Int Ophthalmol [JOURNAL]
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Cost analysis of the Lucia keratoprosthesis in a resource-limited tertiary care center.
Ortiz-Morales G, Muleiro-Alvarez M, Soberanes-Velarde J … +4 more , Navas A, Ramirez-Miranda A, Chodosh J, Graue-Hernandez EO
Int Ophthalmol · 2026 Feb · PMID 41706250 · Publisher ↗
PURPOSE: To analyze the associated costs of the implantation of the Lucia Keratoprosthesis (KPro) in a resource-limited tertiary care center. METHODS: A retrospective chart review was conducted on patients who underwent...
PURPOSE: To analyze the associated costs of the implantation of the Lucia Keratoprosthesis (KPro) in a resource-limited tertiary care center. METHODS: A retrospective chart review was conducted on patients who underwent Lucia KPro implantation. For the first 24 months of follow-up, the costs for initial evaluation, surgery, postoperative visits, and management of complications were assessed and converted to U.S. dollars. Visual outcomes were analyzed based on best-corrected visual acuity (BCVA) improvement and anatomical retention. RESULTS: A total of 24 eyes from 24 patients were analyzed. The mean follow-up was 34 months, with a mean total cost per patient of $6,949.55 ± $1,344.54. The initial surgical cost was $2,582.31 ± 980.13. At the same time, postoperative expenses constituted 62.84% of the total fees, largely driven by the medical costs and surgical management of complications such as glaucoma (37.5%), retroprosthetic membranes (33.3%), and epithelial defects (16.7%). The mean BCVA improved from 2.40 ± 0.28 LogMAR preoperatively to 1.32 ± 1.03 LogMAR at the final follow-up (Δ = 1.08 LogMAR, p < 0.001). Anatomic retention was 95.83%, and functional success (BCVA ≥ 20/200) was achieved in 62.50% of cases. CONCLUSION: The Lucia KPro offers a cost-friendly alternative to address corneal blindness in resource-limited settings. Postoperative care remains a major cost driver. Strategies to prevent complications, telemedicine-based follow-ups, and national subsidy programs could further optimize accessibility and cost-effectiveness. Future multicenter studies should explore cost-sharing models to improve financial feasibility.
Predictive value of a phenylephrine-guided resection algorithm in optimizing eyelid symmetry following bilateral Müller Muscle-Conjunctival Resection.
Ulas MG, Koser E, Efe AC … +4 more , Karademir FP, Ozcelik SS, Diri İ, Taskapılı M
Int Ophthalmol · 2026 Feb · PMID 41701404 · Publisher ↗
To evaluate the anatomical, functional, and aesthetic outcomes of phenylephrine-guided bilateral Müller muscle-conjunctival resection (MMCR) using a standardized resection algorithm designed to optimize eyelid symmetry b...
To evaluate the anatomical, functional, and aesthetic outcomes of phenylephrine-guided bilateral Müller muscle-conjunctival resection (MMCR) using a standardized resection algorithm designed to optimize eyelid symmetry by preoperatively accounting for Hering's phenomenon in patients with mild-to-moderate ptosis METHODS: This retrospective clinical study included patients with good levator function and a positive phenylephrine test who underwent simultaneous bilateral MMCR planned according to a phenylephrine-based resection algorithm. The protocol aimed to simulate postoperative eyelid position and unmask contralateral ptosis related to Hering's law, thereby enabling individualized bilateral surgical planning in a single session. Preoperative and postoperative best-corrected visual acuity (BCVA), margin reflex distance1 (MRD-1) and upper eyelid symmetry were evaluated at postoperative months 1 and 3 RESULTS: A total of 118 eyes from 59 patients (31 females, 28 males) were included. The mean preoperative MRD-1 was 1.24 ± 0.95 mm in the right eye and 1.32 ± 0.84 mm in the left eye. At postoperative month 3, the mean MRD-1 increased to 2.68 ± 0.91 and 2.61 ± 0.78, respectively. Comparison of preoperative and postoperative MRD-1 values demonstrated demonstrated a statistically significant improvement in both eyes at months 1 and 3 (p < 0.001 for each eye). Postoperative MRD-1 outcomes were not significantly different when stratified by the magnitude of the preoperative phenylephrine response (p = 0.32 for right eye, p = 0.06 for left eye). Excellent eyelid symmetry was achieved in 44 patients (74.6%), satisfactory symmetry in 12 (20.3%), and poor symmetry in 3 patients (5.0%). Revision surgery was required in 5 patients (8.4%) during follow-up CONCLUSION: Phenylephrine-guided bilateral MMCR using a standardized resection algorithm is a safe, effective, and highly predictable surgical approach for achieving optimal eyelid symmetry in patients with mild-to-moderate ptosis. Preoperative simulation of postoperative eyelid position by accounting for Hering's phenomenon allows accurate bilateral surgical planning in a single session and may reduce the need for secondary procedures, making this technique a strong first-line alternative to more invasive ptosis repair methods.
Evaluating nerve dysfunction in Behçet's disease: a study using corneal confocal microscopy and electromyography.
