Int Ophthalmol [JOURNAL]
Sun
200 papers
High dose versus low dose Mitomycin-C assisted bleb needling in failing trabeculectomy blebs: a prospective comparative study.
Singh K, Mehta S, Joon A … +3 more , Singh A, Saraf P, Vishwanath S
Int Ophthalmol · 2026 May · PMID 42171827 · Publisher ↗
PURPOSE: To compare the safety and efficacy of high dose versus low dose Mitomycin-C (MMC) for bleb needling in failing trabeculectomy blebs. METHODS: Patients (> 18 years) who did not achieve target intraocular pressure...
PURPOSE: To compare the safety and efficacy of high dose versus low dose Mitomycin-C (MMC) for bleb needling in failing trabeculectomy blebs. METHODS: Patients (> 18 years) who did not achieve target intraocular pressure (IOP) and/or required anti glaucoma medications (AGMs) post trabeculectomy were recruited in this prospective, comparative, interventional study between December 2023-January 2025. MMC augmented bleb needling was performed with random allocation of patients to Group A (high dose MMC-60 μg) and Group B (low dose MMC-20 μg). Primary outcome was "complete success" (IOP 6-18 mmHg or IOP reduction > 20% without AGMs) and "qualified success" (criteria for complete success achieved with AGMs). Secondary outcome included bleb morphological changes on anterior segment optical coherence tomography (ASOCT), factors associated with success and complication rate. RESULTS: A total of 54 patients underwent MMC augmented bleb needling (27 in each group). Baseline parameters were comparable between the groups. IOP decreased significantly from baseline (Group A-26.9 ± 5.3 mmHg; Group B-27.0 ± 4.9 mmHg) to 6 months (Group A -13.39 ± 2.6 mmHg; Group B-13.62 ± 1.7 mmHg) in both the groups and was maintained at 1 year (Group A: 12.72 ± 1.69 mmHg; Group B: 12.61 ± 1.89 mmHg). Complete success was higher in Group A compared to Group B (44.4% vs. 18.5%; p = 0.04) at 6 months and 1 year (35% vs. 5%; p = 0.04). Bleb assessment on ASOCT revealed decrease in internal reflectivity of bleb wall, and increase in bleb wall height and bleb wall thickness. Adverse events included subconjunctival hemorrhage (68.5%; n = 37/54), hypotony (3.7%; n = 2/54), hyphema (3.7%; n = 2/54) and conjunctival buttonhole (1.85%; n = 1/54) which were comparable between the two groups. CONCLUSION: Bleb needling with high dose MMC is a safe and effective measure for reviving failing trabeculectomy blebs with no added adverse outcomes when compared to low dose MMC. ASOCT effectively correlates bleb structure changes with post-operative IOP control.
Late-onset toxic anterior segment syndrome presenting with predominant corneal edema after cataract surgery: a case series.
Bişkiner F, Bahar A, Dogan AS … +2 more , Çelikay O, Kesimal B
Int Ophthalmol · 2026 May · PMID 42165941 · Publisher ↗
PURPOSE: To describe the clinical features, course, and management of late-onset toxic anterior segment syndrome (TASS) presenting predominantly corneal edema following uncomplicated cataract surgery. METHODS: This case...
PURPOSE: To describe the clinical features, course, and management of late-onset toxic anterior segment syndrome (TASS) presenting predominantly corneal edema following uncomplicated cataract surgery. METHODS: This case series includes four patients who developed late-onset TASS after phacoemulsification during a TASS outbreak in our clinic. All patients underwent comprehensive ophthalmologic examination, including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, slit-lamp biomicroscopy, and anterior segment optical coherence tomography (AS-OCT). Corneal edema was graded clinically, and treatment responses were evaluated. RESULTS: All patients presented between postoperative days 3 and 5 with marked visual deterioration and diffuse corneal edema extending from limbus to limbus, without significant anterior chamber reaction. Initial BCVA ranged from 0.16 to 0.4 and decreased to hand motion or counting fingers during disease progression. Central corneal thickness was markedly increased in all cases. Following appropriate treatment, corneal edema gradually resolved and visual acuity significantly improved in all patients. CONCLUSION: Late-onset TASS may present with predominant corneal edema without significant anterior chamber reaction. Early recognition and prompt initiation of intensive corticosteroid therapy are essential for favorable visual outcomes. Clinicians should consider this entity in patients presenting with delayed postoperative corneal edema.
Outcomes and prognostic factors in posterior segment intraocular foreign body injuries.
Zamani G, Hajsharifi A, Shoeibi N … +6 more , Abrishami M, Hoseini SM, Ansari-Astaneh MR, Abrishami M, Bakhtiari E, Shariati MM
Int Ophthalmol · 2026 May · PMID 42165892 · Publisher ↗
BACKGROUNDX: Posterior segment intraocular foreign body (IOFB) injuries are among the most severe forms of ocular trauma and are associated with highly variable visual outcomes. Identifying reliable prognostic factors re...
