Int Ophthalmol [JOURNAL]
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200 papers
GPT-5-assisted versus expert surgeon refractive planning in smooth incision lenticule keratomileusis (SILK): comparative analysis and visual outcomes.
Surico PL, Tsai TH, Ma DH … +8 more , Chang CK, Afflitto GG, Lin HY, Pan CC, Perri A, Di Zazzo A, Lanzetta P, Sun CC
Int Ophthalmol · 2026 May · PMID 42068428 · Full text
PURPOSE: To assess the performance of GPT-5 in refractive surgery planning by comparing its recommendations with expert surgeons and reporting visual outcomes of surgeon-planned Smooth Incision Lenticule Keratomileusis (...
PURPOSE: To assess the performance of GPT-5 in refractive surgery planning by comparing its recommendations with expert surgeons and reporting visual outcomes of surgeon-planned Smooth Incision Lenticule Keratomileusis (SILK) procedures. METHODS: This retrospective, observational study included 134 eyes from 67 patients who underwent SILK procedure using the ELITA femtosecond laser platform from January 2024 to September 2025. GPT-5 generated refractive plans based on manifest and cycloplegic refraction, autorefractometry, visual acuity, keratometry, and pachymetry. These were compared with surgeon-derived values using paired t-tests and correlation analysis. Preoperative and postoperative (1- and 3-month) uncorrected and corrected distance visual acuity (UDVA, CDVA), mean keratometry (Km), and thinnest corneal point were analyzed. Axis concordance was quantified as the absolute angular deviation (Δ Axis) between AI- and surgeon-planned astigmatism axes. RESULTS: AI-generated spherical corrections were more conservative than surgeons' (- 4.29 ± 2.42 D vs. - 4.70 ± 1.98 D; p = 0.0025), whereas cylindrical power did not differ significantly (p = 0.9241). The mean Δ Axis was 61.9° ± 50.1°, indicating substantial misalignment. UDVA improved from 0.74 ± 0.36 logMAR preoperatively to - 0.06 ± 0.07 logMAR at 3 months (p < 0.0001), and postoperative UDVA did not differ significantly from preoperative CDVA, confirming excellent visual recovery. CONCLUSIONS: GPT-5 generated refractive plans that were partially consistent with expert surgeon decisions but lacked the clinical precision required for clinical implementation. In contrast, surgeon-planned SILK procedures achieved excellent visual acuity, corneal stability, and refractive predictability, reinforcing the safety and efficacy of Kerato Lenticule Extraction (KLEx) in real-world clinical practice.
Switch to faricimab in various retinal diseases: real-world data.
Kaplan E, Segal O, Moisseiev E … +1 more , Allon G
Int Ophthalmol · 2026 May · PMID 42068401 · Publisher ↗
OBJECTIVE: To evaluate the efficacy of faricimab in various retinal conditions in previously treated patients. METHODS: This study included patients who received at least three faricimab injections at a large medical cen...
OBJECTIVE: To evaluate the efficacy of faricimab in various retinal conditions in previously treated patients. METHODS: This study included patients who received at least three faricimab injections at a large medical center between April 2023 and October 2024, all of whom were not naive to treatment. RESULTS: A total of 242 eyes from 219 patients were included in the analysis. The diagnoses were: 139 eyes with neovascular age-related macular degeneration (NVAMD), 63 eyes with diabetic macular edema (DME), 24 eyes with polypoidal choroidal vasculopathy (PCV), 5 eyes with choroidal neovascularization (CNV) secondary to central serous retinopathy (CSR), 5 eyes with branch retinal vein occlusion (BRVO) accompanied by cystoid macular edema (CME), 3 eyes with central retinal vein occlusion (CRVO) with CME, and 3 eyes with myopic CNV. Patients had previously received intravitreal injections of medications including bevacizumab, ranibizumab, aflibercept 2 mg, brolucizumab, triamcinolone, and Ozurdex. Following treatment with faricimab, the proportion of eyes with no intraretinal or subretinal fluid increased across all retinal diseases. Additionally, the average central subfield thickness decreased, the interval between injections was extended, and average visual acuity improved in every retinal condition. The average height of the pigment epithelium detachment (PED) decreased in cases of NVAMD and PCV. CONCLUSIONS: Faricimab appears to be effective after the failure of other treatment options.
Epithelial thickness gradients as a diagnostic biomarker for early-stage keratoconus.
Jansone-Langina Z, Gertnere J, Kezika V … +2 more , Rocha-de-Lossada C, Sánchez-González JM
Int Ophthalmol · 2026 Apr · PMID 42053839 · Full text
PURPOSE: To evaluate peripheral-central epithelial thickness (ET) gradients in eyes with keratoconus and regular astigmatism, and to determine their potential utility as a non-invasive biomarker for disease detection in...
