Int Ophthalmol [JOURNAL]
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200 papers
Multimodal imaging evaluation and management of orbital metastasis: experience at a single institution.
Ayres B, Singalavanija T, Demirci H
Int Ophthalmol · 2026 Mar · PMID 41774255 · Full text
BACKGROUND AND PURPOSE: The orbit is an unusual site for metastatic cancer. This study evaluated the ultrasonographic and MRI/CT imaging features of orbital metastasis (OM) as well as demographic, clinical, radiological,...
BACKGROUND AND PURPOSE: The orbit is an unusual site for metastatic cancer. This study evaluated the ultrasonographic and MRI/CT imaging features of orbital metastasis (OM) as well as demographic, clinical, radiological, management, and outcome. METHODS: Retrospective, non-comparative single-institutional chart review of patients with OM. Records were evaluated for age at presentation, race, gender, laterality, site of primary tumor, imaging findings of orbital metastasis, treatment, and outcome. RESULTS: There were 12 males and 15 females whose mean age at presentation was 60 years. Twenty-three patients (85%) had known primary cancer. Primary malignancies were breast carcinoma in 12 patients (44.5%), melanoma in 5 (18.5%), and lung carcinoma in 3 (11.1%). The most present findings were ocular motility disturbances (63%), proptosis (55%), and vision loss (19%). The lesions were well-outlined in 74%, located posterior to the equator in 59%, involved only one quadrant in 56%, and involved the extraocular muscles in 74%. Ultrasound was able to detect orbital or muscle lesions in 24 patients (89%). The shape, configuration, and location of the lesion and detection of extraocular muscle involvement agreed between MRI/CT and US exams. Treatment protocols included radiotherapy, chemotherapy, immunotherapy, hormone therapy and surgical excision. Seventeen patients (63%) had died of metastasis, with a mean overall survival time of 19 months after OM diagnosis. CONCLUSIONS: Breast carcinoma, melanoma, and lung carcinoma are the most common primary malignancies that metastasize to the orbit. OM tends to infiltrate the extraocular muscles. Ultrasound provides reliable parameters and can be used as a primary screening when evaluating suspected OM lesions. The survival time of patients with OM is generally poor.
Actinomyces odontolyticus keratitis: an emerging opportunist in ocular surface diseases.
Thorat D, Panchbhai D, Bagga B … +1 more , Joseph J
Int Ophthalmol · 2026 Mar · PMID 41774226 · Publisher ↗
PURPOSE: To describe the risk factors, clinical and microbiological profile, management, and outcomes of Actinomyces odontolyticus-associated keratitis in a retrospective case series from a tertiary eye care center in So...
PURPOSE: To describe the risk factors, clinical and microbiological profile, management, and outcomes of Actinomyces odontolyticus-associated keratitis in a retrospective case series from a tertiary eye care center in South India. METHODS: A retrospective analysis was conducted on seven patients with culture-proven Actinomyces odontolyticus keratitis at the LV Prasad Eye Institute, Hyderabad, between January 2024 and April 2025. Demographic data, clinical features, risk factors, microbiological findings, treatment course, and outcomes were reviewed. RESULTS: Of the seven patients, five (71%) had pre-existing ocular surface abnormalities, including non-healing epithelial defects (PED) post therapeutic penetrating keratoplasties, spheroidal degeneration, and chemical injury. Six out of seven (86%) had a pre-existing PED before they developed keratitis. Four had undergone prior ocular surgeries and were on long-term topical corticosteroids (average duration 53 days). Corneal ulcers had a median size of 2.7 (IQR,1.5-4.5 mm). Five out of 7 patients responded to topical fortified cefazolin 5%, with complete resolution of infection. The average duration of medical therapy was approximately 72 days (15-150 days). Two patients required adjuvant interventions, including cyanoacrylate glue, bandage contact lens, and anterior chamber reformation for corneal perforation. Three patients underwent optical penetrating keratoplasty. The remaining four had satisfactory outcomes with medical management alone. Final best-corrected LogMAR visual acuity ranged from 2.4 to 0.40 at the last follow-up. CONCLUSIONS: Actinomyces odontolyticus keratitis, though uncommon and often underrecognized in compromised eyes, can cause a non-healing epithelial defect and can be effectively managed with timely microbiological evaluation and appropriate antibiotic therapy.
Relationship between tear meniscus parameters and nasal anatomy: Does nasal septum deviation affect tear parameters?
Erduran B, Yeter V, Tahir E
Int Ophthalmol · 2026 Mar · PMID 41774090 · Publisher ↗
PURPOSE: To investigate whether nasal anatomical alterations associated with nasal septum deviation (NSD) contribute to early functional impairment in the lacrimal drainage system, potentially indicating subclinical stag...
PURPOSE: To investigate whether nasal anatomical alterations associated with nasal septum deviation (NSD) contribute to early functional impairment in the lacrimal drainage system, potentially indicating subclinical stages of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: Sixty-nine patients with unilateral NSD were included. Individuals with clinical or radiological evidence of PANDO were excluded. Lower tear meniscus height (LTMH) and area (LTMA) were bilaterally measured using anterior segment optical coherence tomography (AS-OCT). Nasal anatomical parameters were assessed on both the deviation side (DS) and contralateral side (CS) using paranasal sinus computed tomography (PNS-CT). RESULTS: Both LTMH and LTMA were significantly higher on the DS compared to the CS (p < 0.001). Significant positive correlations were observed between DS-LTMH and LTMA and several nasal anatomical features, including concha nasalis inferior bone thickness (CNI-BT), attachment angle, CNI-maxillary sinus angle (CNI-MS), CNI length, and inferior nasal meatus volume (INMV) (p < 0.05). On the CS, no nasal anatomical parameter demonstrated a significant correlation with both LTMH and LTMA. CONCLUSION: NSD may impair tear drainage even in the absence of clinical signs of PANDO. The observed correlations between tear meniscus parameters and specific nasal anatomical structures suggest that sinonasal alterations secondary to NSD may contribute to subclinical tear stasis. These findings highlight the potential role of nasal anatomy as an early indicator of predisposition to nasolacrimal duct obstruction in asymptomatic individuals.