Erdem HE, Demirci M, Çam F … +6 more , Şanal C, Akkaya Turhan S, Alibaz-Oner F, Gündüz OH, Direskeneli H, Celiker H
Int Ophthalmol · 2026 Feb · PMID 41701403 · Publisher ↗
PURPOSE: To evaluate peripheral nerves in Behçet's disease (BD) by monitoring the corneal nerves with in vivo corneal confocal microscopy (IVCCM) and measuring sympathetic skin response (SSR) and cutaneous silent period...
PURPOSE: To evaluate peripheral nerves in Behçet's disease (BD) by monitoring the corneal nerves with in vivo corneal confocal microscopy (IVCCM) and measuring sympathetic skin response (SSR) and cutaneous silent period (CSP) with electromyography (EMG). METHODS: This cross-sectional study included 90 participants: 60 BD patients, divided into Group 1 (n = 30) with uveitis and Group 2 (n = 30) without uveitis, and 30 healthy controls (Group 3). IVCCM assessed the subbasal nerve plexus (SNP), while EMG measured sensory and motor nerve conduction, CSP and SSR. SNP images were analyzed with ACCMetrics software, and dendritic cell (DC) densities were calculated using ImageJ software. In addition, patients under systemic medication were divided by subgroups and analysed separately. RESULTS: No significant differences in SNP analysis or DC densities were observed across groups (p > 0.05). Patients treated with conventional agents (azathioprine) exhibited significantly lower total DC densities compared to those on colchicine and biological agents (p = 0.003, p = 0.0033). Group 2 demonstrated reduced SSR lower extremity amplitude compared to controls (p = 0.017); nevertheless, no significant differences in CSP durations or SSR latencies were found (p > 0.05). CONCLUSION: Evidence of small fiber neuropathy in BD was suggested by SSR amplitudes, reflecting autonomic nervous system involvement. The lack of significant differences in CSP and SSR latencies may indicate nerve regeneration due to controlled inflammation. Additionally, lower DC densities in patients on conventional treatments may highlight the mechanism of azathioprine at the in vivo level.
Changes in corneal and lenticular transparency in active and inactive Graves' Ophthalmopathy: a comparative densitometric study.
Gündogan AO, Beyoglu A, Kadıoglu E … +3 more , Atıcı EN, Oltulu R, Zengin N
Int Ophthalmol · 2026 Feb · PMID 41701259 · Publisher ↗
PURPOSE: The aim of this study was to compare corneal and lens densitometry (CD and LD) values between active and inactive Graves Ophthalmopathy (GO) and Grave's Disease (GD) patients without ophthalmic involvement and h...
PURPOSE: The aim of this study was to compare corneal and lens densitometry (CD and LD) values between active and inactive Graves Ophthalmopathy (GO) and Grave's Disease (GD) patients without ophthalmic involvement and healthy controls. METHODS: This cross-sectional clinical study included 22 patients with active GO with bilateral ocular involvement (group 1), 36 patients with inactive GO (group 2), 54 patients with GD but without ophthalmopathy (group 3) and 30 age- and gender-matched healthy controls (group 4). All participants underwent comprehensive ophthalmic examination, followed by corneal and lens densitometry assessment using the Pentacam HR imaging system (Oculus Inc., Wetzlar, Germany). RESULTS: Comparative analysis revealed statistically significant differences (p < 0.05) in CD values among the groups across all layers, except for the anterior 10-12 mm (p = 0.117), posterior 0-2 mm (p = 0.185), and posterior 2-6 mm zones (p = 0.099). Active GO patients showed the highest CD values, followed by inactive GO, non-ophthalmopathy GD patients, and healthy controls, respectively. Additionally, CD-mean, CD-SD and CD-max parameters showed statistically significant differences between the groups (all p < 0.05), with active GO demonstrating significantly higher values than other groups. Regarding LD, LD-mean, LD-SD, and LD-max values were significantly higher in all Grave's disease-related groups compared with the control group (p < 0.001). CONCLUSıON: Our study shows that lenticular and corneal clarity is significantly reduced in GO patients, especially during the active period. These findings suggest that Pentacam could be used as a rapid, reliable and non-invasive tool for the early detection of deterioration in corneal and lenticular transparency in these patients.
Comparative analysis of 70 SMILE and 70 toric ICL eyes for myopic oblique astigmatism: a matched cohort study from an initial pool of 11,929 eyes.
Assaf A, Alsaify BA, Troeber L … +5 more , Javadi A, Wiltfang R, Bechmann M, Becker K, Feucht N
Int Ophthalmol · 2026 Feb · PMID 41697454 · Full text
PURPOSE: To compare visual, refractive, and vector-based astigmatic outcomes between Small Incision Lenticule Extraction (SMILE) and toric Implantable Collamer Lens (ICL) implantation in patients with myopic oblique asti...
