi J, Zhang L
Int Ophthalmol · 2026 Jun · PMID 42223749 · Publisher ↗
BACKGROUND: Retinal ganglion cells (RGCs) play a crucial role in the transmission of visual information and are particularly susceptible to degeneration in optic neuropathies such as glaucoma. Current therapeutic strateg...
BACKGROUND: Retinal ganglion cells (RGCs) play a crucial role in the transmission of visual information and are particularly susceptible to degeneration in optic neuropathies such as glaucoma. Current therapeutic strategies primarily focus on lowering intraocular pressure (IOP), the only clinically proven modifiable risk factor, but often fail to completely prevent progressive RGC loss. OBJECTIVE: This review aims to explore the potential of extracellular vesicles (EVs) as a complementary therapeutic approach for RGC degeneration in glaucoma, highlighting their advantages and the challenges associated with their application. METHODS: A comprehensive literature review was conducted to assess the properties of EVs, their therapeutic cargo capabilities, and their implications for RGC neuroprotection. RESULTS: EVs are naturally occurring nano-sized particles that exhibit biocompatibility, the ability to cross biological barriers, and the capacity to deliver therapeutic molecules such as miRNAs and proteins. They demonstrate significant potential for enhancing RGC survival and promoting neuroprotection in glaucoma. However, challenges persist, including cargo heterogeneity, incomplete understanding of biodistribution, variable stability and retention in ocular compartments, and the need for scalable production methods. CONCLUSION: Advancements in EV engineering, focusing on improved targeting, membrane properties, cargo loading, and pharmacokinetics, are essential for their future clinical application. While EV-based therapies should not be viewed as replacements for existing strategies, they represent a promising addition to the neuroprotective landscape for glaucoma and other retinal neurodegenerative conditions. Further research is necessary to overcome translational challenges and facilitate the development of clinically applicable therapies.
Contact lens-associated infectious keratitis: microbiological profile, management, and hygiene behaviors in a tertiary eye hospital.
Atighehchian M, Moradipari Y, Mahdizad Z … +3 more , Abedinifar Z, Molaei F, Zarei-Ghanavati M
Int Ophthalmol · 2026 Jun · PMID 42223562 · Publisher ↗
PURPOSE: To evaluate the microbial spectrum and management of contact lens-associated infectious keratitis (CL-AIK), with an emphasis on behavioral risk factors. METHODS: This retrospective study was conducted between 20...
PURPOSE: To evaluate the microbial spectrum and management of contact lens-associated infectious keratitis (CL-AIK), with an emphasis on behavioral risk factors. METHODS: This retrospective study was conducted between 2021 and 2023 and involved seventy-four eyes of 70 consecutive diagnosed with CL-AIK at a tertiary care eye hospital. The hygiene practices, clinical and diagnostic findings, including corneal smear and culture, in vivo confocal microscopy (IVCM), and polymerase chain reaction (PCR), were analyzed. The associations between risk behaviors and clinical outcomes were examined. RESULTS: A total of 74 eyes from 70 patients (47 females, 63.5%; mean age: 31.24 ± 10.08 years) were reviewed for cases of CL-AIK. The initial best-corrected visual acuity (BCVA) was 1.28 ± 1.27 LogMAR. Diagnostic confirmation was obtained using multiple methods: chocolate agar culture (97.3% usage, 37 (51.4%) positivity), non-nutrient agar with Escherichia coli culture (79.7% usage, 7(11.86%) positivity), PCR testing (79.7% usage, 15 (25.4%) positivity), and IVCM (81.1% usage,18 (29.3%) positivity for Acanthamoeba spp.). Among the 70 patients, 24 (32.4%) rinsed their lenses with tap water, 22 (29.7%) wore lenses overnight, and 14 (18.9%) had exposed to water during showering or swimming. Exposure to water while wearing contact lenses was significantly more common in patients with fungal keratitis (3/4,75%, p = 0.002). The use of expired lenses (3/23, 13.04%; p = 0.008) and prolonged wear (> 12 h; 14/23, 60.8%; p = 0.04) were significantly higher in Acanthamoeba keratitis (AK). CONCLUSION: Although many individuals reported good hygiene practices, high-risk behaviors such as swimming or showering while wearing contact lenses and prolonged daily use (> 12 h) remain important contributors to ocular complications. Prevention strategies should focus not only on general hygiene practices but also on addressing these high-risk behaviors. Additionally, the routine use of multimodal diagnostic techniques has dramatically improved the detection of atypical microorganisms, particularly Acanthamoeba spp.
The use of the smart eye camera for diagnosing and grading cataract in diabetic and non-diabetic patients in an outpatient setting in Jordan.