PURPOSE: To evaluate peripheral-central epithelial thickness (ET) gradients in eyes with keratoconus and regular astigmatism, and to determine their potential utility as a non-invasive biomarker for disease detection in early-stage keratoconus. METHODS: This retrospective cross-sectional analyzed ET with spectral-domain OCT at the cone apex and at 3 mm in the superior, temporal, nasal, and inferior directions. Epithelial thickness gradients (ΔET) were calculated as the difference between peripheral and central ET. Statistical comparisons were performed using non-parametric tests, with significance set at p < 0.05. RESULTS: A total of 396 eyes (208 keratoconus, 188 regular astigmatism) were analyzed. Central ET was significantly reduced in KC (38.55 ± 5.42 µm) vs controls (48.78 ± 3.94 µm; p < 0.001). While peripheral thickness showed minor differences, the ET gradients (ΔET) were markedly steeper in KC across all quadrants (temporal, superior, nasal, inferior, p < 0.001). Within Stage I KC, eyes with more advanced disease exhibited steeper ΔET values, particularly in the nasal and temporal directions. Mean ΔET, demonstrated significant differences between KC (8.43 ± 4.97 µm) and controls (- 1.55 ± 1.77 µm; p < 0.001), and correlated positively with steep keratometry (r = 0.521, p < 0.001) and negatively with thinnest corneal thickness (TCT) (r = - 0.641, p < 0.001). CONCLUSION: ΔET is markedly steeper in keratoconus than in regular astigmatism-even in Stage I-and correlates with steep keratometry and TCT. With areas under the curves (AUCs) up to 0.976, ΔET provides a rapid, non-invasive epithelial-based biomarker for early detection and staging of keratoconus. Its utility for monitoring progression remains to be established in prospective longitudinal studies.
Clinical and demographic characteristics of glaucoma patients in Kingston, Jamaica.
McIntosh BL, Asowata OJ, Funk KL … +3 more , Pixley KR, Brown CS, Cooke Bailey JN
Int Ophthalmol · 2026 Apr · PMID 42053681 · Full text
PURPOSE: To characterize the clinical, demographic, and imaging features of glaucoma among adults receiving care at Kingston Public Hospital (KPH) Ophthalmology clinic, Jamaica's largest public eye care facility. METHODS...
PURPOSE: To characterize the clinical, demographic, and imaging features of glaucoma among adults receiving care at Kingston Public Hospital (KPH) Ophthalmology clinic, Jamaica's largest public eye care facility. METHODS: We conducted a retrospective, cross-sectional chart review of adult glaucoma patients seen at the KPH Ophthalmology Clinic between January 2018 and March 2023. Included patients had documentation of at least two comprehensive ophthalmic examinations and one high-quality optical coherence tomography (OCT) scan (signal strength ≥ 6). Extracted data included demographics, intraocular pressure (IOP), visual acuity, OCT-derived optic nerve head and retinal nerve fiber layer (RNFL) parameters, visual field (VF) metrics, glaucoma severity, comorbidities, and self-reported treatment adherence. Comparisons were performed by age group (< 40 vs. ≥ 40 years) and sex. RESULTS: A total of 324 patients (619 eyes) were included (mean age 58.3 ± 12.3 years; 66.0% female). At presentation, 51.0% had advanced-stage glaucoma, and only 17.3% reported consistent medication use. Hypertension and diabetes were common comorbidities (80.3% and 38.8%, respectively). Mean Goldmann IOP was 22.0 mmHg, mean RNFL thickness was 75.2 ± 14.9 μm, and mean cup-to-disc ratio was 0.73 ± 0.10. VF indices demonstrated moderate functional loss, with worse mean deviation among men. Longitudinal VF data were limited; only 17% of patients had more than one documented test, limiting cohort-wide assessment of functional progression. CONCLUSION: This clinic-based characterization of glaucoma in Jamaica reveals a high burden of advanced disease at presentation, low treatment adherence, and gaps in longitudinal monitoring, supporting the need for prospective studies to develop ancestry-and region-specific OCT reference data and improve equitable glaucoma care.
The Efficacy and Safety of Recombinant Human Nerve Growth Factor (rhNGF) in Patients With Dry Eye Disease: A Systematic Review and Meta-analysis.
Qutub MF, Alajmi TS, Alnabihi AN … +5 more , Alamoudi A, Almarwani SH, Ageel SE, Tabbakh BS, Alghamdi LN
Int Ophthalmol · 2026 Apr · PMID 42053663 · Publisher ↗
BACKGROUND: Dry eye disease (DED) is a multifactorial condition affecting the ocular surface. Recombinant human nerve growth factor (rhNGF) has emerged as a potential new treatment for neurosensory dysfunction. The aim o...
BACKGROUND: Dry eye disease (DED) is a multifactorial condition affecting the ocular surface. Recombinant human nerve growth factor (rhNGF) has emerged as a potential new treatment for neurosensory dysfunction. The aim of this study is to evaluate the efficacy and safety of rhNGF in patients with DED. METHODS: A comprehensive search of six online databases-Medline, CENTRAL, Web of Science, Ovid Medline, ClinicalTrials.gov, and Google Scholar-was conducted to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of rhNGF in patients with dry eye disease, focusing on outcomes such as tear production, ocular surface integrity, and adverse events. RESULTS: The results demonstrated that rhNGF significantly improved tear production compared with placebo, as measured by the Schirmer test (MD = 3.84; 95% CI: 2.17-5.51; P < 0.00001; I = 8%). No significant differences were observed in corneal and conjunctival staining (MD = -0.69; 95% CI: -1.62 to 0.25; P = 0.15; I = 0%) or tear breakup time (TBUT) (MD = 0.18; 95% CI: -1.08 to 1.45; P = 0.78; I = 80%). Non-severe adverse events were more frequent with rhNGF, while serious adverse events were similar between groups. Non-severe adverse events were more frequent in the rhNGF group, while the incidence of serious adverse events was comparable to that of the placebo group. CONCLUSION: rhNGF shows promise for improving tear production in patients with dry eye disease, as demonstrated by significant improvement in Schirmer test results. However, evidence for broader clinical efficacy remains limited, with other outcomes showing non-significant or heterogeneous findings. Current data are based on a small number of trials, indicating the need for larger, well-designed studies to clarify the therapeutic role and safety profile of rhNGF in dry eye disease.