BACKGROUNDX: Posterior segment intraocular foreign body (IOFB) injuries are among the most severe forms of ocular trauma and are associated with highly variable visual outcomes. Identifying reliable prognostic factors remains clinically challenging. METHODS: This longitudinal study included 117 patients who underwent surgical removal of posterior segment IOFBs at a tertiary referral center between 2016 and 2021. Demographic data, injury characteristics, ocular findings, surgical variables, and Ocular Trauma Score (OTS) were recorded. Best-corrected visual acuity (BCVA, logMAR) was assessed preoperatively and up to 12 months postoperatively. Univariate and multivariable linear regression analyses were performed to identify predictors of final BCVA. RESULTS: Mean BCVA improved significantly from 1.51 ± 0.84 logMAR preoperatively to 0.97 ± 0.77 logMAR at 12 months (P < 0.001). Poor visual outcome was significantly associated with the presence of RAPD, endophthalmitis, retinal detachment, traumatic cataract, and larger IOFB size. OTS demonstrated the strongest independent association with final BCVA (β = - 0.81, P < 0.001). Hammering-related injuries were associated with better visual outcomes. CONCLUSION: Visual outcomes after posterior segment IOFB injuries are largely determined by initial trauma severity. The Ocular Trauma Score is a robust predictor of final visual acuity and should be incorporated into early risk stratification and patient counseling.
Post-vitrectomy hypotony: mechanisms, risk factors and management strategies.
Ceylan FA
Int Ophthalmol · 2026 May · PMID 42165852 · Publisher ↗
PURPOSE: Ocular hypotony remains a clinically significant complication following vitreoretinal surgery, particularly in complex retinal detachment repair, repeat vitreoretinal surgery, and silicone oil removal. This revi...
PURPOSE: Ocular hypotony remains a clinically significant complication following vitreoretinal surgery, particularly in complex retinal detachment repair, repeat vitreoretinal surgery, and silicone oil removal. This review aims to synthesize current evidence regarding the mechanisms, risk factors, clinical consequences, and management strategies of post-vitrectomy hypotony. METHODS: This narrative review provides a qualitative synthesis of recent literature focusing on mechanisms, risk factors, clinical consequences, and management of post-vitrectomy hypotony. RESULTS: Consistent evidence identifies silicone oil removal, absence of intraocular tamponade, long axial length, repeat vitreoretinal surgery, anterior proliferative vitreoretinopathy, and preoperative intraocular pressure asymmetry as major risk factors. While early postoperative hypotony following small-gauge vitrectomy is typically transient and self-limiting, persistent hypotony represents a clinically significant condition associated with progressive structural damage, including hypotony maculopathy, choroidal folds, outer retinal injury and, in advanced cases, phthisis bulbi. CONCLUSIONS: Post-vitrectomy hypotony should be considered a multifactorial and dynamic process rather than a single-complication entity. A mechanism-based, individualized management strategy combined with meticulous surgical technique and early recognition of persistent hypotony is essential to optimize long-term visual outcomes.
Response to "Are procedural refinements truly original? About Dolar Bilge's article 'lower eyelid retraction repair using autologous auricular scapha cartilage'".
Dolar Bilge A
Int Ophthalmol · 2026 May · PMID 42159914 · Publisher ↗
Abstract loading — click title to view on PubMed.
Central subfield thickness changes and factors associated with OCT-confirmed cystoid macular edema after slow-coagulation transscleral cyclophotocoagulation for glaucoma.
Hosny R, Alshunnar MS, Khodeiry MM … +2 more , Lee RK, Sayed MS
Int Ophthalmol · 2026 May · PMID 42159842 · Publisher ↗
PURPOSE: To quantify serial central subfield thickness (CSFT) changes after slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) for glaucoma, estimate the incidence of OCT-confirmed cystoid macular edema (CME)...
PURPOSE: To quantify serial central subfield thickness (CSFT) changes after slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) for glaucoma, estimate the incidence of OCT-confirmed cystoid macular edema (CME), and explore baseline factors associated with CME, including diabetes and prior diabetic macular edema. METHODS: Retrospective cohort of 31 eyes undergoing SC-TSCPC for glaucoma with OCT imaging preoperatively and postoperatively at 1, 3, 6, 9, and 12 months and at last follow-up (range 9-30 months). OCT-confirmed CME was defined as cystoid intraretinal changes on OCT; increased CSFT alone was not classified as CME. Changes over time were assessed with non-parametric repeated-measures testing, and subgroup comparisons were exploratory and univariate because of the small sample size. RESULTS: Mean baseline CSFT was 279 ± 25 um and peaked at 355 ± 153 um at 1 month, then declined to 293 ± 25 um at 12 months (p < 0.001 across visits). Mean CSFT at last follow-up remained higher than baseline (294 ± 25 vs. 279 ± 25 um; p < 0.001). OCT-confirmed CME developed in 8/31 eyes (25.8%), first detected at 1-6 months (mean 2.1 ± 1.8). Eyes that developed OCT-confirmed CME had higher preoperative CSFT than eyes without CME (311 ± 21 vs. 267 ± 15 um; p < 0.001). In exploratory univariate analyses, OCT-confirmed CME occurred more frequently in eyes with diabetes mellitus (p = 0.031) and prior diabetic macular edema (p < 0.001). Mean intraocular pressure decreased from 36.1 ± 9.0 to 15.2 ± 3.6 mmHg at 12 months (p < 0.001). Mean corrected distance visual acuity (CDVA) changed from 0.90 ± 0.90 logMAR preoperatively to 1.02 ± 0.85 logMAR at last follow-up (p = 0.004), and CDVA at last follow-up did not differ between eyes with and without OCT-confirmed CME (p = 0.992). CONCLUSION: SC-TSCPC was associated with a transient postoperative increase in CSFT and a clinically relevant incidence of OCT-confirmed CME. In this small retrospective cohort, higher preoperative CSFT and diabetes-related retinal disease identified a subgroup with greater observed CME frequency, but these findings should be interpreted as exploratory associations rather than independent risk factors. Postoperative OCT surveillance may help identify early anatomic edema, particularly in higher-risk eyes.