PURPOSE: To compare visual, refractive, and vector-based astigmatic outcomes between Small Incision Lenticule Extraction (SMILE) and toric Implantable Collamer Lens (ICL) implantation in patients with myopic oblique astigmatism. METHODS: In this retrospective, matched cohort study, 140 eyes (70 SMILE, 70 toric ICL) with oblique astigmatism were treated at a single center. Groups were matched preoperatively for refractive cylinder and spherical equivalent within ± 0.50 D. Postoperative outcomes at six weeks were assessed, including uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SEQ), astigmatism correction using vector analysis (Alpins method), and safety and efficacy indices. A post hoc power analysis was performed for the astigmatic correction index. RESULTS: The efficacy index was 0.97 ± 0.17 in the ICL group and 0.94 ± 0.15 in the SMILE group. The safety index was 1.02 ± 0.11 (ICL) versus 1.01 ± 0.09 (SMILE). UDVA equal to or better than preoperative CDVA was achieved in 83% of ICL eyes and 79% of SMILE eyes. SEQ within ± 0.50 D was observed in 85.7% (ICL) versus 81.4% (SMILE). The astigmatic correction index was 0.97 for ICL and 1.04 for SMILE. Linear regression showed stronger correlation between target and achieved astigmatism in the ICL group (slope = 1.04, R = 0.77) compared to SMILE (slope = 0.76, R = 0.67). Power analysis confirmed 80.5% power to detect clinically meaningful differences. CONCLUSIONS: Both SMILE and toric ICL are effective and safe for correcting myopic oblique astigmatism. However, toric ICL demonstrated slightly greater precision in axis alignment and refractive predictability, supporting its use in cases of high oblique astigmatism where rotational accuracy is critical.
Prevalence and severity of dry eye disease among ophthalmologists, optometrists, and nurses: a cross-sectional questionnaire-based survey.
AlSahli A, Husein N, Chowdhury TH … +6 more , Hasan AA, Alkaram M, AlDhaheri HS, Al Qassimi N, Abuhaleeqa K, Hamam O
Int Ophthalmol · 2026 Feb · PMID 41697442 · Publisher ↗
PURPOSE: Dry eye disease (DED) is a common ocular condition that, if left untreated, can lead to visual impairment. The present study was conducted to investigate the prevalence of DED among ophthalmologists, optometrist...
PURPOSE: Dry eye disease (DED) is a common ocular condition that, if left untreated, can lead to visual impairment. The present study was conducted to investigate the prevalence of DED among ophthalmologists, optometrists, and nurses. METHODS: This cross-sectional study included ophthalmologists, optometrists, and nurses who attended the Emirates Society of Ophthalmology (ESO) conference in 2024 in the United Arab Emirates. Eligible participants were asked to complete the Dry Eye Questionnaire (DEQ-5), based on which the presence and severity of DED were assessed. RESULTS: The study included 203 participants (53.2% males), with the majority being ophthalmologists (47.8%), followed by nurses (17.2%), optometrists (13.8%), and others (21.2%). The overall prevalence of DED was 82.8%. DED prevalence was significantly higher among females than males (88.4% vs 77.8%, p = 0.046), and female optometrists had a 4.36-fold higher risk of DED than male optometrists (p = 0.013). Regarding DED severity, 27.6% of the participants had mild DED, 35.5% had moderate DED, and 19.7% had severe DED. Females who worked as ophthalmologists (RR = 1.72, p = 0.045) and those engaged in other professions (RR = 3.31, p = 0.002) had a significantly higher risk of severe DED. CONCLUSION: This study highlights alarmingly high rates of DED among ocular care professionals. Female optometrists had a significantly higher risk of DED than male optometrists.
Evaluation of blepharoptosis, meibomian gland morphology, and dry eye parameters in older individuals with sarcopenia: a case-control study.
Yener NP, Avcı S, Ismayılov AS
Int Ophthalmol · 2026 Feb · PMID 41697414 · Publisher ↗
PURPOSE: To evaluate blepharoptosis (BP), meibomian gland (MG) morphology, and dry eye parameters in older individuals diagnosed with sarcopenia. METHODS: This cross-sectional, case-control study included 52 patients wit...
PURPOSE: To evaluate blepharoptosis (BP), meibomian gland (MG) morphology, and dry eye parameters in older individuals diagnosed with sarcopenia. METHODS: This cross-sectional, case-control study included 52 patients with sarcopenia and 30 age-matched healthy controls. Sarcopenia was diagnosed according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. BP was assessed by measuring palpebral fissure (PF), margin reflex distance 1 (MRD1), and levator function (LF). Dry eye evaluation included the Ocular Surface Disease Index (OSDI) questionnaire, noninvasive tear break-up time (NITBUT), meibography, and Schirmer I test. RESULTS: PF, MRD1, and LF values were significantly lower in the sarcopenia group compared to that in the controls (p = 0.044, p = 0.001, and p < 0.001, respectively). Body mass index (BMI) showed a negative correlation with PF (r = -0.383, p = 0.036). BP was observed in 10.9% of the sarcopenia group and 3.3% of controls (p = 0.077). MG loss and meiboscore were significantly higher in the sarcopenia group (p = 0.001 and p < 0.001), while NITBUT was significantly lower (p = 0.031). No significant differences were found in OSDI scores or Schirmer test results between the two groups. CONCLUSIONS: Older individuals with sarcopenia exhibited reduced LF and changes in MG morphology and tear film stability. BP and tear film instability may be underrecognized manifestations of sarcopenia and should be considered in comprehensive geriatric and ophthalmologic assessments. Further studies are needed to better understand the relationship between sarcopenia, eyelid functions, and dry eye.