Postoperative residual refractive astigmatism analysis in cylinder correction with toric IOL in patients with different degrees of astigmatism using AS-OCT and total keratometry.
de Paula A, Leucci L, Corsi A
Int Ophthalmol · 2026 Apr · PMID 42053655 · Publisher ↗
PURPOSE: To analyze the refractive outcomes in patients with different degrees of astigmatism undergoing cataract surgery with toric monofocal IOL implantation. METHODS: A consecutive series of patients that underwent ca...
PURPOSE: To analyze the refractive outcomes in patients with different degrees of astigmatism undergoing cataract surgery with toric monofocal IOL implantation. METHODS: A consecutive series of patients that underwent cataract surgery and Toric IOL implantation was reviewed. The preoperative evaluation of anterior and posterior keratometry, corneal topo/tomography was performed with AS-OCT Casia 2. Basing on real cylinder, the patients were divided in three groups. Group 1: total corneal astigmatism ≤ 1D, group 2: total corneal astigmatism between 1 and 1.5 D, group 3: total corneal astigmatism ≥ 1.5D. The residual post-operative refractive astigmatism and the percentage of astigmatic correction were evaluated one months after the surgery. Vector astigmatism analysis was performed applying the Alpins method. RESULTS: 100 eyes of 100 patients were enrolled. The mean post-operative refractive astigmatism (in absolute values) was 0.23 ± 0.28 D; 0.16 ± 0.27 D and 0.48 ± 0.44 D in group 1, 2 and 3 respectively. The best percentage of astigmatic correction was found in group 2 (88.05 ± 20.11%) with a significant difference with group 1 and 3. The average AE was 5.68 ± 8.33° in group 1, 2.2 ± 4.13° in group 2 and 3.97 ± 4.89° in group 3. The differences were significant in particularly between the second and the third group and less between the first and the second group. The best DV and IOS were found in group 2. CONCLUSION: Toric IOL was successfully applied in any amount of astigmatism and that the best refractive results were achieved in mild astigmatism.
Corneal astigmatism magnitude, axis distribution, and ocular biometric characteristics in cataract surgery candidates: a tertiary center study from the Western Black Sea region of Turkey.
Göğüş Çamlı B, Aktaş Özaltun Ö, Gündüz Çetinkaya B … +1 more , Ekizoğlu A
Int Ophthalmol · 2026 Apr · PMID 42047922 · Publisher ↗
PURPOSE: To evaluate ocular biometric parameters and corneal astigmatism characteristics in cataract surgery candidates from the Western Black Sea region of Turkey. METHODS: This retrospective cross-sectional study inclu...
PURPOSE: To evaluate ocular biometric parameters and corneal astigmatism characteristics in cataract surgery candidates from the Western Black Sea region of Turkey. METHODS: This retrospective cross-sectional study included patients who underwent preoperative ocular biometry between December 2023 and December 2025 at the only tertiary referral hospital in Karabük, Turkey. One eye per patient was analyzed. Measurements were obtained using the Nidek AL-Scan optical biometer and included axial length (AL), keratometry (K1, K2, Km), corneal astigmatism magnitude, central corneal thickness (CCT), anterior chamber depth (ACD), and white-to-white distance (WTW). Astigmatism axis was classified as with-the-rule (WTR), against-the-rule (ATR), or oblique. Correlation analyses and multivariate logistic regression were performed to identify factors associated with ATR astigmatism and clinically significant astigmatism (≥ 1.00 D). RESULTS: A total of 1087 eyes were included, with a mean age of 68.82 ± 8.48 years. Mean AL was 23.27 ± 0.92 mm and mean corneal astigmatism was 0.81 ± 0.56 D. WTR astigmatism was most common (45.2%), followed by ATR (37%) and oblique (17.9%), and nearly 1/3 of eyes had astigmatism > 1.00 D. A significant age-related shift from WTR to ATR was observed (p < 0.001). AL was positively correlated with ACD and WTW and negatively correlated with Kmean (p < 0.001). In multivariate analysis, age was independently associated with ATR astigmatism, AL and mean keratometry were associated with ≥ 1.00 D astigmatism. CONCLUSION: Corneal astigmatism is common in this population, highlighting the need for comprehensive preoperative biometric evaluation; given its dynamic nature, individualized assessment is essential for optimal surgical planning.
Risk factors affecting visual outcomes following vitrectomy for retinal detachment secondary to branch retinal vein occlusion.
Lin G, Liu X, Zhou Y … +1 more , Xiong Y
Int Ophthalmol · 2026 Apr · PMID 42047876 · Publisher ↗
PURPOSE: To analyze clinical characteristics and visual outcomes of retinal detachment (RD) following branch retinal vein occlusion (BRVO) in patients undergoing vitrectomy, and to identify risk factors influencing visua...
PURPOSE: To analyze clinical characteristics and visual outcomes of retinal detachment (RD) following branch retinal vein occlusion (BRVO) in patients undergoing vitrectomy, and to identify risk factors influencing visual prognosis. METHODS: This retrospective study included 28 consecutive eyes with RD secondary to BRVO that underwent vitrectomy between January 2013 and December 2021. Preoperative data included best-corrected visual acuity (BCVA), fibrovascular membrane (FVM) severity (non-FVM, mild FVM, severe FVM), macular status, and retinal detachment extent. All patients underwent 23-gauge pars plana vitrectomy with phacoemulsification. Visual outcomes and complications were analyzed using univariable and multivariable regression models. RESULTS: Mean patient age was 59.3 ± 6.7 years with 60.7% being female. Median preoperative BCVA was counting fingers. Retinal reattachment was achieved in all 28 eyes with no recurrent RD during follow-up. Three patients (10.7%) developed postoperative macular holes (MH), with two achieving spontaneous closure. Multivariable analysis revealed that severe FVM (coefficient = 0.351, 95%CI: 0.119-0.642, P = 0.003) and macula-off status (coefficient = 0.239, 95%CI: 0.064-0.422, P = 0.010) were independent risk factors for poorer final BCVA. Preoperative BCVA did not correlate with final visual outcomes (P = 0.764). CONCLUSION: In this small retrospective series, vitrectomy achieved a high anatomical reattachment rate for RD secondary to BRVO. Severe fibrovascular membranes and macula-off retinal detachment were identified as independent risk factors associated with poorer visual outcomes. Postoperative MH formation was observed, particularly in eyes with FVM.