Revisiting the ocular use of chlorhexidine: an agent to remember in multidrug-resistant bacterial and fungal keratitis.
Arici M, Ciftci MD, Barut Selver O
Int Ophthalmol · 2026 May · PMID 42142178 · Publisher ↗
BACKGROUND: Chlorhexidine, a well-established antiseptic in systemic medicine and dentistry, has long been overlooked in ophthalmology outside its role in Acanthamoeba keratitis. However, recent evidence supports its pot...
BACKGROUND: Chlorhexidine, a well-established antiseptic in systemic medicine and dentistry, has long been overlooked in ophthalmology outside its role in Acanthamoeba keratitis. However, recent evidence supports its potential as an effective adjunct or alternative agent in multidrug-resistant (MDR) bacterial keratitis, where treatment options remain limited and therapeutic challenges are escalating. This review aims to revisit ocular use of chlorhexidine. METHODS: A comprehensive search was performed in the PubMed database using combinations of the following keywords: "chlorhexidine", "keratitis", "Acanthamoeba keratitis", "fungal keratitis", "bacterial keratitis", "ocularinfections", and "antimicrobial resistance". Studies relevant to the ophthalmological use of chlorhexidine, particularlyin the context of keratitis and antimicrobial resistance, were utilized. RESULTS: The results revealed chlorhexidine's antimicrobial mechanisms, ocular formulations, and clinical applications, while highlighting emerging evidence from case reports, retrospective analyses, and in vitro studies that suggest potential activity against MDR ocular pathogens, including extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Pseudomonas spp. CONCLUSIONS: As the threat of antimicrobial resistance rises globally, chlorhexidine merits renewed attention and clinical evaluation within ophthalmology, particularly as a viable and accessible therapeutic option in resistant infections. Although current evidence is limited to preclinical studies and case reports, chlorhexidine shows potential efficacy in MDR and may warrant further investigation in well-designed clinical trials.
Bilateral fuchs uveitis syndrome and its association with multiple sclerosis.
Kasapoglu GG, Altan C, Ozkocak BY … +2 more , Atik BK, Basarir B
Int Ophthalmol · 2026 May · PMID 42142135 · Publisher ↗
PURPOSE: To investigate the prevalence of multiple sclerosis (MS) among bilateral Fuchs uveitis syndrome (FUS) cases and compare their clinical characteristics with unilateral cases. METHODS: Patients with bilateral FUS...
PURPOSE: To investigate the prevalence of multiple sclerosis (MS) among bilateral Fuchs uveitis syndrome (FUS) cases and compare their clinical characteristics with unilateral cases. METHODS: Patients with bilateral FUS (Study group) and unilateral FUS (Control group) were reviewed retrospectively. All patients in the study group underwent fluorescein angiography (FA) and magnetic resonance imaging (MRI) and neurological consultation. Whereas in the control group, patients with posterior segment involvement underwent FA. MRI and neurological consultation were performed on patients with neurological symptoms. The relationship between MS diagnosis and data was evaluated. RESULTS: Forty eyes of 20 patients in the study group and 40 eyes of 40 patients in the control group were included. Neurological evaluations revealed that 15% (3/20) of the patients in the study group diagnosed with MS, whereas neurologic symptoms were observed in one patient in the control group; however, MRI findings did not support a diagnosis of MS. Study group showed a higher prevalence of diffuse keratic precipitates (p < 0.001, χ2 test), while iris nodule subtypes differed between groups, with Busacca nodules predominating in study group and Koeppe nodules in control group (p = 0.019, p = 0.008 respectively, χ2 test). There was no significant difference between MS and non-MS eyes with fundus and FA findings (p > 0.05, χ2 test). CONCLUSION: The frequency of MS disease was found to be higher in bilateral FUS patients than in unilateral FUS cases. MS should be kept in mind in the diagnosis and follow-up of patients with bilateral FUS, and neurological investigations should be carried out when necessary.
Comparison of 45° Kelman and 45° ıntrepid balanced phaco tips in torsional phacoemulsification for hard cataracts: ıntraoperative efficiency and corneal endothelial outcomes.
Açar NB, Akmaz O, Küsbeci T … +3 more , Yüksel B, Demirtaş AA, Ayıntap E
Int Ophthalmol · 2026 May · PMID 42142124 · Publisher ↗
PURPOSE: To compare the effects of the 45° Kelman phaco tip and the 45° Intrepid Balanced phaco tip used during torsional phacoemulsification in hard cataracts on intraoperative energy use and surgical times, as well as...