Quantitative analysis of choroidal changes in retinal vein occlusion using ultra-widefield swept-source optical coherence tomography angiography.
Bai G, Wei H, Li S
Int Ophthalmol · 2026 Feb · PMID 41697387 · Publisher ↗
PURPOSE: Choroidal alterations are implicated in the pathophysiology of retinal vein occlusion (RVO), yet comprehensive spatial analysis has been limited by conventional imaging. This study aims to leverage ultra-widefie...
PURPOSE: Choroidal alterations are implicated in the pathophysiology of retinal vein occlusion (RVO), yet comprehensive spatial analysis has been limited by conventional imaging. This study aims to leverage ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) to quantitatively assess spatial changes in the choroidal vascularity index (CVI) and choroidal thickness (CT) in patients with RVO. METHODS: This cross-sectional study included 38 patients with unilateral RVO and 40 healthy controls. Using ultra-widefield SS-OCTA, volumetric CVI and CT were quantified across a 24 × 20 mm area. Data from nine anatomical grids were compared among RVO-affected, contralateral fellow, and healthy control eyes. The correlation between central macular thickness (CMT) and choroidal parameters in RVO eyes was also analyzed. RESULTS: Compared to controls, RVO-affected eyes showed significantly decreased CVI in the nasal-superior and optic disc grids, and reduced CT in the nasal-superior, optic disc, and nasal-inferior grids. No significant differences in CVI or CT were found between RVO-affected and fellow eyes. In RVO eyes, CMT was negatively correlated with CVI in the nasal-superior and macular grids, but showed no significant correlation with CT. CONCLUSION: Ultra-widefield SS-OCTA reveals specific spatial patterns of reduced CVI and CT in RVO, predominantly in the nasal and peripapillary regions. These findings suggest choroidal involvement in RVO includes both vascular and stromal components, and that CVI may serve as a sensitive biomarker for monitoring disease-related choroidal alterations.
Inflammatory parameters in idiopathic intracranial hypertension and their relationship with optic disc findings.
Sensoy E, Uke Uzun S, Ayan ME … +1 more , Yilmaz Can F
Int Ophthalmol · 2026 Feb · PMID 41689729 · Publisher ↗
PURPOSE: This study aimed to investigate the role of systemic inflammation in patients diagnosed with idiopathic intracranial hypertension (IIH) and to evaluate the relationship of various hematological inflammatory mark...
PURPOSE: This study aimed to investigate the role of systemic inflammation in patients diagnosed with idiopathic intracranial hypertension (IIH) and to evaluate the relationship of various hematological inflammatory markers with retinal nerve fiber layer (RNFL) thickness. METHODS: The study included 30 newly diagnosed IIH patients and 30 age- and sex-matched healthy individuals. Neutrophil, lymphocyte, monocyte, platelet, immature granulocyte, and RDWSD levels were recorded in all cases; derived inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), were calculated from these parameters. RNFL thickness was measured by optical coherence tomography, and the relationships between lumbar puncture (LP) opening pressures and inflammatory parameters were analyzed. RESULTS: In the IIH group, neutrophil, platelet, and immature granulocyte levels, as well as SII and SIRI values, were significantly higher compared to healthy controls (p < 0.05). RNFL thickness correlated positively with platelet, neutrophil, immature granulocyte counts, and SII (p < 0.05), whereas LP opening pressure and Frisen grade showed no association with inflammatory parameters (p > 0.05).Among the evaluated markers, immature granulocyte count demonstrated the highest diagnostic accuracy for distinguishing IIH, with an AUC of 0.824 in ROC analysis. CONCLUSION: This study shows that inflammatory markers, including immature granulocyte count, SII, and SIRI, are significantly elevated in patients with IIH. Among these parameters, immature granulocyte count demonstrated the strongest associations with disease-related structural findings, suggesting its potential role as an inflammatory indicator in IIH. These findings highlight associations between systemic inflammatory parameters and IIH, without causality.
Outpatient visits and secondary surgeries following open globe injuries: a single institution retrospective analysis.
Vought R, Vought V, Henry RK … +2 more , Oydanich M, Khouri AS
Int Ophthalmol · 2026 Feb · PMID 41689707 · Full text
Open globe injuries (OGIs) impose a significant burden on patients and the healthcare system. This study reports outpatient visits and secondary surgeries associated with OGIs METHODS: A retrospective chart review of OGI...