Khalil MB, Abu-Ismail L, Alawadhi A … +11 more , Aloudat B, Bahzar AA, Althunibat A, Alajarmeh A, Al Dalahmeh O, Khemlani RJ, Tomita K, Nishimura H, Morilova U, Nakayama S, Shimizu E
Int Ophthalmol · 2026 Jun · PMID 42223495 · Publisher ↗
UNLABELLED: AIM\PURPOSE: To study the association of DM among multiple risk factors with the presence of cataract in an outpatient setting in Jordan using only the Smart Eye Camera (SEC), a smartphone-attachable slit-lam...
UNLABELLED: AIM\PURPOSE: To study the association of DM among multiple risk factors with the presence of cataract in an outpatient setting in Jordan using only the Smart Eye Camera (SEC), a smartphone-attachable slit-lamp device. We also evaluated the agreement of 4 observers, independently watching the web-saved video captures from the SEC, on cataract diagnosis and grading. METHODS: Patients underwent anterior segment video acquisition using the SEC, which provides slit-beam illumination comparable to conventional slit-lamp microscope. The leading observer reviewed web-saved videos and graded cataracts using our modified LOCS III. 3 additional observers independently evaluated the SEC videos and recorded their findings. Patients had their charts reviewed, when accessible, for medical conditions and medications. RESULTS: We analyzed 392 eyes of 204 patients. 102 were diabetic and 102 non-diabetic patients. The total number of cataract patients was 106. In diabetics, 59 (57.8%) were cataract patients and in non-diabetics there were 47 (46.1%). The odds ratio for the presence of any type of cataract in any eye of a diabetic patient was 1.606 with a p-value of 0.093, i.e., not statistically significant. Age and hypertension were significantly associated with cataract of any type. Kappa inter-observer agreement for the 4 observers was fair overall and substantial for diagnosing clinically significant nuclear cataract. CONCLUSION: The Smart Eye Camera is a small, fast, and reliable tool for the diagnosis of clinically significant cataract in the outpatient setting (Fleiss Kappa among 4 observers of 0.601) and would be of great value for nation-wide cataract surgery screening campaigns. Nuclear cataract is associated with hypertension and age in this pool from Jordan.As keywords are mandatory for this journal, please provide 3-6 keywords. Smart Eye Camera Cataract DiabetesPlease confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Mohammed Bilal] Last name [Khalil]. Author 5 Given name: [Aisha Ali] Last name [Bahzar]. Author 8 Given name: [Odeh Al] Last name [dalahmeh]. Author 9 Given name: [Rohan Jeetendra] Last name [Khemlani]. Also, kindly confirm the details in the metadata are correct.Author 8 Given name: Odeh Last name: Al dalahmeh Correct metadata details.
Clinical characteristics and factors associated with uveitis in juvenile idiopathic arthritis: a long-term single-center experience.
Sarısoy D, Aydın F, Avar Aydın PÖ … +2 more , Yalçındağ FN, Özçakar ZB
Int Ophthalmol · 2026 May · PMID 42184063 · Publisher ↗
PURPOSE: Juvenile Idiopathic Arthritis uveitis (JIA-U) can progress without obvious clinical signs and cause permanent damage if left untreated, therefore early detection through regular screening is crucial for managing...
PURPOSE: Juvenile Idiopathic Arthritis uveitis (JIA-U) can progress without obvious clinical signs and cause permanent damage if left untreated, therefore early detection through regular screening is crucial for managing the disease. This study aimed to evaluate the prevalence of uveitis and factors associated with uveitis in Juvenile Idiopathic Arthritis (JIA) patients. METHODS: The medical records of patients with a diagnosis of non-systemic JIA who were under the care of the Department of Paediatric Rheumatology at Ankara University between June 2010 and June 2024 were reviewed retrospectively. The demographic, clinical and laboratory characteristics of the patients were recorded and compared between those with and without uveitis. RESULTS: 144 patients (92 girls, 63.9%; 83 oligoarticular JIA, 57.6%) were included in the study. Uveitis was detected in 26 patients (18.1%). 12 patients (46.2%) with JIA-U experienced complications and 3 of these patients had complications at the time of JIA-U diagnosis. The group who experienced JIA-U was characterised with female sex (p = 0.048), anti-nuclear antibody (ANA) positivity (p = 0.039), younger age at the time of JIA diagnosis (p = 0.014), and more frequent articular flare-ups (p = 0.014). No significant difference was found between the groups when comparing JIA subtypes and affected joints (p > 0.05). CONCLUSION: Uveitis may present with an insidious clinical course in patients with JIA. Particularly, early onset of the disease, female gender, positive ANA status, and articular relapses should be considered warning signs for uveitis.