PURPOSE: To compare the effects of the 45° Kelman phaco tip and the 45° Intrepid Balanced phaco tip used during torsional phacoemulsification in hard cataracts on intraoperative energy use and surgical times, as well as their effects on postoperative anterior segment parameters and the corneal endothelium. MATERIALS AND METHODS: In this retrospective comparative study, 180 eyes of 180 patients who met the inclusion criteria were included, comprising 90 patients in the 45° Intrepid Balanced phaco tip group and 90 patients in the 45° Kelman phaco tip group. Clinical findings were obtained preoperatively and on postoperative Day 1 and month 1, corneal endothelial and morphological parameters assessed by specular microscopy, optical biometry measurements were obtained, and intraoperative phacoemulsification device parameters were recorded. The groups were compared in terms of preoperative characteristics, intraoperative parameters, and postoperative corneal findings. RESULTS: There were no significant differences between the groups in terms of preoperative demographic or ocular characteristics. Compared with the Kelman group, the Intrepid Balanced group had significantly lower mean torsional amplitude, torsional ultrasound time, cumulative dissipated energy, aspiration time, and fluid usage (all p ≤ 0.007). However, there was no significant difference in total surgical time (p = 0.115). At postoperative month 1, the endothelial cell density was significantly greater in the Intrepid Balanced group than in the Kelman group (2075.52 ± 346.24 vs. 1929.96 ± 317.29 cells/mm, p = 0.008). Endothelial cell loss (360.20 ± 207.25 vs. 500.22 ± 271.90 cells/mm) and the percentage of endothelial cell loss (14.94 ± 8.64% vs. 20.37 ± 10.31%) were significantly lower in the Intrepid Balanced group (both p < 0.001). CONCLUSION: In torsional phacoemulsification for hard cataracts, the 45° Intrepid Balanced phaco tip was associated with greater intraoperative efficiency and less endothelial damage than the 45° Kelman phaco tip. These findings suggest that the Intrepid Balanced tip may offer advantages in terms of intraoperative efficiency and endothelial preservation under the surgical settings used in this study.
Effect of 0.1% sodium hyaluronate on femtosecond laser scanning during small incision lenticule extraction.
Shuai Y, Liu X, Zeng T … +1 more , Chen K
Int Ophthalmol · 2026 May · PMID 42133190 · Full text
PURPOSE: To assess efficacy of 0.1% sodium hyaluronate on femtosecond laser scanning during small incision lenticule extraction (SMILE). METHODS: A prospective randomized clinical trial was conducted involving 100 patien...
PURPOSE: To assess efficacy of 0.1% sodium hyaluronate on femtosecond laser scanning during small incision lenticule extraction (SMILE). METHODS: A prospective randomized clinical trial was conducted involving 100 patients (200 eyes) who were prepared to undergo binocular SMILE. The two eyes of each participant were randomly assigned to either the 0.1% sodium hyaluronate eye drop group (HA group) or the no 0.1% sodium hyaluronate eye drop group (NHA group). Prior to the laser scan of SMILE, the HA group received an application of 0.1% sodium hyaluronate to the eye immediately. The NHA group did not receive 0.1% sodium hyaluronate. The number of intraoperative cases of black area and opaque bubble layer (OBL) and the lenticule separation time were recorded. Then, the Strehl Ratio (SR) was used to evaluate postoperative optical quality. RESULTS: The incidence of OBL and black area in HA group and NHA group was no statistical significance. The lenticule separation time of the HA group was significantly shorter than that of the NHA group (Z = - 5.940, P < 0.01). The SR values of the HA group and the NHA group were as following 0.3608 (0.2879, 0.4359) and 0.3079 (0.2537, 0.3820) one month after SMILE, with significant difference between the two groups (Z = - 3.163, P < 0.01). No additional complications were reported in any of the patients. CONCLUSIONS: The immediate application of 0.1% sodium hyaluronate during femtosecond laser scanning in SMILE may contribute to more favorable conditions for femtosecond laser scanning, facilitate lenticule separation, and is associated with better postoperative optical quality, as indicated by higher SR values at one month.
Corneal epithelial mapping after accelerated corneal cross-linking: early remodeling patterns.
Rattan SA, Jawad AA
Int Ophthalmol · 2026 May · PMID 42133149 · Publisher ↗
PURPOSE: To evaluate early regional corneal epithelial thickness changes following accelerated epithelium-off corneal cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography (AS...