Does hyperopic correction worsen exotropia? A retrospective comparison in Children with high hyperopia.
Unlu BH, Ural Fatihoglu O, Karatas E … +2 more , Yaman A, Berk AT
Int Ophthalmol · 2026 Mar · PMID 41770474 · Publisher ↗
PURPOSE: This study aimed to evaluate the effect of refractive correction on ocular deviation in children with exotropia and high hyperopia, and to compare treatment outcomes between partial and full hyperopic correction...
PURPOSE: This study aimed to evaluate the effect of refractive correction on ocular deviation in children with exotropia and high hyperopia, and to compare treatment outcomes between partial and full hyperopic correction. The main objective was to evaluate if complete hyperopic correction leads to worsening of exotropia in comparison to partial correction. METHODS: This retrospective study included 43 patients diagnosed with high hyperopia (≥ + 3.00 D) and exotropia (≥ 10 prism diopters). Patients were categorized into two groups based on the level of spectacle correction: Group 1 received partial correction and Group 2 received full correction. Statistical analysis was conducted to compare best-corrected visual acuity (BCVA), amblyopia, and the degree of exotropia deviation. RESULTS: The average age at first admission and the follow-up duration were 6.3 (± 3.1) years and 3.7 (± 3.0) years, respectively. Before spectacle correction, the mean visual acuity was 0.45 ± 0.28; it increased to 0.63 ± 0.31 after treatment (p < 0.001). Additionally, the number of patients diagnosed with amblyopia significantly decreased (p = 0.001). Twenty-seven patients received partial correction, while sixteen were treated with full correction. Although a slight reduction in exodeviation was observed, there were no statistically significant differences in the overall population or within any of the subtypes (constant exotropia and intermittent exotropia) when comparing deviation angles between the partial and full correction groups before and after treatment (p > 0.05). CONCLUSION: Refractive correction is essential for improving visual acuity and reducing amblyopia in children with exotropia and significant hyperopia. Our results suggest that the use of high hyperopic spectacle correction did not demonstrate worsening of exotropia in this cohort.
The role of intubation and dacryocystorhinostomy in the management of functional nasolacrimal duct obstruction: a systematic review.
Ang T, Muthineni V, Almater A … +1 more , Selva D
Int Ophthalmol · 2026 Mar · PMID 41770463 · Publisher ↗
PURPOSE: To review the role of nasolacrimal intubation and dacryocystorhinostomy (DCR) in functional nasolacrimal duct obstruction (FNLDO). METHODS: A systematic search was conducted from inception to the 31st March 2025...
PURPOSE: To review the role of nasolacrimal intubation and dacryocystorhinostomy (DCR) in functional nasolacrimal duct obstruction (FNLDO). METHODS: A systematic search was conducted from inception to the 31st March 2025 on PubMed, EMBASE and Web of Science databases. All studies describing a clinical diagnosis of "functional" obstruction was included. These included studies referencing historical variations of the term "functional block", "partial obstruction" and its associated clinical tests, such as patent syringing and/or positive Jones I and /or I testing", and/or adjunctive imaging including dacryocystogram (DCG) and/or dacryoscintigraphy (DSG). Studies depicting patients < 18 years-old, "complete" acquired nasolacrimal duct obstruction, clear evidence of NLDS; and ongoing epiphora despite prior DCR and anatomical patency were excluded. RESULTS: The search yielded 19 studies including 15 retrospective and 4 prospective studies. In 5 studies, patients were clearly defined as FNLDO with patent lacrimal syringing and/or Jones testing, DCG excluding nasolacrimal stenosis, and, if available, DSG to characterise the location of drainage delay. The remaining studies included terms such as "functional block" or "functional epiphora" defined as nasolacrimal duct patency via syringing only; and patent syringing and delayed DSG, without DCG excluding nasolacrimal duct stenosis (NLDS). Two studies were retrospective comparative studies between nasolacrimal intubation and DCR. Complete resolution for endoscopic DCR ranged from 64.7-97.2%, external DCR ranged from 53.8-94.1%; and nasolacrimal intubation ranged from 34.1-76%. CONCLUSION: Characterising the nature and extent of impaired nasolacrimal tear drainage is imperative in determining the most appropriate intervention. In FNLDO, DCR appears to have higher success rates than nasolacrimal intubation. Intubation represents a less invasive option for patients. Ultimately, determining appropriate management requires patient education and informed consent regarding the available options, efficacy, risks and clinical outcomes.
Visual outcomes after blunt ocular trauma: clinical findings, management, and prognostic factors.
Yılmaz YC, Hayat ŞÇ, Kelebek M … +1 more , Gözel ME
Int Ophthalmol · 2026 Mar · PMID 41770460 · Publisher ↗
PURPOSE: To characterize ocular findings, management strategies, and factors associated with visual outcomes following blunt ocular trauma, with particular emphasis on the prognostic relevance of macular commotio retinae...