Open globe injuries (OGIs) impose a significant burden on patients and the healthcare system. This study reports outpatient visits and secondary surgeries associated with OGIs METHODS: A retrospective chart review of OGI repairs at a Level 1 Trauma Center from 2015-2023 was conducted. Two areas of resource utilization, outpatient office visits and secondary surgeries required within a year of the injury were recorded and predictors were identified RESULTS: Of 619 patients (mean age 46±22 years; 76.7% male), most had OGIs from blunt traumatic etiology (57.0%) with injury in zone I (65.9%). On average, patients had 5.3±4.7 office visits, where 8% of patients had no follow-up, 76% had 1-9 visits, and 16% had 10 or more visits. Thirty-five percent required at least one secondary surgery (mean 0.5±0.8). Clinical factors, including presenting best-corrected visual acuity (BCVA), predicted utilization. Predictors for office visits included injury zone (p=0.02), retinal detachment (p<0.001), vitreous hemorrhage (p=0.014), and traumatic cataract (p=0.011). Retinal detachment (p<0.001), and traumatic cataract (p<0.001) were predictive of secondary surgeries. The most common surgeries were pars plana vitrectomy (n=124), cataract extraction (n=46), enucleation (n=33), and corneal transplant (n=21) CONCLUSION: OGI management often requires additional procedures with significant follow-up. Overall trends suggest greater utilization among eyes with significant injury that still maintain potential for visual recovery.
A randomized controlled single-blinded study comparing a 30-gauge needle to a 34-gauge needle for intravitreal injections.
Tiosano A, Mekaiten O, Golan N … +2 more , Ben-Ishai M, Fogler MS
Int Ophthalmol · 2026 Feb · PMID 41686360 · Publisher ↗
PURPOSE: To compare safety, efficacy and patient experience when treated with intravitreal injections of a 30-gauge needle compared to a 34-gauge needle. METHODS: A Prospective Randomized controlled study in a single ter...
PURPOSE: To compare safety, efficacy and patient experience when treated with intravitreal injections of a 30-gauge needle compared to a 34-gauge needle. METHODS: A Prospective Randomized controlled study in a single tertiary medical center. Patients were randomly assigned to receive prescheduled intravitreal injection with either a 30 or a 34-gauge needle. Intravitreal injections were performed by a senior vitreoretinal surgeon or by a resident. After the intravitreal injection was performed, patients were asked to grade pain sensation on a Visual Analog Scale (VAS score). In addition, the presence or absence of subconjunctival hemorrhage (SCH) was recorded, as well as any post-injection complications in the following month. RESULTS: Our cohort included 91 patients with a total of 114 injections. Mean age was 72.8 ± 12, with 51 females and 40 males. The mean pain score in the 30-gauge group was 3.17 ± 2.11 vs 3.05 ± 2.45 in the 34-gauge group. There was no statistically significant difference in the mean pain score among the two groups (p = 0.571) nor in gender (p = 0.563) overall. However, when the injections performed by a senior vitreoretinal surgeon, 34-gauge needles were statistically significantly less painful than 30-gauge needles (2.5 ± 2.0 vs. 3.4 ± 1.8; p = 0.04). Additionally, no difference was recorded in formation of SCH among the groups (p = 1). CONCLUSION: The use of a 34-gauge needle was found to be less painful when used by a senior vitreoretinal surgeon and with similar safety profile as the 30 gauge needle. This may further improve patient satisfaction and increase treatment adherence.
Comparing widefield and ultra-widefield optical coherence tomography angiography with fluorescein angiography in diabetic retinopathy: a review.
Pourbagherkhah P, Jaldian HB
Int Ophthalmol · 2026 Feb · PMID 41677995 · Publisher ↗
PURPOSE: Diabetic retinopathy (DR) is a major cause of vision impairment worldwide. Widefield optical coherence tomography angiography (WF-OCTA) is a non-invasive alternative to widefield fluorescein angiography (WF-FA)...
PURPOSE: Diabetic retinopathy (DR) is a major cause of vision impairment worldwide. Widefield optical coherence tomography angiography (WF-OCTA) is a non-invasive alternative to widefield fluorescein angiography (WF-FA) that provides high-resolution imaging of retinal vasculature. This systematic review evaluates the diagnostic performance of WF-FA and ultra-widefield (UWF)-FA vs. WF-OCTA and UWF-OCTA in detecting DR-related retinal vascular changes. METHODS: A systematic search was conducted, following PRISMA guidelines. Studies reporting quantitative or qualitative findings on microaneurysms (MAs), intra-retinal microvascular abnormalities (IRMAs), and neovascularization (NV), or foveal avascular zone (FAZ) changes were analyzed. RESULTS: A total of 12 studies (648 eyes) met the inclusion criteria. Findings suggest that WF-OCTA detect NV with high sensitivity (96.55%) and specificity (94.74%), comparable to WF-FA. However, WF-FA showed potential in certain qualitative aspects, suggesting a possible complementary role. CONCLUSION: WF-OCTA and UWF-OCTA are promising non-invasive alternatives to WF-FA and UWF-FA, offering high diagnostic accuracy, rapid imaging, and depth-resolved vascular analysis.
Assessing systemic endothelial dysfunction in glaucoma subtypes and pseudoexfoliation using photoplethysmography-based flow mediated dilation.
Karakuzu FZ, Buyukaksu M, Aslan F … +1 more , Sircan-Kucuksayan A
Int Ophthalmol · 2026 Feb · PMID 41670792 · Publisher ↗
PURPOSE: To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethys...
PURPOSE: To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethysmography-based flow-mediated dilation (PPG-FMD) technique and examine associations between endothelial function and ophthalmic structural parameters. METHODS: In this prospective cross-sectional study, 55 participants were enrolled: POAG (n = 12), PEXG (n = 14), PEXS (n = 16), and controls (n = 13). Systemic endothelial function was measured noninvasively by PPG-FMD, quantifying vascular reactivity from pulse amplitude changes during reactive hyperemia. Ophthalmic parameters included intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness assessed by spectral-domain OCT. Group comparisons and correlation analyses were performed with Kruskal-Wallis and Dunn post-hoc tests, and Pearson or Spearman correlation analyses as appropriate. RESULTS: Mean PPG-FMD dilation index values were significantly lower in the POAG (85.4 ± 6.0%) and PEXG (82.5 ± 4.3%) groups compared to controls (124.5 ± 10.1%, p < 0.001). The PEXS group showed nonsignificant reduction. Endothelial function was positively correlated with GCC (r = 0.311, p = 0.027) and RNFL thickness (r = 0.378, p = 0.007) and negatively correlated with IOP (r = - 0.339, p = 0.013). No significant association was found with central corneal thickness. CONCLUSIONS: Our findings highlight that systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, especially PEXG and POAG. The PPG-FMD method offers a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma. TRANSLATIONAL RELEVANCE: This study demonstrates, for the first time, that PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, offering a novel clinical marker that complements IOP and OCT metrics for identifying high-risk patients.
Correction: Resilient back-propagation machine learning-based classification on fundus images for retinal microaneurysm detection.
Steffi S
Int Ophthalmol · 2026 Feb · PMID 41665825 · Publisher ↗
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Comparison of epithelium-off versus iontophoresis-assisted transepithelial corneal collagen cross-linking in keratoconus: a systematic review and meta-analysis.
Alajmi TS, Alasmari FF, Alasmari TF … +7 more , Bamusa A, Almarwani SH, Aljadani HT, Alaslab AK, Alghamdi A, Alalyani MA, Qutub MF
Int Ophthalmol · 2026 Feb · PMID 41661382 · Publisher ↗
BACKGROUND / PURPOSE: Keratoconus is a progressive corneal ectasia characterized by stromal thinning and protrusion, leading to irregular astigmatism and visual impairment. To mitigate these issues, iontophoresis-assiste...
BACKGROUND / PURPOSE: Keratoconus is a progressive corneal ectasia characterized by stromal thinning and protrusion, leading to irregular astigmatism and visual impairment. To mitigate these issues, iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) was developed to enhance riboflavin penetration while preserving the epithelium, aiming for comparable biomechanical effects with fewer adverse events. This systematic review and meta-analysis aim to compare the efficacy and safety of iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) and standard epithelium-off corneal collagen cross-linking (S-CXL) in the management of keratoconus. METHODS: This systematic review and meta-analysis was registered with PROSPERO (ID: CRD420251091187). PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), ClinicalTrials.gov, Google Scholar, and DOJA were searched from inception until August 2025. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and Newcastle-Ottawa Scale (NOS) for observational cohort studies. Meta-analysis was conducted using Review Manager (RevMan) version 5.4 (Cochrane Collaboration). A random-effects model was used to assess heterogeneity across studies. RESULTS: 14 studies with a total of 629 patients were included, with10 incorporated into the quantitative analysis. Pooled analysis showed no significant difference between S-CXL and I-CXL in K-max reduction (mean difference MD = 0.52 D; 95% CI = [- 0.20, 1.23]; P = 0.16). I-CXL had more improvement in UCVA and BCVA, but without statistical significance (UCVA MD = - 0.03 logMAR; P = 0.30; BCVA MD = - 0.01 logMAR; P = 0.57). there was no significant difference between the two in terms of ECC, CCT, and TPT. I-CXL was associated with less adverse events and better patient comfort. CONCLUSION: Both S-CXL and I-CXL are effective in halting keratoconus progression. S-CXL offered better corneal flatting, whereas I-CXL achieved better visual acuity parameters with less side effects and better patient comfort. Due to the high heterogeneity, lack of long-term trials, especially on pediatric population, further research is required.
Effect of pupil dilation on spherical and toric IOL calculations using a swept source OCT ocular biometer.
McLintock C, Uprety S, McKelvie J … +1 more , Lee G
Int Ophthalmol · 2026 Feb · PMID 41661359 · Full text
BACKGROUND: We aim to evaluate the effect of pharmacological pupil dilation on spherical and toric intraocular lens (IOL) power calculations using biometric measurements from the Anterion optical biometer. METHODS: This...
BACKGROUND: We aim to evaluate the effect of pharmacological pupil dilation on spherical and toric intraocular lens (IOL) power calculations using biometric measurements from the Anterion optical biometer. METHODS: This was a prospective observational study of adults undergoing cataract surgery. Pre- and post-dilation biometric measurements were obtained using the Anterion biometer. IOL power calculations, including both spherical and toric values, were performed using the following formulas: Barrett Universal II, Cooke K6, EVO, Hill-RBF, Hoffer® QST, Kane, and Pearl-DGS. Vector analysis was used to compare pre- and post-dilation corneal astigmatism and toric IOL magnitude and axis. RESULTS: A total of 74 eyes from 37 patients (17 male, 20 female; mean age 52.4 ± 7.8 years) were analysed. Pupil dilation resulted in a statistically significant increase in reported central corneal thickness (CCT, p < 0.05), while other biometric parameters remained unaffected. Both spherical and toric IOL power calculations showed no significant changes across formulas following dilation. Vector analysis revealed that the centroid difference in corneal astigmatism and toric IOL magnitude ranged from 0.09 D to 0.05, and axis orientation differences ranged from 3° to 6°, indicating no systematic bias due to dilation. Approximately 75% of eyes showed changes of < 0.50 D in spherical IOL power, while ~ 25% exceeded 0.50 D. For toric IOL power, ~ 90% of eyes showed changes < 0.50 D, with ~ 25% reaching or exceeding 0.50 D. CONCLUSION: Most eyes show minimal IOL power variation with pupil dilation; however, a subset may experience clinically relevant differences, particularly in toric IOL calculations.
Choroidal thickness changes in patients with systemic lupus erythematosus treated with hydroxychloroquine using three dimensional maps.
Bartol-Puyal FA, Chacón González M, García Navarro D … +3 more , Arias-Peso B, Méndez-Martínez S, Pablo L
Int Ophthalmol · 2026 Feb · PMID 41661356 · Full text
PURPOSE: To compare variations in choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ) and healthy subjects for at least one year. METHODS: Cross-section...
PURPOSE: To compare variations in choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ) and healthy subjects for at least one year. METHODS: Cross-sectional study enrolling patients between 30 and 55 years of age with SLE and treated with HCQ for at least one year, and aged-matched healthy subjects. Exclusion criteria included any other ophthalmological disorder or previous treatment, and systemic treatment with immunosuppressive drugs or a dose of corticosteroids higher than 5 mg/d. Macular CT was measured automatically in a grid of 30 × 30 cubes using Triton swept-source optical coherence tomography (Topcon). These were merged into 25 zones (each one comprising 6 × 6 cubes). Three-dimensional (3D) CT maps were created using Microsoft Excel and mean CT values in the grid of 30 × 30 cubes. One eye of each patient was randomly selected for the study. RESULTS: 60 patients and 54 healthy subjects were recruited. Mean age was 45.16 ± 6.43 and 43.79 ± 8.98 years (p = 0.346), respectively. Mean axial length was 23.52 ± 0.96 and 23.67 ± 0.87 mm (p = 0.137), respectively. Mean SLE duration was 125.58 ± 63.10 months, and mean duration of HCQ was 87.87 ± 52.13 months. There were no differences in intraocular pressure (p = 0.271) or spherical equivalent (p = 0.219). Choroidal zones number 9, 14, 15, 19 and 20 (central nasal locations) were thicker in SLE patients. Neither SLE duration, nor HCQ duration had any influence on CT (p > 0.05). CONCLUSIONS: Patients with SLE treated with HCQ for one or more years present higher CT values than healthy subjects. Nasal zones seem to be the most sensitive to these changes, while the other choroidal locations remain similar apparently. However, neither duration of SLE nor duration or dose of HCQ treatment seemed to have any influence on CT.
An intensity-aware vision transformer framework for precise localization of vitreous hemorrhage in fundus imaging.
Lavanya M, Rampriya R, Nagarajan A … +1 more , Govindharaj I
Int Ophthalmol · 2026 Feb · PMID 41653268 · Publisher ↗
BACKGROUND: Vitreous hemorrhage is a serious ocular condition that requires accurate and timely diagnosis. Traditional methods for identifying affected areas in fundus images have limitations in precision and reliability...
BACKGROUND: Vitreous hemorrhage is a serious ocular condition that requires accurate and timely diagnosis. Traditional methods for identifying affected areas in fundus images have limitations in precision and reliability. There is a need for advanced techniques to enhance the detection of vitreous hemorrhage and improve patient outcomes. PROBLEM: Detecting hemorrhages in color fundus images is difficult due to elements such as noise, feature intensity, and overlapping areas. In particular, the variation in feature intensity between different sections of the retina and lens leads to uniform (homogeneous) characteristics. METHODS: This study introduces a Feature Intensity Vision Transformer (FIVT) model utilizes vision transformer technology to detect high-intensity regions within segmented patches based on minimal pixel distributions. The model follows a systematic pipeline involving input image pre-processing, patch extraction (1 × 1-32 × 32), feature intensity estimation using the gray-level co-occurrence matrix (GLCM), and Vision Transformer-based intensity classification to produce a precise region detection mask. Feature distribution is analyzed to identify maximum intensity areas. High and low-intensity regions are classified, and pixels with significant feature content are matched with trained inputs. The model is trained using external images and high-feature regions until accuracy stabilizes. DATASET: We utilize the "exudate-hemorrhage-health" retinal image dataset to evaluate the proposed FIVT. This dataset comprises over 3,000 fundus color images, which include both internal and external references. Out of these, 536 images showing infections are employed to examine the infected areas. For the training process, 3,000 images are categorized into healthy, hemorrhage, and exudate groups. RESULTS: Compared to other methods, the FIVT model achieved a 12.13% improvement in detection accuracy, a 12.55% increase in specificity, and a 12.32% enhancement in sensitivity, demonstrating robust performance across varying illumination and feature intensity conditions. CONCLUSION AND FUTURE SCOPE: The model effectively handles varying illumination and intensity distributions, improving the precision of vitreous hemorrhage localization. However, its performance can be further enhanced with larger, multi-institutional datasets and integration of 3D volumetric data. Future work will focus on clinical validation and adaptation of the framework for related retinal disorders such as diabetic retinopathy and macular edema.
Complications of minimally invasive surgery for primary open-angle glaucoma in patients with diabetic retinopathy: a retrospective cohort study.
Vaddavalli R, Madkour N, Jishu JA … +5 more , Hussein MH, Abdelghany AA, Abdelmaksoud A, Fawzy MS, Toraih EA
Int Ophthalmol · 2026 Feb · PMID 41642413 · Full text
OBJECTIVE: Minimally invasive glaucoma surgery (MIGS) has become increasingly popular for treating primary open-angle glaucoma (POAG). However, data regarding complications for patients with comorbid diabetic retinopathy...
OBJECTIVE: Minimally invasive glaucoma surgery (MIGS) has become increasingly popular for treating primary open-angle glaucoma (POAG). However, data regarding complications for patients with comorbid diabetic retinopathy (DR) are limited. This study aimed to compare complications after MIGS in POAG patients with and without DR. METHODS: This is a retrospective cohort study using the TriNetX global health network. Adult patients with POAG who underwent MIGS were identified, with one group having comorbid DR and the other without. Propensity score matching was applied, yielding 518 patients per group for analysis. Complications assessed included vision loss, hypotony, ocular hypertension, cataract formation, eye infection, and any ocular hemorrhage. The primary outcomes were post-procedure complication rates and their statistical significance. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. RESULTS: Patients with DR who underwent MIGS had a higher risk for vision loss (32.8% vs. 24.4%, HR 1.443, 95% CI 1.13-1.841) and ocular hemorrhage (13.4% vs. 4.3%, HR 3.194, 95% CI 1.929-5.288) compared to those without DR. Cataract formation rates were lower in DR patients at 3 months (44.4% vs. 50.6%, p = 0.046) and 6 months (53.3% vs. 59.5%, p = 0.048) post-surgery. No significant differences were observed in rates of hypotony, ocular hypertension, or eye infection. CONCLUSION: MIGS in patients with DR is associated with an increased risk of post-procedure complications, particularly vision loss and ocular hemorrhage. These findings can aid in the clinical management and counseling of patients with both POAG and DR considering MIGS.
Comparison of outcomes of circumferential versus hemi-gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma: 24-Month results.
Cubuk MO, Ucgul RK, Orenc P … +1 more , Ucgul AY
Int Ophthalmol · 2026 Feb · PMID 41636873 · Publisher ↗
PURPOSE: To compare the clinical outcomes of circumferential (360°) versus hemi (180°) gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with primary open-angle glaucoma (POAG) over a 24-month follow-up....
PURPOSE: To compare the clinical outcomes of circumferential (360°) versus hemi (180°) gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with primary open-angle glaucoma (POAG) over a 24-month follow-up. METHODS: This retrospective, comparative study included 90 eyes of 90 patients with POAG who underwent either standalone circumferential GATT (n = 46) or hemi-GATT (n = 44). Inclusion criteria required uncontrolled intraocular pressure (IOP) (≥ 20 mmHg) despite maximal medical therapy or intolerance to medications. Main outcomes included surgical success (complete and qualified), IOP, number of anti-glaucoma medications, and postoperative complications. Complete success was defined as achieving a target IOP of 6-18 mmHg with ≥ 20% reduction from baseline without medications or further surgery. Qualified success allowed medication use. RESULTS: At 24 months, mean IOP reduction was greater in the circumferential GATT group (- 10.1 ± 5.3 mmHg; 39.7%) than the hemi-GATT group (- 8.0 ± 3.8 mmHg; 32%) (p < 0.05). Complete success was achieved in 58.7% and 34.1% of eyes in the circumferential and hemi-GATT groups, respectively (p = 0.006). Qualified success rates were 78.2% (circumferential GATT) vs. 61.3% (hemi-GATT) (p = 0.051). The most common complication was transient hyphema, observed more frequently after circumferential GATT (54.6%) than hemi-GATT (31.8%) (p = 0.03). IOP spikes (> 30 mmHg) occurred in 10.8% of circumferential and 9% of hemi-GATT eyes (p = 0.71), all managed conservatively. CONCLUSIONS: Both circumferential and hemi-GATT effectively lowered IOP in patients with POAG. Circumferential GATT achieved greater IOP reduction and higher complete success, while hemi-GATT was associated with fewer hyphema events. Hemi-GATT may be preferable in patients at higher bleeding risk, whereas circumferential GATT may provide superior IOP control.
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