PURPOSE: To evaluate early regional corneal epithelial thickness changes following accelerated epithelium-off corneal cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography (AS-OCT), and to explore their relationship with anterior corneal curvature and spherical equivalent. DESIGN: Prospective case series. METHODS: Ninety eyes of 75 patients with progressive keratoconus underwent accelerated epithelium-off CXL (9 mW/cm for 10 min). Epithelial thickness profiles were assessed using spectral-domain AS-OCT preoperatively and at 1 and 3 months postoperatively. Changes in central and sectoral epithelial thickness were analyzed using repeated-measures ANOVA with post hoc adjustment. Correlations between epithelial parameters, spherical equivalent, and maximum keratometry (Kmax) were evaluated. RESULTS: Baseline central epithelial thickness was 59.7 ± 5.8 µm. At 1 month, central thickness showed minimal change, while at 3 months it increased to 62.9 ± 4.0 µm (P < 0.001). Sectoral analysis demonstrated relative thinning in nasal and inferonasal outer regions (1-3 µm; P < 0.05) and thickening in selected temporal sectors. The thinnest epithelial point shifted from the inferotemporal to the inferonasal regions. Kmax demonstrated a borderline postoperative change (P = 0.051), and no statistically significant correlations were observed between epithelial thickness changes and Kmax at any time point. Spherical equivalent remained unchanged (P = 0.19). CONCLUSIONS: Accelerated epithelium-off CXL was associated with early, region-specific changes in epithelial thickness within three months after surgery. Variability in measurements due to the tear film and the short follow-up period likely influences these results, reflecting early surface remodeling rather than permanent stromal stabilization. Epithelial mapping may provide additional structural information during early postoperative monitoring; however, its ability to predict long-term treatment outcomes requires further research.
FilmArray® multiplex PCR panels on corneal swabs in suspected infectious keratitis: a pragmatic real-world study.
Ben Addou Idrissi S, Kouara S, Benatiya Andaloussi FZ … +7 more , Mrhari A, Moutei H, Chraibi F, Abdellaoui M, Yahyaoui G, Mahmoud M, Benatiya Andaloussi I
Int Ophthalmol · 2026 May · PMID 42133105 · Publisher ↗
PURPOSE: To evaluate the clinical utility of a pragmatic, off-label multiplex PCR strategy using FilmArray® panels on corneal swabs in suspected infectious keratitis, with emphasis on diagnostic yield, turnaround time, a...
PURPOSE: To evaluate the clinical utility of a pragmatic, off-label multiplex PCR strategy using FilmArray® panels on corneal swabs in suspected infectious keratitis, with emphasis on diagnostic yield, turnaround time, and early therapeutic impact in routine care. METHODS: This prospective, single-center observational study was conducted over 24 months (January 2024-December 2025) at a tertiary referral center. In episodes of clinically suspected infectious keratitis, corneal swabs were immersed in brain-heart infusion medium. A FilmArray® Meningitis/Encephalitis (ME) panel was used as first-line testing, with selective FilmArray® Blood Culture Identification 2 (BCID2) panel use when clinically indicated. Conventional bacterial and fungal cultures were systematically performed. Outcomes included diagnostic yield of the PCR algorithm, turnaround time (TAT), concordance patterns with culture, and early treatment changes after PCR results. RESULTS: Fifty episodes were included. The multiplex PCR algorithm (ME ± BCID2) detected at least one pathogen in 50% of cases, with viral detections, mainly herpes simplex virus type 1, accounting for a substantial proportion of PCR-positive results. Conventional culture was positive in 32% of cases and identified bacterial and/or fungal pathogens. Median TAT was 6.5 h for PCR versus 79 h for culture, corresponding to a median reduction of 72.5 h. PCR findings were associated with treatment modification within 24 h in 32% of cases, with additional changes after 48 h in 6%, predominantly antiviral initiation or targeted antimicrobial adjustment. CONCLUSIONS: In this real-world exploratory study, the main advantage of the pragmatic FilmArray® strategy was the marked reduction in turnaround time compared with culture, providing microbiological information within hours rather than days. Because PCR and culture differ fundamentally in detectable pathogen classes, particularly due to viral detection by PCR, these findings should not be interpreted as evidence of diagnostic superiority. FilmArray® testing may serve as a complementary approach in selected severe, atypical, pretreated, or culture-negative keratitis cases when rapid therapeutic decisions are needed.
Efficacy and safety of netarsudil compared with prostaglandin-based therapies: a Bayesian network meta-analysis.
Liu J, Zuo M, Liu X
Int Ophthalmol · 2026 May · PMID 42133103 · Publisher ↗
The study aimed to compare the efficacy and safety of netarsudil (NET), alone or in fixed-dose combinations (FDC), in comparison with prostaglandin analogues (PGAs: bimatoprost [BIM], latanoprost [LAT], travoprost [TRA],...
The study aimed to compare the efficacy and safety of netarsudil (NET), alone or in fixed-dose combinations (FDC), in comparison with prostaglandin analogues (PGAs: bimatoprost [BIM], latanoprost [LAT], travoprost [TRA], and tafluprost [TAF]) for the treatment of primary open-angle glaucoma (POAG) or ocular hypertension. Literature search in PubMed, Embase, Cochrane Library, Web of Science (inception to July 2025). Identified 26 randomized controlled trials (RCTs) (5,390 patients). The primary outcome was the mean difference in intraocular pressure (IOP) reduction at 3 months; the secondary outcome was the incidence of conjunctival hyperemia. Pair-wise meta-analysis used Cochrane Review Manager 5.4, Bayesian network meta-analysis via Aggregate Data Drug Information System (ADDIS) with Markov Chain Monte Carlo (MCMC) simulations. Inconsistency assessed via node-splitting, convergence evaluated via Brooks-Gelman-Rubin method. Network meta-analysis showed 3-month IOP -lowering hierarchy: FDC > BIM > TRA > LAT > TAF > NET. Conjunctival hyperemia incidence (highest to lowest): TAF > FDC > NET > BIM > TRA > LAT. Node-splitting confirmed consistency (P ≥ 0.05), convergence was satisfactory. Funnel plots indicated no publication bias for IOP outcomes but potential bias for conjunctival hyperemia. Although NET ranked lower in IOP-lowering efficacy compared to most PGAs and FDC, it demonstrated a favorable safety profile, particularly with a relatively lower incidence of conjunctival hyperemia than TAF and FDC. These findings suggest that NET may serve as a valuable alternative in patients who are intolerant to PGAs or require adjunctive therapy, warranting further investigation in targeted populations.