Influence of chronic hyperglycemia on corneal endothelium structural integrity with emphasis on hexagonality.
Sharma S, Madan VV, Prasad N … +1 more , Banerjee S
Int Ophthalmol · 2026 May · PMID 42183919 · Publisher ↗
BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by lasting hyperglycemia, which can poorly affect various ocular structures, including the corneal endothelium. The corneal endothelium plays a...
BACKGROUND: Diabetes mellitus is a chronic metabolic disorder characterized by lasting hyperglycemia, which can poorly affect various ocular structures, including the corneal endothelium. The corneal endothelium plays a critical role in sustaining corneal transparency, and structural alterations such as reduced endothelial cell density and loss of hexagonal cell morphology may compromise its function. Endothelial cell hexagonality is a sensitive indicator of cellular pleomorphism and early endothelial stress. AIM: To study the influence of chronic hyperglycemia on the structural integrity of the corneal endothelium, with special emphasis on endothelial cell hexagonality. METHODOLOGY: This observational, cross-sectional comparative study was conducted at a tertiary care centre from June 2024 to March 2025. A total of 200 participants were enrolled, comprising 100 patients with diabetes mellitus (Group A) and 100 age-matched non-diabetic controls (Group B). One eye (preferably the right eye) of each participant was evaluated using specular microscopy. Corneal endothelial parameters assessed included endothelial cell density (ECD), hexagonality percentage (HEX), coefficient of variation (CV) of cell area, and central corneal thickness (CCT). Glycaemic control was assessed using glycated haemoglobin (HbA1c) levels. Statistical analysis was performed using independent t-test, chi-square test, and Pearson correlation. RESULTS: The diabetic group demonstrated significantly lower ECD (2577 ± 324.32 cells/mm2) and HEX (45.9 ± 7.37%) compared to non-diabetic controls (2714 ± 242.29 cells/mm2 and 52.14 ± 10.51%, respectively; p < 0.001). No significant difference was observed in CV and CCT between the groups. HEX showed a significant negative correlation with HbA1c levels (r = - 0.55, p < 0.001) and duration of diabetes (r = - 0.47, p = 0.002). CONCLUSION: Chronic hyperglycemia is associated with significant deterioration of corneal endothelial structural integrity, particularly reflected by reduced HEX and ECD. These changes correlate with poor glycemic control and longer duration of diabetes, highlighting the need for regular corneal endothelial evaluation in diabetic patients.
The effects of COVID-19 infection on ophthalmologic findings in pregnant women: a prospective controlled observational study.
Turgut FG, Satır Özel C, Aktaş N … +3 more , Ayşit E, Kurtoğlu GN, Demirçivi E
Int Ophthalmol · 2026 May · PMID 42183895 · Publisher ↗
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic infection that may affect multiple organs through endothelial dysfunction and inflammatory mechanisms. Ocular structures with rich microvascular networks, suc...
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic infection that may affect multiple organs through endothelial dysfunction and inflammatory mechanisms. Ocular structures with rich microvascular networks, such as the retina and optic nerve, may therefore be vulnerable. Although the acute phase of the pandemic has passed, COVID-19 remains endemic, and data regarding its ocular effects during pregnancy are limited. OBJECTIVE: To evaluate potential changes in the optic nerve and retinal structures of pregnant women with polymerase chain reaction (PCR)-confirmed COVID-19 infection during pregnancy. MATERIALS AND METHODS: This prospective observational study included 80 pregnant women aged 18-40 years between 16 and 34 weeks of gestation. Participants were divided into a non-severe COVID-19-positive group (n = 32) and a control group without infection (n = 48). Women with pre-existing ocular or chronic systemic diseases were excluded. All participants underwent comprehensive ophthalmologic examination, including best-corrected visual acuity, intraocular pressure, central corneal thickness, fundus examination, and optical coherence tomography (OCT). Retinal nerve fiber layer, ganglion cell complex, and macular thickness parameters were analyzed. RESULTS: The mean age of participants was 31.6 ± 5.8 years. No statistically significant differences were observed between the study and control groups in any ophthalmological parameters. Similarly, infection occurring in the second or third trimester was not associated with significant changes. CONCLUSION: Non-severe COVID-19 infection during pregnancy was not associated with measurable structural alterations in ocular microvascular structures as assessed by OCT.
Beyond imaging: AI agents as autonomous clinical assistants in uveitis.
Pichi F
Int Ophthalmol · 2026 May · PMID 42171833 · Publisher ↗
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