PURPOSE: To characterize ocular findings, management strategies, and factors associated with visual outcomes following blunt ocular trauma, with particular emphasis on the prognostic relevance of macular commotio retinae. METHODS: This retrospective study included 288 patients with BOT who presented to a tertiary referral center between January 2021 and July 2025. Demographic characteristics, injury mechanisms, ocular findings, and treatment modalities were reviewed. Visual acuity (VA) was recorded at presentation and at final follow-up; poor visual outcome was defined as a final VA ≥ 1.0 LogMAR. Macular commotio retinae was graded based on the extent of foveal involvement, and its association with visual outcomes was analyzed. RESULTS: The median patient age was 36 years (IQR 27-48), and 51.4% were male. Falls (28.8%) and assaults (27.8%) were the most common mechanisms of injury. Traumatic cataract (24.0%) and hyphema (15.6%) were the most frequent anterior segment findings, while commotio retinae (25.7%) was the most common posterior segment lesion. Median VA improved significantly from 0.7 (IQR 0.4-1.3) LogMAR at presentation to 0.4 (IQR 0.22-0.7) LogMAR at final follow-up (p < 0.001); however, 14.2% of eyes had poor final visual outcomes. Higher grades of macular commotio retinae were strongly associated with poor visual outcome (p < 0.001). In contrast, anterior segment findings such as hyphema and traumatic cataract were not predictive in this cohort. Half of the patients (n = 144) were managed conservatively, while phacoemulsification and pars plana vitrectomy were the most commonly performed interventions. CONCLUSIONS: Blunt ocular trauma results in a broad spectrum of anterior and posterior segment injuries with variable visual prognosis. Grading the severity of macular commotio retinae provides clinically meaningful prognostic information, as higher grades are associated with persistent visual impairment. In contrast, many anterior segment injuries are potentially reversible with appropriate treatment. Comprehensive posterior segment evaluation and individualized management are essential to optimize visual outcomes after blunt ocular trauma.
A thirteen-year tertiary centre experience with infectious keratitis in the elderly population.
Karahan E, Barut Selver O, Aydemir S … +2 more , Yesim Metin D, Palamar M
Int Ophthalmol · 2026 Mar · PMID 41770441 · Publisher ↗
PURPOSE: This study aims to elucidate the classification, clinical presentation, follow-up, and treatment outcomes of elderly patients diagnosed with infectious keratitis. METHODS: This retrospective single-center analys...
PURPOSE: This study aims to elucidate the classification, clinical presentation, follow-up, and treatment outcomes of elderly patients diagnosed with infectious keratitis. METHODS: This retrospective single-center analysis, conducted at a tertiary ophthalmology center (Ege University Medical Faculty Hospital, Department of Ophthalmology, Izmir, Turkiye), included 317 patients aged ≥ 60 years diagnosed with infectious keratitis between January 2012 and January 2025. Microbiological culture results, clinical course, comorbidities, treatments, and outcomes were evaluated. RESULTS: The female-to-male ratio was 0.89 and the mean age was 72.1 ± 7.23 years (range: 60-96 years). Positive culture results were identified in 128 (40.4%) of 317 patients, with 81 (63.3%) bacterial and 47 (36.7%) fungal infections. Streptococcus pneumoniae (29.7%) was the most common pathogen. Most lesions were central/paracentral (89.9%) and single (79.2%). The mean best-corrected visual acuity (BCVA) improved from 2.33 ± 0.99 LogMAR to 1.99 ± 1.08 LogMAR (95% CI, 0.15-0.53; paired-samples t test, p < 0.001). Most patients (76.3%) responded favorably to empirical treatment. Recurrence occurred in 34 patients, 22 required corneal transplantation, and 9 underwent evisceration. Dry eye (43.8%) and systemic immunosuppression (36.9%) were the most common comorbidities. CONCLUSION: In the present study, differing from some others that report coagulase-negative Staphylococci as the predominant agent in elderly infectious keratitis patients, the most common pathogen was Streptococcus pneumoniae. This finding highlights potential regional or methodological differences. The presence of dry eye and systemic immunosuppression significantly influenced unfavorable outcomes, emphasizing the importance of addressing these risk factors. Tailored treatment strategies may improve outcomes in this population.
Juvenile open-angle glaucoma: a clinicopathological update and review.
Nadeem S
Int Ophthalmol · 2026 Mar · PMID 41770405 · Publisher ↗
PURPOSE: This review aims to highlight the characteristic clinical features, pathophysiology, risk factors, genetics, diagnostic work-up, therapeutic management, and recent advances in the clinical setting and management...
PURPOSE: This review aims to highlight the characteristic clinical features, pathophysiology, risk factors, genetics, diagnostic work-up, therapeutic management, and recent advances in the clinical setting and management of juvenile open-angle glaucoma (JOAG). METHODS: A retrospective literature review of PubMed and Google was judiciously done to provide this update [2000-2025]. A diagnosis of JOAG is established on the basis of history and clinical examination, tonometry, angle evaluation by gonioscopy, central corneal thickness (CCT) evaluation, and slit lamp biomicroscopy for evaluation of optic disc changes and retinal nerve fiber layer (RNFL) loss. Structural [optical coherence tomography (OCT) and OCT angiography] and functional assessment [automated perimetry] is important in diagnosis and monitoring it. RESULTS: Juvenile open-angle glaucoma is a rare type of primary open-angle glaucoma affecting individuals between 3 and 40 years of age. Classically described as having an early age of onset, high intraocular pressures, normal-appearing angles on gonioscopy, optic disc cupping, and visual field loss; other forms like juvenile ocular hypertension and juvenile normal tension glaucoma are also observed. Trabeculodysgenesis is the primary pathology hindering the normal egress of aqueous humor from the trabeculum; it is currently classified into four clinical subtypes on the basis of gonioscopic angle appearance. Male gender and myopia are risk factors. The MYOC gene mutations are commonly implicated in its pathogenesis. Medical therapy is the first-line management, but selective laser trabeculoplasty also yields favourable outcomes. Surgical management consensus is based on surgeon expertise and preference and is indicated for inadequate intraocular pressure control with non-invasive procedures. CONCLUSION: JOAG is a heterogeneous and challenging disease, and a multidisciplinary approach is required in its diagnosis and management. Screening of patients at risk or those with a family history or risk factors may allow for earlier diagnosis and prevent visual disability. Prognosis depends on the stage of diagnosis, patient compliance, and prompt appropriate management. Lifelong follow-up is necessary to prevent visual morbidity from this optic neurodegenerative disorder.