Intriguing roles of Müller glia: a special emphasis on the development and pathology of Müller glia cells in the retina.
Gupta P, Gopenath TS, Singh SK
Int Ophthalmol · 2026 May · PMID 42105166 · Publisher ↗
PURPOSE: The aspiration of this review is to discuss the intricate development of Müller glial cells (MGCs) and their indispensable neuroprotective and regenerative roles, as well as novel avenues of treatment for retina...
PURPOSE: The aspiration of this review is to discuss the intricate development of Müller glial cells (MGCs) and their indispensable neuroprotective and regenerative roles, as well as novel avenues of treatment for retinal neurodegenerative diseases. MGCs are the principal radial glial cells of the vertebrate retina, extending from what is composed of a characteristic funnel-shaped morphology spanning throughout the retinal thickness. Their cell bodies are in the inner nuclear layer (INL), and their processes span from the outer limiting membrane to the inner limiting membrane, where they strongly associate with neurons, blood vessels, and the extracellular matrix across all layers of retinal structure. These cells preserve ionic and water homeostasis, control neurotransmitter uptake, and participate in constructing the blood retinal barrier (BRB), as well as deliver crucial metabolic help to neurons by means of the glutamate-glutamine cycle, thus excluding excitotoxic injury. METHODS: First, we analysed the molecular processes underlying MGCs activation: pro-inflammatory molecules, Reactive oxygen species (ROS), and survival pathways. Special notice was made of changes in gene expression upon activation and the recrudescence of embryonic developmental programs that permit cell-cycle re-entry and retinal regeneration. Systematic searches of Google Scholar and PubMed to find relevant literature. RESULTS: Upon activation, Müller's glia, a type of retinal support cell, commence the expression of protective genes, such as Zfp36, Mt1, and Slc14a1. Some creatures could regenerate; however, in mammals, this capacity is limited, which is particularly evident in the retina, where, despite the activation of Müller's glia, full regeneration of damaged photoreceptors is not achieved. MGCs produces retinal progenitors that assist photoreceptors and interneurons while maintaining retinal integrity. MGCs contain progenitor cells that can differentiate into both neurons and other retinal cell types. Molecular targets for retinal therapeutics that utilize MGCs include pathways that regulate inflammation and oxidative stress. CONCLUSION: Müller glial cells are essential for maintaining retinal health, safeguarding neurons, and facilitating their regeneration. Targeted molecular therapy is addressed as a promising strategy for retinal neurodegenerative diseases, using their regenerative and protective potential.
Explainable dual-stage context-aware SwinUNet for accurate optic disc and optic cup segmentation in glaucoma assessment.
Gopi Kannan P, Balasubramanian C, Jarin T
Int Ophthalmol · 2026 May · PMID 42101737 · Publisher ↗
PURPOSE: Accurate segmentation of glaucoma-related anatomical structures from retinal fundus images is crucial for reliable clinical assessment and early disease diagnosis. However, variations in illumination, low contra...
PURPOSE: Accurate segmentation of glaucoma-related anatomical structures from retinal fundus images is crucial for reliable clinical assessment and early disease diagnosis. However, variations in illumination, low contrast, and complex structural patterns make precise boundary delineation of the optic disc (OD) and optic cup (OC) challenging. This study aims to improve the accuracy of OD and OC segmentation for glaucoma assessment. METHODS: An Enhanced SwinUNet model is proposed, integrating hierarchical transformer-based feature extraction with a Dual-Stage Context-Aware Feature Refinement (DCF-Refine) module embedded in skip connections. A preprocessing stage is applied using CLAHE-based contrast enhancement in LAB color space along with min-max normalization to improve image quality and stabilize training. The model employs Swin Transformer (ST) blocks to capture both local structural details and long-range dependencies. The DCF-Refine module enhances feature fusion through sequential Spatial Context Refinement (SCR) and Channel Context Refinement (CCR). RESULTS: Experimental evaluation on the Drishti-GS and REFUGE datasets demonstrates that the proposed Enhanced SwinUNet achieves superior performance compared to existing segmentation methods, attaining accuracies of 99.3% and 99.1%, respectively. CONCLUSION: The proposed model provides highly accurate and reliable segmentation of OD and OC structures, effectively addressing challenges in retinal image analysis. Its strong performance supports improved glaucoma-related structural assessment and has potential for clinical application.
Comparison of corneal topography maps of a swept-source OCT biometer and a Scheimpflug device.