Formulation of treatment protocol for ocular surface squamous neoplasia.
Daryabari SH, Aghamollaei H, Hassanpour SR … +4 more , Rezaei J, Hosseini Imeni SM, Sepandi M, Raei M
Int Ophthalmol · 2026 Apr · PMID 42047870 · Publisher ↗
In this study we report a structured, evidence-based treatment protocol for ocular surface squamous neoplasia (OSSN) by integrating findings from a systematic literature review with expert clinical insights. We performed...
In this study we report a structured, evidence-based treatment protocol for ocular surface squamous neoplasia (OSSN) by integrating findings from a systematic literature review with expert clinical insights. We performed a two-step methodology. First, a comprehensive systematic review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies on OSSN treatment. Articles were screened based on predefined inclusion and exclusion criteria. Next, a focused group discussion was conducted with expert ophthalmologists to develop a consensus-driven treatment protocol. Discussions were transcribed and thematically analyzed to identify key recommendations for treatment selection and follow-up strategies. Based on the literature review and expert panel consensus, a structured treatment protocol was developed. Surgical treatment is recommended in cases with uncertainty regarding the diagnosis, resource limitations, exclusive corneal involvement, and poor patient compliance with medical treatment or follow-up. Medical treatment with interferon α-2b or 5-fluorouracil is preferred in other scenarios, with agent selection based on side-effect profile and medication availability. Adjuvant therapy is advised when surgical margins are involved. Furthermore, a standardized follow-up schedule is proposed, ensuring long-term monitoring for recurrence. In conclusion, this protocol provides a structured, adaptable framework for OSSN treatment, offering clear guidelines for selecting the appropriate treatment strategy. By balancing evidence-based recommendations with clinical considerations, this protocol aims to optimize patient outcomes.
Correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with different corneal astigmatism degrees: a retrospective cohort study.
Zhang M, Luo X
Int Ophthalmol · 2026 Apr · PMID 42047855 · Publisher ↗
PURPOSE: To investigate the correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with varying degrees of corneal astigmatism, and to identify factors influencing patie...
PURPOSE: To investigate the correlation between postoperative visual recovery and subjective visual satisfaction in cataract patients with varying degrees of corneal astigmatism, and to identify factors influencing patient-reported outcomes following modern cataract surgery. METHODS: This retrospective cohort study analyzed 682 eyes of cataract patients who underwent phacoemulsification with standard monofocal non-toric intraocular lens (IOL) implantation targeting emmetropia between January 2022 and December 2022. Patients were stratified into four groups based on preoperative corneal astigmatism: Group 1 (< 0.75 D, n = 250), Group 2 (0.75-1.50 D, n = 245), Group 3 (1.51-2.50 D, n = 121), and Group 4 (> 2.50 D, n = 66). Primary outcomes included best-corrected visual acuity (BCVA), uncorrected distance visual acuity (UDVA), and patient satisfaction scores measured using the modified NEI VFQ-25 questionnaire. Secondary outcomes encompassed visual symptoms and spectacle independence for distance vision. RESULTS: Mean postoperative UDVA improved significantly across all groups (p < 0.001), with Group 1 achieving 0.12 ± 0.08 logMAR compared to 0.36 ± 0.14 logMAR in Group 4. Postoperative BCVA was ≥ 20/30 in 97.1% of all eyes, confirming good visual potential across groups. Patient satisfaction composite scores decreased progressively with increasing astigmatism magnitude (Group 1: 88.4 ± 9.2 vs. Group 4: 67.1 ± 15.8; p < 0.001). Spectacle independence for distance vision was achieved in 92.5% of Group 1 patients versus 45.5% in Group 4. Multiple regression analysis revealed that postoperative UDVA (β = - 0.42, p < 0.001), residual astigmatism (β = - 0.38, p < 0.001), and severity of glare symptoms (β = - 0.21, p = 0.003) were significant independent predictors of reduced satisfaction (adjusted R2 = 0.57). CONCLUSIONS: Higher degrees of preoperative corneal astigmatism are associated with reduced postoperative visual satisfaction despite good BCVA outcomes. These findings support a low threshold for astigmatism management and highlight the importance of comprehensive patient counseling regarding expected visual outcomes based on preoperative astigmatism magnitude.
Old clear penetrating keratoplasty with high astigmatism: conservative solution with customized foldable Toric Piggyback intraocular lens.
Mularoni C, Servillo A, Gaudenzi D … +2 more , Fabbri E, Mularoni A
Int Ophthalmol · 2026 Apr · PMID 42018245 · Publisher ↗
PURPOSE: To evaluate the efficacy and safety of toric foldable intraocular lens (IOL) for high astigmatism correction in eyes with prior penetrating keratoplasty (PK). METHODS: Clinical data were retrospectively collecte...
PURPOSE: To evaluate the efficacy and safety of toric foldable intraocular lens (IOL) for high astigmatism correction in eyes with prior penetrating keratoplasty (PK). METHODS: Clinical data were retrospectively collected at baseline and 12 months postoperatively from pseudophakic patients with high astigmatism (> 2 D), and previous PK, who underwent implantation of customized foldable toric IOLs using the piggyback technique. Uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest refraction, keratometry, refractive and topographic cylinder, endothelial cell count (ECC), and complications were assessed. To account for inter-eye correlation, analyses were performed using generalized estimating equations (GEE), and estimated differences (est.) with 95% confidence intervals (CI) were reported. RESULTS: Fourteen eyes of 11 patients (2 women, 9 men; mean age 62 ± 21 years) were included. The mean interval between PK and piggyback implantation was 24.18 years. Uncorrected and best-corrected visual acuity improved at 12 months (UCVA: est. - 0.69 logMAR; 95% CI, - 0.84 to - 0.54; p < 0.001; BCVA: est. - 0.20 logMAR; 95% CI, - 0.29 to - 0.11; p < 0.001). Total refractive astigmatism was reduced (est. - 4.09 diopters; 95% CI, - 5.20 to - 2.99; p < 0.001), whereas topographic astigmatism remained unchanged (est. - 0.03 diopters; 95% CI, - 0.21 to 0.16; p = 0.76). Endothelial cell count did not show a statistically significant change over time (est. - 67.8 cells/mm; 95% CI, - 139.6 to 4.0; p = 0.07). One eye experienced recurrent IOL rotation (80°), requiring explant and replacement. CONCLUSIONS: The favorable refractive outcomes and safety profile support the use of the piggyback technique with a customized toric foldable IOL for correcting high astigmatism in pseudophakic eyes that have undergone PK many years before. Larger sample size and prospective study are needed.
Topical ROCK inhibition accelerates recovery after Descemetorhexis Without Endothelial Keratoplasty (DWEK) in Fuchs endothelial corneal dystrophy: a prospective comparative clinical trial.
Jain P, Pradhan A, Dutta P … +2 more , Rangari P, Sodhi PK
Int Ophthalmol · 2026 Apr · PMID 42018070 · Publisher ↗
PURPOSE: To compare the clinical efficacy and recovery kinetics of Descemetorhexis Without Endothelial Keratoplasty (DWEK) performed with and without adjunctive topical ripasudil 0.4% in eyes with Fuchs endothelial corne...
PURPOSE: To compare the clinical efficacy and recovery kinetics of Descemetorhexis Without Endothelial Keratoplasty (DWEK) performed with and without adjunctive topical ripasudil 0.4% in eyes with Fuchs endothelial corneal dystrophy (FECD). SETTING: Cornea and Refractive Surgery Services, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India. DESIGN: Prospective, randomized, interventional, comparative clinical study. METHODS: Twenty-four eyes with mild-to-moderate FECD underwent phacoemulsification with a standardized 4-mm central DWEK and were randomized to DWEK-alone (Group A) or DWEK + topical ripasudil 0.4% four times daily for eight weeks (Group B). Primary outcomes were changes in best-corrected visual acuity (BCVA, logMAR), central corneal thickness (CCT), and peripheral endothelial cell density (ECD) over 6 months. Secondary outcomes were time to corneal clearing, optical quality (higher-order aberrations), and complications. RESULTS: BCVA improved significantly in both groups, with faster recovery in Group B (0.24 ± 0.11 vs. 0.36 ± 0.14 logMAR at 6 months; p < 0.05). CCT decreased more rapidly in Group B (572.1 ± 27.5 µm vs. 590.2 ± 29.8 µm; p = 0.04). Peripheral ECD remained stable in Group A but showed a mild gain in Group B (p = 0.04). Group B achieved earlier corneal deturgescence (mean 8 ± 2 weeks vs. 12 ± 3 weeks). No eye in either group developed persistent edema, interface haze, or required rescue keratoplasty. CONCLUSIONS: Adjunctive topical ripasudil after DWEK accelerates endothelial recovery, corneal deturgescence, and visual rehabilitation compared with DWEK alone, without compromising safety.
Transscleral diode cyclophotocoagulation for refractory glaucoma: real-world efficacy and safety.
Ertan E, Uran M
Int Ophthalmol · 2026 Apr · PMID 42018025 · Publisher ↗
PURPOSE: To evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TSCPC) in patients with refractory glaucoma using real-world clinical data from a tertiary referral center. METHODS: This re...
PURPOSE: To evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TSCPC) in patients with refractory glaucoma using real-world clinical data from a tertiary referral center. METHODS: This retrospective study reviewed the medical records of 143 patients who underwent primary TSCPC for refractory glaucoma between December 2022 and January 2024. Data regarding intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of IOP-lowering medications, repeat treatments, and postoperative complications were collected. Surgical success was defined as achieving an IOP between 6 and 21 mmHg with at least a 20% reduction from baseline, with (qualified success) or without (complete success) adjunctive medical therapy, in the absence of glaucoma-related phthisis bulbi, loss of light perception, or the need for additional glaucoma surgery other than repeat TSCPC. RESULTS: A total of 143 eyes from 143 patients (57.0% male) with a mean age of 62.0 ± 15.7 years were included. Neovascular glaucoma was the most common diagnosis (62.0%). Mean IOP decreased significantly from 35.9 ± 11.0 mmHg preoperatively to 16.2 ± 8.3 mmHg at the 12-month follow-up (p < 0.001). Overall surgical success was achieved in 65.8% of eyes, including 16.8% complete success and 49.0% qualified success. The mean number of antiglaucoma medications decreased from 2.8 ± 1.0 to 1.5 ± 1.1 (p < 0.001). Postoperative complications occurred in 10.9% of eyes and were predominantly mild and transient. No cases of persistent hypotony or phthisis bulbi were observed. CONCLUSIONS: In a real-world tertiary care setting, TSCPC was associated with significant IOP reduction and an acceptable safety profile over 12 months in patients with refractory glaucoma. Despite the high proportion of neovascular glaucoma cases, no sight-threatening complications such as persistent hypotony or phthisis bulbi were observed during follow-up. However, longer-term studies are needed to confirm the durability and long-term safety of these outcomes.
Refractive outcomes following low astigmatism correction guided by toric calculator recommendations.
Zlatkin R, Reitblat O, Trifonov I … +6 more , Laks A, Xia S, Cahn M, Einan-Lifshitz A, Bahar I, Sella R
Int Ophthalmol · 2026 Apr · PMID 42018012 · Publisher ↗
PURPOSE: To examine refractive outcomes after cataract extraction with a toric correction of 1.0 diopter as recommended by the Barrett Toric Calculator. METHODS: Retrospective analysis of patients who underwent cataract...
PURPOSE: To examine refractive outcomes after cataract extraction with a toric correction of 1.0 diopter as recommended by the Barrett Toric Calculator. METHODS: Retrospective analysis of patients who underwent cataract surgery in two tertiary medical centers with a toric intraocular lens (IOL) providing a 1.0 diopter correction in the IOL plane. Electronic patient charts were screened for preoperative and postoperative data, including visual acuity, subjective refraction, biometry measurements, and corneal tomography. Refractive outcomes were compared to a control group with low astigmatism who had undergone cataract extraction with a non-toric monofocal lens and another group with high-toric IOLs. RESULTS: Twenty-six eyes with low-toric IOLs (LT) were compared to 28 non-toric monofocal IOLs (NT) and 47 high-toric IOLs (HT). The trimmed (tr) mean centroid prediction error in refractive astigmatism (RA) was similar between LT and HT groups (0.08D@1.3° vs. 0.11D@93.0°, p = 0.24), as was the postoperative RA centroid (0.09D@109.8° vs. 0.2D@93.9°, p = 0.1). The LT group had a lower tr-mean centroid and absolute postoperative RA than the NT group (0.09D@09.8° vs. 0.49D@175.7°, p<0.001, 0.29D vs. 0.84D, p = 0.001). Simulation showed improved outcomes with low-toric IOLs in the NT group: lower centroid astigmatism (0.11D@35.1°, p = 0.001) and lower absolute residual astigmatism (0.54D, p = 0.009). CONCLUSIONS: Correction of 1.0 diopter in the IOL plane demonstrates comparable accuracy and precision to higher astigmatism correction with toric IOLs, with potentially favorable refractive outcomes compared to patients eligible for this correction but fitted with monofocal non-toric IOLs.
Orthokeratology for stable mild-to-moderate keratoconus: a pilot study on safety and corneal remodeling via quantitative OCT analysis.
Zhang C, Hu Z, Li W … +4 more , Zhang X, He C, Lin S, Wang B
Int Ophthalmol · 2026 Apr · PMID 41996040 · Full text
OBJECTIVE: To assess the efficacy and safety of overnight orthokeratology (Ortho-K) in patients with stable, mild-to-moderate keratoconus and myopia, with a focus on epithelial and Bowman's layer structural changes. METH...
OBJECTIVE: To assess the efficacy and safety of overnight orthokeratology (Ortho-K) in patients with stable, mild-to-moderate keratoconus and myopia, with a focus on epithelial and Bowman's layer structural changes. METHODS: A prospective single-center cohort study enrolled 13 patients (24 eyes) with stable, mild-to-moderate keratoconus (Amsler-Krumeich grades I-II, age 14-21 years) who were fitted with Euclid Emerald Ortho-K lenses and followed for 18 months to evaluate clinical outcomes. Primary outcome measures included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive error, axial length, corneal topographic parameters, corneal and corneal epithelial thickness (central, nasal, temporal), and quantitative analysis of the cross-sectional area of Bowman's layer using optical coherence tomography (OCT). Treatment-related adverse events and patient dropout were also recorded. RESULTS: After 18 months of intervention, UCVA improved significantly from logMAR 0.59 ± 0.29 to 0.19 ± 0.16 (p < 0.05). The mean myopic refraction significantly decreased from - 2.46 ± 1.25 D to - 0.62 ± 0.24 d (p < 0.05). Characteristic corneal epithelial remodeling was observed: significant thinning in the central zone (from 54 ± 9 to 41 ± 8 μm, p < 0.05) and significant thickening in the nasal and temporal zones (from 51 ± 11 to 64 ± 17 μm and from 62 ± 13 to 71 ± 9 μm, respectively; p < 0.05 for both). The key safety finding was the absence of statistically significant changes in the cross-sectional area of Bowman's layer at the nasal and temporal locations before and after treatment (p > 0.05). Axial length remained stable (mean elongation: 0.14 ± 0.13 mm, p = 0.583). Total higher-order aberrations (HOA) showed a decreasing trend that did not reach statistical significance. Five of the 18 initially enrolled patients discontinued treatment, primarily due to visual symptoms (nocturnal glare, halos) or tolerance issues (dry eye, handling difficulties). A total of 23 episodes of mild corneal punctate staining were recorded, all of which resolved completely following temporary lens discontinuation and pharmacological treatment, with no serious complications. CONCLUSION: In rigorously selected patients with stable, mild-to-moderate keratoconus, overnight orthokeratology induces predictable epithelial remodeling-characterized by central thinning and paracentral thickening-leading to significant improvements in uncorrected visual acuity and refractive stability. Critically, high-resolution OCT revealed no significant change in the cross-sectional area of Bowman's layer over 18 months, suggesting that this intervention does not compromise deep stromal structural integrity. These findings support orthokeratology as a viable, non-surgical adjunct for daytime spectacle independence in a highly selected ectatic population, provided that stringent fitting protocols and longitudinal structural monitoring are implemented.
Longitudinal evaluation of optic nerve head perfusion after phacoemulsification using OCT angiography.
Derakhshan A, Azadmehr O, Bakhtiari E … +1 more , Shariati MM
Int Ophthalmol · 2026 Apr · PMID 41984338 · Publisher ↗
BACKGROUND: Cataract surgery may influence posterior segment microcirculation; however, its effect on optic nerve head (ONH) perfusion remains incompletely understood. Optical coherence tomography angiography (OCTA) enab...
BACKGROUND: Cataract surgery may influence posterior segment microcirculation; however, its effect on optic nerve head (ONH) perfusion remains incompletely understood. Optical coherence tomography angiography (OCTA) enables noninvasive assessment of ONH microvasculature and may reveal subtle postoperative changes. METHODS: This prospective cohort study enrolled 76 eyes from 38 patients undergoing uncomplicated phacoemulsification cataract surgery. ONH OCTA imaging was performed preoperatively and at 1 week, 1 month, and 3 months postoperatively using the OptoVue system. Radial peripapillary capillary (RPC) vessel density parameters were measured across whole-image, peripapillary, inside-disc, and sectoral regions. ONH tomographic parameters were also recorded. Repeated-measures ANOVA and ANCOVA were used to assess time-dependent changes, adjusting for age, sex, axial length, phacoemulsification energy, and surgery duration. The fellow eye served as an internal control. RESULTS: Whole-image RPC vessel density for both small and all vessels increased significantly at all postoperative time points compared with baseline (p < 0.01). Sectoral and regional RPC parameters remained largely stable, except for the superior peripapillary sector, which demonstrated a significant time-dependent change independent of covariates. No significant vascular changes were observed in the fellow eyes. ONH tomographic parameters, including cup-to-disc ratios, rim area, disc area, cup volume, and peripapillary retinal nerve fiber layer thickness, showed no significant postoperative changes. CONCLUSION: Uncomplicated phacoemulsification cataract surgery is associated with an increase in global ONH microvascular perfusion as measured by OCTA, without accompanying structural alterations. These findings highlight the importance of considering cataract status when interpreting ONH OCTA metrics and suggest that postoperative scans should be regarded as a new baseline for longitudinal assessment.
Agreement of wavefront-based refraction with autorefraction and manifest refraction across refractive and astigmatic profiles in refractive surgery candidates.
Doostparast A, Zarei-Ghanavati S, Semnani F … +5 more , Ghandhari M, Doostparast A, Salar E, Islampanah M, Eslampoor A
Int Ophthalmol · 2026 Apr · PMID 41973261 · Publisher ↗
BACKGROUND: To assess the agreement between wavefront-based refraction (WFR) using a pyramidal aberrometer (PERAMIS) and conventional non-cycloplegic (NCR), cycloplegic (CR), and manifest refraction (MR) techniques acros...
BACKGROUND: To assess the agreement between wavefront-based refraction (WFR) using a pyramidal aberrometer (PERAMIS) and conventional non-cycloplegic (NCR), cycloplegic (CR), and manifest refraction (MR) techniques across refractive types and astigmatic axes. METHODS: This cross-sectional study evaluated 111 right eyes of refractive surgery candidates. WFR from PERAMIS was compared with NCR, CR, and MR for sphere, cylinder, spherical equivalent (M), blur (B), and astigmatic vectors (J0, J45). Subgroup analyses examined ametropia status, myopia severity, and astigmatic axis. RESULTS: A consistent refractive trend: CR < MR < NCR < WFR was observed for M, even within the subgroups. WFR consistently yielded more myopic measurements than CR, MR, and NCR (M-MD: - 0.56 D (p < 0.001), - 0.39 D (p < 0.001), and - 0.10 D (p < 0.05), respectively). WFR demonstrated excellent correlation with NCR (ICC = 0.98), CR (ICC = 0.96), and MR (ICC = 0.97) for M. This correlation remained high for other refractive components (ICC > 0.90) except J45, where moderate correlation was observed (ICC: 0.75-0.82). The correlation was superior in myopic eyes (ICC values > 0.90 except for J45; MDs almost < 0.50 D) compared to hyperopic eyes (ICC values ranging from 0.71 (WFR-MR cylinder) to 0.93 (WFR-NCR sphere, MDs < 0.75 D). Furthermore, WFR showed an excellent correlation with NCR, CR, and MR across astigmatism types (M: ICCs: 0.93-0.99, MDs < 0.75 D). Despite the high correlation, the limits of agreement (LoA) were wide in the whole population, especially for WFR-CR (LoA for M: - 1.67:0.55 D) and WFR-MR (LoA for M: - 1.41:0.63 D), with similar patterns across all subgroups. CONCLUSION: Pyramidal WFR may be a valuable complement to conventional refractive measurements, particularly in patients with myopia. However, its tendency toward myopic bias and wide LoAs limits its interchangeability with CR or MR. Clinicians should interpret WFR cautiously, especially in hyperopic eyes, and consider confirming measurements with subjective methods. These findings support the utility of pyramidal WFR as an efficient initial estimate in refractive evaluations, especially for surgical screening, but not as a standalone replacement for traditional refraction.
Anatomic and functional outcomes of intravitreal faricimab for polypoidal choroidal vasculopathy: a review.