Correlation between ocular surface characteristics and tear lymphotoxin-alpha in patients with type 2 diabetes mellitus of different courses.
Wen Y, Ding Q, Liu Y … +1 more , Zhang H
Int Ophthalmol · 2026 Mar · PMID 41770392 · Publisher ↗
OBJECTIVE: This study aims to investigate the correlation between ocular surface characteristics and tear Lymphotoxin-alpha (LTA) levels in type 2 diabetes mellitus (T2DM) patients at different disease durations, in orde...
OBJECTIVE: This study aims to investigate the correlation between ocular surface characteristics and tear Lymphotoxin-alpha (LTA) levels in type 2 diabetes mellitus (T2DM) patients at different disease durations, in order to explore the potential role of LTA as a biomarker for the pathogenesis of diabetic dry eye syndrome (DES). METHODS: This retrospective controlled study evaluated ocular surface function in 90 subjects from June 2023 to June 2025: Group A (T2DM ≤ 5 years), Group B (T2DM > 5 years) as the study groups, and a control group (non-DM), 30 per group. Masked researchers assessed ocular surface indicators [Ocular Surface Disease Index (OSDI) score, non-invasive tear meniscus height (NTMH), non-invasive first tear film break-up time (NITBUTf), non-invasive average tear film break-up time (NITBUTav), meibomian gland loss score, eyelid margin assessment (EMS), corneal fluorescein staining score (CFS), and the Schirmer's I test (SIt)]. Tear LTA concentration was detected using immunochromatography. The relationships between the duration of T2DM and different parameters were assessed using Spearman's correlation method. RESULTS: The control group had higher tear LTA levels (1.79 ± 0.32 ng/mL) than both T2DM groups (Group A: 0.64 ± 0.14 ng/mL; Group B: 0.51 ± 0.12 ng/mL; P < 0.05). Ocular surface function (NTMH, NITBUTf, NITBUTav and SIt) declined, while symptom and sign scores (OSDI, EMS and CFS) increased in T2DM groups, worsening in Group B (P < 0.05). DES prevalence was higher in Group A (26.67%) and Group B (53.33%) than controls (6.67%) (P < 0.05). Tear LTA levels showed a strong negative correlation with T2DM duration, OSDI, meibomian loss, EMS, and CFS (all P < 0.05), but positively with NTMH, NITBUTf, NITBUTav, and SIt (all P < 0.05). CONCLUSION: Ocular surface function in patients with T2DM deteriorates with the prolongation of disease duration. The decrease in tear LTA level may be associated with the immune imbalance mechanism of diabetic DES.
Vitamin E TPGS-enhanced riboflavin accelerated transepithelial cross-linking versus accelerated epithelium-off protocol in progressive keratoconus: a prospective randomized trial.
Jain P, Rangari P, Dutta P … +1 more , Pradhan A
Int Ophthalmol · 2026 Feb · PMID 41758421 · Publisher ↗
PURPOSE: To compare the efficacy and safety of accelerated transepithelial (epi-on) corneal collagen cross-linking (CXL) using a Vitamin E D-α-tocopheryl polyethylene glycol succinate (TPGS)-enhanced riboflavin formulati...
PURPOSE: To compare the efficacy and safety of accelerated transepithelial (epi-on) corneal collagen cross-linking (CXL) using a Vitamin E D-α-tocopheryl polyethylene glycol succinate (TPGS)-enhanced riboflavin formulation with an accelerated epithelium-off (epi-off) CXL protocol in progressive keratoconus. DESIGN: Prospective randomized comparative clinical trial. METHODS: Fifty eyes of fifty patients aged 12-35 years with documented progressive keratoconus were randomized (1:1). In the epi-on group, 0.1% riboflavin enhanced with Vitamin E TPGS was used followed by UVA irradiation at 9 mW/cm for 10 min (total fluence 5.4 J/cm). In the epi-off group, the epithelium was removed, the cornea was saturated with iso-osmolar 0.1% riboflavin, and identical UVA irradiation was applied. The primary outcome was change in maximum keratometry (Kmax) at 12 months. Secondary outcomes included UDVA, CDVA, refractive error, keratometric indices, corneal pachymetry, higher-order aberrations, stromal demarcation line depth, endothelial cell density, and safety parameters (infectious keratitis, persistent epithelial defect, clinically significant haze, endothelial decompensation, and sustained IOP rise requiring therapy). RESULTS: Both groups showed significant improvement in UDVA/CDVA and significant flattening of keratometric parameters at 12 months (all intragroup p < 0.001). Mean corneal thickness behavior differed between groups, with relative pachymetric preservation in the epi-on arm compared with thinning in the epi-off arm (intergroup p < 0.05). Demarcation line depth was deeper in the epi-off arm (p < 0.001). No sight-threatening complications, endothelial decompensation, or sustained IOP elevation were observed in either group. CONCLUSIONS: At 12 months, accelerated transepithelial CXL using a Vitamin E TPGS-enhanced riboflavin formulation demonstrated visual and tomographic stabilization comparable to accelerated epi-off CXL. CLINICAL TRIAL REGISTRATION: CTRI /2024/06/069279.