Müller M, Hemkeppler E, Böhm M … +3 more , Jandewerth T, Lwowski C, Kohnen T
Int Ophthalmol · 2026 May · PMID 42090040 · Full text
PURPOSE: Rating of central corneal topography of a swept-source OCT biometer (IOL Master 700) and tomographic maps from a Scheimpflug device (Pentacam AXL) by different experienced professionals regarding irregularities...
PURPOSE: Rating of central corneal topography of a swept-source OCT biometer (IOL Master 700) and tomographic maps from a Scheimpflug device (Pentacam AXL) by different experienced professionals regarding irregularities to support decisions on implanting premium intraocular lenses (IOLs). METHODS: In this prospective study healthy eyes (H), irregular corneas (I) and eyes with previous corneal refractive surgery (P) were randomly selected. Five observers with different experience in corneal map evaluation compared the corneal topography maps of both devices individually. They answered a questionnaire for each picture and eye and the matched pictures. The questionnaire included the similarity in regularity of the cornea, the classification of the pictures regarding the included patient groups and the decision of premium IOL implantation. RESULTS: The study included 25 eyes per group. The correct category (H, I or P) was reported in 52% to 70% of individual cases. Except one observer (p < 0.001) there were no significant difference between the two devices. Most observers rated irregular corneas significantly different than healthy or post refractive surgery eyes (p < 0.001). There were significant inter-observer agreements among the three observers for rating implantation premium IOLs 0.137 to 0.374 (p < 0.05) and rating the correct category 0.435 (p < 0.001). CONCLUSIONS: Irregular corneas were rated as significantly different to healthy or post refractive surgery eyes. Most observers rated the images of the swept-source OCT biometer and the Scheimpflug device equally. Regarding the selection of premium IOL experienced colleagues are preferable.
Residual refraction after myopic implantable collamer lens implantation: clinical data vs optical models.
Oleszko A, Muzyka-Woźniak M, Terlecka M
Int Ophthalmol · 2026 May · PMID 42090030 · Full text
PURPOSE: To compare the predictive accuracy of four optical modelling scenarios for postoperative refraction after myopic Implantable Collamer Lens (ICL) implantation using patient-specific clinical biometry and to valid...
PURPOSE: To compare the predictive accuracy of four optical modelling scenarios for postoperative refraction after myopic Implantable Collamer Lens (ICL) implantation using patient-specific clinical biometry and to validate the results against clinical postoperative refraction and vault data. METHODS: This retrospective study analysed 215 eyes following myopic ICL implantation. Four optical vergence models were implemented using patient-specific preoperative biometry and measured postoperative vault. The scenarios differed in their treatment of corneal and phakic intraocular lens (pIOL) thickness: (A) thick cornea and thick pIOL; (B) thin cornea and thick pIOL; (C) thick cornea and thin pIOL; (D) thin cornea and thin pIOL. Postoperative spherical equivalent refraction was defined by objective autorefraction, with a sensitivity analysis for the subjective refraction in a subset of eyes. Prediction accuracy was assessed using mean error, mean absolute error, refractive accuracy thresholds, and Bland-Altman analysis. Two-dimensional dispersion was evaluated using standard distance deviation and standard deviational ellipses (SDE). Ellipse-aligned variance was compared using Brown-Forsythe tests with Bonferroni correction. The prediction accuracy of all scenarios were contrasted against the standard. RESULTS: Scenarios assuming a centrally thick pIOL (A and B) systematically overestimated postoperative refraction, with biases exceeding + 1.0 D and wide limits of agreement (> ± 3.0 D). Thin-pIOL models demonstrated substantially improved agreement. Scenario C showed the lowest bias (0.30 ± 0.48 D), narrowest limits of agreement (- 0.62-1.21 D), smallest SDE area, and significantly reduced variance along both ellipse-aligned axes compared with Scenarios A and B (p < 0.001). No significant dispersion difference was observed between Scenarios C and D. Scenario C achieved prediction accuracy that was very close to that of the manufacturer's calculation algorithm. CONCLUSION: For myopic ICLs with central thinning and a central aperture, optical models assuming a thin pIOL provide postoperative refractive prediction. Model selection should prioritize optical relevance along the visual axis rather than anatomical complexity.
Acute dacryocystitis: Microbiological profiles from an infectious diseases perspective.
Koçak FM, Poslu Karademir F
Int Ophthalmol · 2026 May · PMID 42090022 · Publisher ↗
PURPOSE: This study aimed to investigate the microorganisms isolated, antimicrobial resistance patterns, clinical profiles, and therapeutic approaches in adult acute dacryocystitis cases requiring multidisciplinary manag...