Chang CW, Liu PK, Cheng KC … +7 more , Lai HC, Wu HJ, Lee DY, Lo MW, Chen KJ, Lin HC, Chang YC
Int Ophthalmol · 2026 Apr · PMID 41973161 · Publisher ↗
PURPOSE: This review examines anatomic and functional outcomes of intravitreal faricimab for treating polypoidal choroidal vasculopathy (PCV), a neovascular age-related macular degeneration subtype common in Asian popula...
PURPOSE: This review examines anatomic and functional outcomes of intravitreal faricimab for treating polypoidal choroidal vasculopathy (PCV), a neovascular age-related macular degeneration subtype common in Asian populations. Faricimab is a bispecific antibody targeting both VEGF-A and Ang-2, potentially offering more durable effects than standard anti-VEGF monotherapy. METHODS: A narrative review was conducted by searching PubMed, Embase, and Web of Science through July 2024. Keywords included faricimab, polypoidal choroidal vasculopathy, and anti-VEGF. Eligible studies comprised English-language, peer-reviewed human trials (prospective, retrospective, case series, and reports). Conference abstracts and non-peer-reviewed sources were excluded. RESULTS: In treatment-naïve patients, preliminary data suggest that faricimab may yield favorable results, though findings are largely derived from small retrospective studies. Functionally, a one-year study reported significant improvement in mean best-corrected visual acuity (BCVA), from 0.30±0.33 logMAR at baseline to 0.16±0.26 logMAR at final visit. However, some studies note visual gains may not be statistically significant during initial loading phase. Anatomically, high polyp regression rates are key findings, with one study reporting 61.1% rate after three monthly injections. High rates of dry macula (60-80%) and significant reductions in central foveal thickness (CFT) and central choroidal thickness (CCT) are consistently observed. For patients with suboptimal response to prior anti-VEGF therapies, switching to faricimab presents mixed picture. While a prospective cohort study found no significant average improvement in visual acuity for switched PCV eyes, a case report showed dramatic improvement from 20/100 to 20/60 after two injections in a ranibizumab-refractory case. Anatomically, switched patients show significant reduction in choroidal thickness and serous pigment epithelial detachments (PEDs). However, the presence of polypoidal lesions was identified as a negative predictive factor for successfully extending the treatment interval. CONCLUSIONS: Based on limited retrospective evidence, faricimab may represent a promising therapeutic candidate for PCV, with several studies reporting anatomical improvements. The dual mechanism of action targeting both VEGF-A and Ang-2 may help address certain pathological features of the disease; however, confirmation from larger prospective studies is needed.
From synthetic to biological rings: CAIRS for visual preservation after PMMA ICRS extrusion in keratoconus, a case report.
Barbara A, Barbara R
Int Ophthalmol · 2026 Apr · PMID 41961335 · Publisher ↗
PURPOSE: To report the outcome of partial replacement of an extruded PMMA intracorneal ring segment (ICRS) with corneal allogenic intrastromal ring segment (CAIRS) in advanced keratoconus. CASE PRESENTATION: A patient wi...
PURPOSE: To report the outcome of partial replacement of an extruded PMMA intracorneal ring segment (ICRS) with corneal allogenic intrastromal ring segment (CAIRS) in advanced keratoconus. CASE PRESENTATION: A patient with advanced keratoconus previously treated with a pair of Ferrara ring segments, achieved stable visual improvement for over 20 years. In 2024, extrusion of one segment occurred. The extruded PMMA segment was removed and replaced with a full-thickness CAIRS, while the second segment was left in situ. Despite technical challenges in adapting the CAIRS to the pre-existing tunnel, implantation was successful and visual acuity was preserved. CONCLUSION: Partial exchange of an extruded ICRS with CAIRS is feasible and may maintain prior visual and biomechanical gains, offering an alternative to complete segment removal in selected cases.
Evaluation of the corneal endothelium in clear grafts after deep anterior lamellar keratoplasty using specular microscopy.
Sahin EE, Faiz Turan M, Koçluk Y … +1 more , Kasım Tekdemir B
Int Ophthalmol · 2026 Apr · PMID 41961333 · Publisher ↗
PURPOSE: To evaluate postoperative endothelial cell function and corneal transparency in patients who underwent deep anterior lamellar keratoplasty (DALK) due to keratoconus (KC), macular corneal dystrophy (MCD), lattice...
PURPOSE: To evaluate postoperative endothelial cell function and corneal transparency in patients who underwent deep anterior lamellar keratoplasty (DALK) due to keratoconus (KC), macular corneal dystrophy (MCD), lattice corneal dystrophy (LCD), or corneal scarring. METHODS: This retrospective study included 55 eyes of 55 patients who underwent DALK between 2014 and 2023 and 56 eyes of 56 healthy individuals as controls. Endothelial cell density (ECD) and cell morphology were assessed using specular microscopy, and corneal densitometry measurements were obtained using Pentacam at postoperative months 1, 6, and 12. Outcomes were compared between the patient and control groups and among diagnostic subgroups within the DALK cohort. RESULTS: At postoperative month 1, corneal densitometry values were significantly higher in the DALK group compared with the control group (p < 0.0001). Endothelial cell density was significantly lower in the DALK group than in controls (p < 0.0001). No significant difference in ECD was observed among the diagnostic subgroups (KC, MCD, LCD, and corneal scarring) (p = 0.367). In the MCD group, anterior and central 0-2 mm densitometry values at postoperative month 1 were significantly higher than those in the KC and LCD groups (p = 0.026); however, no significant differences were observed at months 6 and 12. CONCLUSIONS: Although endothelial cell density was reduced in all diagnostic groups after DALK compared with healthy controls, adequate endothelial cell function was preserved. The preservation of endothelial function in patients with macular corneal dystrophy indicates that DALK can be safely performed in this patient population.
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