Comparative outcomes of phaco-trabeculectomy versus phaco-tube implantation: a 6-year review.
Alhussain B, Alkhodier A, Almeshari N … +1 more , Alobaida I
Int Ophthalmol · 2026 Feb · PMID 41733808 · Full text
BACKGROUND: Combined cataract and glaucoma surgeries are common in patients diagnosed with both visually significant cataract and uncontrolled intraocular pressure (IOP). Although phacoemulsification with Ahmed glaucoma...
BACKGROUND: Combined cataract and glaucoma surgeries are common in patients diagnosed with both visually significant cataract and uncontrolled intraocular pressure (IOP). Although phacoemulsification with Ahmed glaucoma valve (phaco-AGV) implantation and phacoemulsification with trabeculectomy (phaco-trab) are established surgical options, limited data are available on their long-term comparative outcomes, particularly in large patient cohorts. METHODOLOGY: A retrospective cohort study involving 249 eyes of patients who underwent either phaco-AGV (n = 120) or phaco-trab (n = 129) procedures at a tertiary eye center was conducted. Patients were followed for up to 6 years after surgery. The primary outcome measure was surgical success, defined as an IOP between 6 and 21 mmHg with or without glaucoma medications and without further glaucoma surgery or light perception vision loss. Secondary outcomes included IOP level, number of glaucoma medications, best-corrected visual acuity (BCVA), and postoperative complications. Surgical outcomes were analyzed using Kaplan‒Meier survival curves, and chi‒square and ANOVA tests were used to assess differences between the two groups. RESULTS: At the final follow-up, the cumulative probability of surgical success was slightly greater in the phaco-trab group than in the phaco-AGV group (59.9% vs. 40.1%, P < 0.001). The mean IOP was significantly lower in both groups at the final follow-up than at baseline (p < 0.001), with comparable final IOP levels. The mean number of glaucoma medications was significantly lower in the phaco-trab group than in the phaco-AGV group (p < 0.05). Postoperative complications were more frequent in the phaco-AGV group (32.5%) than in the phaco-trab group (16.3%) (p = 0.003). Visual acuity improvements were comparable between the groups. CONCLUSION: Both the phaco-AGV and phaco-trab procedures effectively reduced IOP and improved visual acuity in patients with coexisting cataract and glaucoma. However, phaco-trab was associated with a lower rate of postoperative complications and required fewer long-term glaucoma medications. These findings suggest that while both procedures are viable options, phaco-trab, compared with phaco-AGV, may offer a more favorable risk‒benefit profile across an extended follow-up.
Corneal power, axial length-to-corneal radius ratio, and myopia status prior to corneal refractive surgery: a cross-study analysis.
Xin Y, Zhang X, Xin Y
Int Ophthalmol · 2026 Feb · PMID 41733784 · Publisher ↗
We examined the interplay among corneal refractive power, the axial-length-to-corneal radius of curvature ratio (AL/CR), and myopia severity in patients before corneal refractive surgery. We included 1208 myopic patients...
We examined the interplay among corneal refractive power, the axial-length-to-corneal radius of curvature ratio (AL/CR), and myopia severity in patients before corneal refractive surgery. We included 1208 myopic patients with a median age of 22 years (P25 = 19, P75 = 27) and a preoperative spherical equivalent (SE) of - 4.88 D (P25 = - 6.50, P75 = - 3.50). Myopia status was classified using the spherical equivalent refraction into low, moderate and severe myopia. Key measurements included corneal curvature radius (CR), flat (K1) and steep (K2) corneal curvatures, anterior corneal surface astigmatism (ΔK), central corneal thickness (CCT), axial length (AL), and AL/CR. Severe myopic patients were slightly older than other cases. CR was smaller in severe myopia. Significant differences were observed in K2 and ΔK between severe and less severe myopic patients, but not in K1 and CCT. Female patients exhibited a lower AL than male patients, but AL/CR differences were only significant in the mild myopia group. A linear relationship was found between increasing AL/CR and decreasing SE. Multivariate analysis adjusted for age and sex revealed that each 1 mm increase in AL resulted in a 1.98 D decrease in SE, while a 1 mm increase in CR led to a 5.00 D increase in SE. A 0.1 unit increase in AL/CR corresponded to a 1.48 D decrease in SE. Severe myopia was associated with steeper corneal curvature, particularly in the steep axis. AL/CR did not differ between genders in moderate and severe myopia, suggesting its reliability as an index for assessing myopic refractive state.
Clinicopathological characteristics and outcomes of 42 cases of ocular adnexal sarcoma.
Wu Y, He W
Int Ophthalmol · 2026 Feb · PMID 41733753 · Publisher ↗
PURPOSE: To study the clinicopathological features, treatment, and prognosis of ocular adnexal sarcomas diagnosed at a tertiary comprehensive hospital in China during 13 years. METHODS: A case series of patients with his...
PURPOSE: To study the clinicopathological features, treatment, and prognosis of ocular adnexal sarcomas diagnosed at a tertiary comprehensive hospital in China during 13 years. METHODS: A case series of patients with histopathological diagnoses of ocular adnexal sarcomas at a tertiary general hospital over 13 years. Medical records of demographic details, clinicopathological features, treatment, and prognosis at the time of presentation were reviewed. RESULTS: Forty-two cases of ocular adnexal sarcomas were found throughout the study period. The mean age was 37.1 years, with 27 males and 15 females. The most common clinical manifestation was exophthalmos (61.9%), and the median time to diagnosis was 6 months. These tumors most often occurred in the orbit (83.3%). The most common TNM stage at presentation was T2N0M0 (63.6%). Fifteen different histological types were identified; rhabdomyosarcoma accounted for the highest percentage (21.4%), followed by liposarcoma and malignant solitary fibrous tumor (16.7%). The diagnosis of each subtype depended on histomorphologic characteristics, supplemented by immunohistochemistry and molecular pathology. Most patients (56.8%) underwent multimodality therapy. Thirty-seven (88.1%) patients completed follow-up, while five patients were lost to follow-up. Of these 37 patients, 24 (64.9%) survived and 13 (35.1%) died; 19 (51.4%) experienced local recurrence, and 13 (35.1%) developed metastasis. CONCLUSIONS: Ocular adnexal sarcomas are rare and histologically diverse, with rhabdomyosarcoma predominating in children and liposarcoma and malignant solitary fibrous tumor in adults. Middle-aged and elderly patients presenting with unilateral proptosis accompanied by visual impairment, especially in cases of cranio-orbital communication associated with headache, should raise suspicion for the possibility of malignant solitary fibrous tumor to avoid delayed diagnosis. Among liposarcomas, atypical lipomatous tumor/highly differentiated liposarcoma is more common. Accurate pathological diagnosis is crucial and requires a combination of histomorphologic, immunohistochemical, and molecular evaluation.
Evaluation of hyperreflective spots as a novel biomarker in patients with glaucoma.
Kasal K, Girgin Y, Karahan E
Int Ophthalmol · 2026 Feb · PMID 41733702 · Publisher ↗
PURPOSE: To evaluate hyperreflective spots (HRS) detected by optical coherence tomography (OCT) in healthy and glaucomatous eyes and their correlation with retinal ganglion cell (RGC) loss. METHODS: A total of 65 patient...
PURPOSE: To evaluate hyperreflective spots (HRS) detected by optical coherence tomography (OCT) in healthy and glaucomatous eyes and their correlation with retinal ganglion cell (RGC) loss. METHODS: A total of 65 patients with primary open-angle glaucoma (POAG) and 65 healthy controls were enrolled, and data were collected from one eye of each participant. In glaucoma patients, the eye with better visual acuity was selected; if equal, the eye with the higher OCT image quality was included. In the control group, the eye with the higher OCT image quality was selected for analysis. OCT scans of the fovea's thinnest section were analyzed, and an area 3000 µm wide at the center was selected. HRS were defined as small spots (≤ 30 µm) with moderate reflectivity and no shadowing. HRS counts were compared between groups, and correlations with OCT parameters associated with RGC loss were assessed. RESULTS: The mean age was similar between groups (glaucoma: 62.48 ± 19.77 years; control: 59.75 ± 6.65 years; P = 0.085). Inter-rater agreement for HRS counts was excellent (ICC = 0.927, 95% CI: 0.89-0.94). Glaucoma patients had significantly higher HRS counts than controls (29.65 ± 7.68 vs. 11.86 ± 5.05, P < 0.001). HRS counts positively correlated with vertical and horizontal cupping diameters (r = 0.45, P < 0.001) and negatively correlated with neuroretinal rim area (r = - 0.46, P < 0.001), total RNFL thickness (r = - 0.39, P < 0.001), and mean GCC thickness (r = - 0.43, P < 0.001). Correlation coefficients were similar after adjusting for age, intraocular pressure (IOP), and signal strength index (SSI). CONCLUSIONS: HRS strongly correlate with RGC and RNFL loss in glaucoma and may serve as as a valuable biomarker in the follow-up of glaucoma.
The floppy thyroid eye disease.
Agarwal A, Bothra N, Gupta A … +1 more , Naik MN
Int Ophthalmol · 2026 Feb · PMID 41729409 · Publisher ↗
PURPOSE: To report unique clinical features and management challenges in patients with co-existing Thyroid Eye Disease (TED) and Floppy Eyelid Syndrome (FES). METHODS: Retrospective, multicentric, interventional case ser...
PURPOSE: To report unique clinical features and management challenges in patients with co-existing Thyroid Eye Disease (TED) and Floppy Eyelid Syndrome (FES). METHODS: Retrospective, multicentric, interventional case series of 9 patients presenting as TED with FES over a period of eight years. RESULTS: Seventeen eyes with co-existing TED and FES were analysed. The average age at presentation was 51.5 years. There were five males and four females in the cohort. Hypothyroidism and hyperthyroidism were noted in four cases each, while a single patient was euthyroid at presentation. The average exophthalmometry value was 25.5 mm (range, 22-30 mm). All but one had bilateral presentation. Of the 17 eyes, 13 (76%) had episodes of spontaneous globe luxation. Eleven eyes (65%) had congestive signs or surface exposure, which mimicked clinically active TED. Lash ptosis was observed in six (35%) eyes. All (100%) eyes had significant lower eyelid retraction (LER) with inferior scleral show. Upper eyelid retraction was absent in 14 (82%) eyes. Of the six cases where orbital imaging was available, fat-predominant disease was seen in nine orbits. CONCLUSION: TED and FES can rarely co-exist. The lax or ptotic upper eyelid tends to mask upper eyelid retraction, with LER being a more obvious sign. Spontaneous globe luxation may be more common in this cohort, warranting early orbital decompression. Congestive signs and corneal exposure may mimic clinically active TED, potentially leading to corticosteroid misuse.
Outcomes of phaco-goniosynechialysis surgery for refractory acute primary angle-closure glaucoma after trabeculectomy complicated by low corneal endothelial cell density.
Tang W, Liu Y, Zhang Y … +2 more , Chen T, Zou W
Int Ophthalmol · 2026 Feb · PMID 41729366 · Publisher ↗
PURPOSE: To evaluate the efficacy and safety of phacoemulsification combined with goniosynechialysis (phaco + GSL) in patients with acute primary angle-closure glaucoma (APACG) after failed trabeculectomy, complicated by...
PURPOSE: To evaluate the efficacy and safety of phacoemulsification combined with goniosynechialysis (phaco + GSL) in patients with acute primary angle-closure glaucoma (APACG) after failed trabeculectomy, complicated by refractory glaucoma and low corneal endothelial cell density (CECD). METHODS: Fourteen patients with APACG whose intraocular pressure (IOP) was uncontrolled after trabeculectomy were enrolled in this retrospective study. These patients also had a CECD < 900 cells/mm. The patients were enrolled between August 2020 and June 2024. Preoperative and postoperative IOP, CECD, best-corrected visual acuity (BCVA), the number of IOP-lowering medications, anterior chamber depth, and postoperative complications were recorded. RESULTS: The mean CECD increased from 756.6 ± 106.2 cells/mm preoperatively to 1138.18 ± 221.88 cells/mm at 6 months postoperatively. Mean IOP decreased from 34.54 ± 10.61 mmHg preoperatively to 13.21 ± 2.51 mmHg postoperatively. The mean number of IOP-lowering medications decreased from 2.82 ± 1.47 to 0.09 ± 0.30 pre- and postoperatively, respectively. The mean time between trabeculectomy and phaco + GSL was 4.0 ± 3.61 months. Thirteen of the 14 eyes (92.86%) showed improved BCVA; one eye (7.14%) showed decreased BCVA because of associated retinitis pigmentosa. No corneal endothelial decompensation was observed. The mean anterior chamber depth increased from 1.47 ± 0.26 mm preoperatively to 2.81 ± 0.38 mm postoperatively. The mean extent of peripheral anterior synechiae decreased from 351.43° ± 24.78°-117.14° ± 23.30° CONCLUSIONS: Early postoperative evaluation of CECD may not reflect the true corneal endothelial status in APACG. Even after failed trabeculectomy, with uncontrolled IOP and a CECD < 900 cells/mm, phaco + GSL is an effective and safe approach to reduce IOP and the number of IOP-lowering medications and to partially improve visual acuity, with no serious complications.
Comparison of different antibiotic prophylaxis regimens for the prevention of endophthalmitis after penetrating keratoplasty.
Li SJ, Jin L, He LW … +1 more , Zhou SY
Int Ophthalmol · 2026 Feb · PMID 41721919 · Publisher ↗
OBJECTIVES: To investigate the incidence of endophthalmitis following penetrating keratoplasty (PKP) and compare the effectiveness of different antibiotic regimens during the perioperative period. METHODS: A retrospectiv...
OBJECTIVES: To investigate the incidence of endophthalmitis following penetrating keratoplasty (PKP) and compare the effectiveness of different antibiotic regimens during the perioperative period. METHODS: A retrospective cohort study was conducted involving 3706 patients who underwent PKP at Zhongshan Ophthalmic Center between 2012 and 2021. The preventive effects of intraoperative intraoperative local antibiotic injection, preoperative intravenous antibiotic administration, and the combination of both were evaluated. Logistic regression and survival analyses were performed to compare differences in endophthalmitis incidence among the different antibiotic prophylaxis groups. RESULTS: Postoperative endophthalmitis occurred in 15 of 3706 patients (0.40% incidence). Among 419 patients with underlying infectious corneal disease, 12 developed postoperative endophthalmitis (2.86% incidence). Among 3287 patients with non-infectious corneal diseases, 3 developed postoperative endophthalmitis (0.09% incidence; OR: 32.28, 95% CI 9.07-114.85). For patients with primary non-infectious corneal disease, no statistically significant difference was observed between the intraoperative intraoperative local antibiotic injection, group and the combined antibiotic administration group (P = 0.079). CONCLUSION: The primary corneal disease is a key risk factor for endophthalmitis after PKP. For non-infectious keratopathy, intraoperative local antibiotic injection, alone is appears adequate for preventing postoperative endophthalmitis.
Loading dose and 12-month outcomes in treatment-naïve patients with neovascular age-related macular degeneration treated with faricimab, with AI-based analysis of fluid dynamics.
Barbosa M, Bartolomeo N, Schuetz YP … +4 more , Nascimbeni AC, Castro DG, Barry MP, Ambresin A
Int Ophthalmol · 2026 Feb · PMID 41712059 · Publisher ↗
PURPOSE: To evaluate the effects of loading dose and 12 months of faricimab treatment on visual function, retinal anatomy, and fluid dynamics in a real-world cohort of treatment-naïve patients with neovascular age-relate...
PURPOSE: To evaluate the effects of loading dose and 12 months of faricimab treatment on visual function, retinal anatomy, and fluid dynamics in a real-world cohort of treatment-naïve patients with neovascular age-related macular degeneration (nAMD). METHODS: Patients received intravitreal faricimab 6 mg monthly (to Month 4) followed by personalized treat-and-extend regimens allowing 4-week interval adjustments. Best-corrected visual acuity (BCVA), retinal anatomy, and fluid dynamics (evaluated using an artificial intelligence-based automated fluid quantification system) were assessed monthly to Month 4, then at Months 6, 9, and 12. RESULTS: Fifty-one patients (57 study eyes; mean [SD] BCVA: 66.5 [13.4] letters; mean [SD] central retinal thickness [CRT]: 340.7 [84.7] μm at baseline) were enrolled. Significant improvements in mean BCVA (+ 3.3 letters; P < 0.001) and CRT (- 70.5 μm; P < 0.001) were observed by Month 4. Maximal pigment epithelium detachment (PED) height reduced significantly from baseline to Month 4. Improvements were maintained to Month 12. Intra- and subretinal fluid and PED volumes were significantly reduced versus baseline at all time points. At Month 12, 73.3% of patients were on treatment intervals of 12 weeks or longer. Three adverse events were observed, including one mild intraocular inflammation. CONCLUSION: Treatment with faricimab resulted in rapid and sustained functional and anatomical improvements in treatment-naïve nAMD.
Bilateral simultaneous external dacryocystorhinostomy: outcomes and patient satisfaction in a single-stage approach.
Acır NÖ, Fırat TG, Demir K
Int Ophthalmol · 2026 Feb · PMID 41711985 · Publisher ↗
OBJECTIVE: To evaluate the viability of simultaneous bilateral external dacryocystorhinostomy (ex-DCR) through a multidimensional analysis of surgical feasibility, patient-reported outcomes, complication incidence, and c...
OBJECTIVE: To evaluate the viability of simultaneous bilateral external dacryocystorhinostomy (ex-DCR) through a multidimensional analysis of surgical feasibility, patient-reported outcomes, complication incidence, and cost-efficacy. METHODS: The study included 54 eyes of 27 patients who underwent bilateral simultaneous ex-DCR for bilateral symptomatic epiphora due to NLDO. Patient symptoms were systematically assessed using the validated Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire. Additionally, all patients completed a Thurstone scale-based questionnaire to evaluate the surgical process and postoperative period in terms of functional success, psychological relief, overall satisfaction, economic benefits, and medical outcomes. RESULTS: The mean patient age of 56.5 ± 13.1 years (range: 22-78) at the time of surgery. Postoperatively, the mean NLDO-SS decreased to 12.7 ± 5.7 (range: 2-26), demonstrating a statistically significant reduction in total scores (p < 0.001). The mean surgical duration was 72.0 ± 15.5 min (range: 52-125). No intraoperative or postoperative complications were observed in any patient. Anatomic success was achieved in 53/54 eyes (success rate: 98.1%), while functional success was observed in 52/54 eyes (success rate: 96.2%). Postoperative patient evaluation using the Thurstone scale revealed functional success scores of 4.5 ± 0.8 for the right side and 4.4 ± 0.8, psychological relief (4.6 ± 0.8), overall patient satisfaction (4.7 ± 0.6), economic advantages (4.7 ± 0.5), and medical benefits (4.7 ± 0.5). CONCLUSION: Our preliminary findings demonstrate that single-session bilateral ex-DCR can be a safe and effective option in appropriately selected patients with high surgical success rates, reasonable operative duration, excellent patient satisfaction, and significant functional improvement without major complications.
Accuracy of ChatGPT in differentiating ocular surface neoplasms using text-based summaries: a comparative analysis of pterygium, pseudopterygium, and CIN.
De Luca L, Carlà MM, Menna F … +3 more , Lupo S, Mancini M, Meduri A
Int Ophthalmol · 2026 Feb · PMID 41706333 · Publisher ↗
PURPOSE: Differentiating conjunctival intraepithelial neoplasia (CIN) from pterygium and pseudopterygium remains clinically challenging, especially in early or atypical presentations. Artificial intelligence (AI), partic...
PURPOSE: Differentiating conjunctival intraepithelial neoplasia (CIN) from pterygium and pseudopterygium remains clinically challenging, especially in early or atypical presentations. Artificial intelligence (AI), particularly large language models such as ChatGPT, may serve as decision-support tools by synthesizing complex diagnostic input. This study aimed to evaluate the diagnostic reliability of ChatGPT-4 in distinguishing between these ocular surface lesions and its ability to recommend appropriate treatment strategies based on multimodal clinical data. METHODS: Sixty anonymized case profiles were compiled from patients with histopathologically confirmed CIN (n = 20), pterygium (n = 20), and pseudopterygium (n = 20) from January 2024 to March 2025. Each case included demographic details, clinical findings, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM) descriptions. For each case, clinical data-including patient history, slit-lamp findings, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM) results-were synthesized into standardized clinical vignettes. These were uploaded to ChatGPT (version 4.0), prompting the model: "Based on this case, what is the most likely diagnosis and what treatment would you recommend?" The model's outputs were compared to the final clinical diagnoses and treatment plans made by a panel of three ocular surface disease specialists with more than 5 years of experience. It is important to note that ChatGPT analyzed only structured multimodal textual summaries derived from clinical examination, AS-OCT, and IVCM descriptions, and did not process raw clinical images. RESULTS: ChatGPT accurately identified CIN in 85% of cases, pterygium in 75%, and pseudopterygium in 70%. Misclassifications primarily occurred between CIN and pseudopterygium, particularly in cases with inflammatory or traumatic histories. ChatGPT's treatment recommendations agreed with expert judgment in 80% of cases, with the highest accuracy observed in CIN cases (90%). The model demonstrated a tendency to over-treat benign lesions but rarely missed neoplastic diagnoses. CONCLUSION: ChatGPT-4 showed promising accuracy in differentiating between CIN, pterygium, and pseudopterygium using detailed multimodal clinical data. While not a substitute for clinical expertise, it may serve as a useful triage or decision-support tool, particularly in settings with limited access to subspecialists. Further integration with image-based AI systems could enhance diagnostic performance.
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