PURPOSE: This study aimed to investigate the microorganisms isolated, antimicrobial resistance patterns, clinical profiles, and therapeutic approaches in adult acute dacryocystitis cases requiring multidisciplinary management, and to present epidemiological data from Turkey. METHODS: We retrospectively analyzed adult patients referred from a tertiary ophthalmology hospital to the infectious diseases (ID) specialist between January 2022 and April 2025. Clinical and microbiological data were obtained from electronic medical records. Pathogen identification and susceptibility testing were performed using routine microbiological methods, and the results were interpreted according to applicable standard criteria. RESULTS: Sixty-eight patients were included (mean age: 54.9 years; 79.4% female). Of the 68 included patients, 49 underwent microbiological sampling when indicated and sufficient material was available; 38 (77.6%) had positive cultures, yielding 49 isolates. Staphylococcus aureus (n = 12) was the most frequent isolate. Pseudomonas aeruginosa and Enterobacteriaceae were the leading Gram-negative pathogens. All tested Gram-positive isolates were susceptible to vancomycin. Susceptibility to other antibiotics varied across pathogen groups. All fungal isolates were Candida species. Prior antibiotic exposure was not associated with lower culture positivity in this sample. CONCLUSION: In adult acute dacryocystitis, culture-based therapy is essential, particularly for complex or nonresponsive cases. This study presents local epidemiological data and may help guide empirical therapy and support individualized antimicrobial management.
Safety of resident performed surgeries in complex cataract cases and comparative analysis with staff surgeons: a review of 1500 consecutive cases.
Derin Sengun G, Durmus E, Aykut V … +2 more , Oguz H, Esen F
Int Ophthalmol · 2026 May · PMID 42090014 · Publisher ↗
PURPOSE: To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff...
PURPOSE: To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff surgeons in a teaching hospital and determine the risk factors associated with posterior capsule tear (PCT) and POD1 IOP elevation. METHODS: This retrospective study included all cases of primary phacoemulsification in patients aged 18 years or older, performed by residents and staff surgeons from May 27, 2022, to May 31, 2023 in a tertiary eyecare center in Turkey. There were no exclusion criteria. Data collected included primary surgeon, level of experience, preoperative status of cases, intraoperative complications, other operative details and POD1 IOP measurements. RESULTS: A total of 1500 surgeries were included; 68.8% were performed by residents. Overall intraoperative complication rates were similar in groups in simple and complex cases. There was no statistically significant difference in PCT rates between groups in simple (2.4% and 1.9%, p = 0.800) and complex cases (3.7% and 5.1%, p = 0.455). Rate of POD1 IOP elevation above 25 mm Hg was also similar in groups (22.7% and 22.6%, p = 0.903). Pseudoexfoliation + small pupil and special cataracts were significant risk factors for PCT among residents (p = 0.048 and p = 0.033, respectively). Pseudoexfoliation + small pupil, glaucoma or ocular hypertension and uveitis were significant risk factors for POD1 IOP elevation. CONCLUSION: Overall intraoperative complication and PCT rates were comparable between residents and staff surgeons in both simple and complex cases. Resident involvement was not a risk factor for POD1 IOP elevation.
Clinical and multimodal imaging features of ocular syphilis with posterior segment involvement: a 10-case series.
Wei L, Wei S, Wang Z
Int Ophthalmol · 2026 May · PMID 42084651 · Publisher ↗
BACKGROUND: Ocular syphilis masquerades as posterior uveitis, causing delayed diagnosis. We delineated phenotypes, imaging and outcomes in treatment-naïve disease. METHODS: A retrospective, observational case series was...
BACKGROUND: Ocular syphilis masquerades as posterior uveitis, causing delayed diagnosis. We delineated phenotypes, imaging and outcomes in treatment-naïve disease. METHODS: A retrospective, observational case series was conducted on 10 consecutive patients (15 eyes; 6 females, 4 males; mean age 48.3 ± 12.1 years) diagnosed with syphilitic posterior uveitis between January 2013 and December 2024. All patients underwent comprehensive ophthalmic evaluation, serologic confirmation (positive Treponema pallidum particle agglutination and rapid plasma reagin), and multimodal imaging assessment including color fundus photography, fundus fluorescein angiography (FFA), and spectral-domain optical coherence tomography (SD-OCT). The primary outcome was the change in best-corrected visual acuity (BCVA, logMAR) after standard intravenous penicillin G therapy, analyzed using the Wilcoxon signed-rank test. RESULTS: (1) Phenotype distribution: ASPPC was the most prevalent posterior-segment lesion (8/15 eyes, 53.3%), followed by optic perineuritis/papillitis (5 eyes, 33.3%) and retinal vasculitis (2 eyes, 13.3%). (2) Multimodal imaging features: SD-OCT in ASPPC consistently showed outer retinal disruption and ellipsoid zone loss, while FFA revealed characteristic early hypofluorescence with late speckled hyperfluorescence and leakage; optic perineuritis showed early disc hyperfluorescence with marked late-phase leakage; and retinal vasculitis demonstrated arterial wall staining with peripheral non-perfusion. (3) Visual outcomes: Following treatment, 14 eyes (93.3%) showed visual improvement, with median BCVA improving from 0.40 to 0.00 logMAR (P < 0.001). The initial misdiagnosis rate was 60% (6/10). CONCLUSIONS: In patients presenting with ocular syphilis as the initial manifestation, ASPPC is the most common posterior segment lesion. Multimodal imaging provides critical diagnostic clues. Despite frequent initial misdiagnosis, prompt penicillin therapy yields favorable visual outcomes. Routine syphilis serology screening is strongly recommended for any patient with unexplained posterior uveitis or optic neuropathy.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe