BMC Ophthalmology[JOURNAL]
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200 papers
Bilateral anterior lens luxation with secondary glaucoma strongly associated with self-application of a percussion massage gun to closed eyelids: a case report.
Chen Y, Wang Z, Zhou R … +7 more , Zhao Y, Liu X, Gou Y, Ren H, Xie B, Li D, Li H
BMC Ophthalmol · 2026 Jun · PMID 42277757 · Full text
BACKGROUND: Percussion massage guns (PMGs) have gained widespread popularity for muscle recovery; however, standardized safety guidelines for application to anatomically vulnerable regions are lacking. Previously reporte...
BACKGROUND: Percussion massage guns (PMGs) have gained widespread popularity for muscle recovery; however, standardized safety guidelines for application to anatomically vulnerable regions are lacking. Previously reported PMG-associated ocular injuries have been limited to unilateral or mild bilateral involvement. We report the first documented case of bilateral anterior lens luxation with secondary glaucoma strongly associated with self-application of a PMG to closed eyelids. CASE PRESENTATION: A 62-year-old Chinese male with type 2 diabetes mellitus and bilateral meibomian gland dysfunction presented with progressive visual decline and headache for 20 and 10 days, respectively, beginning approximately 7 days after discontinuing self-application of a PMG to closed eyelids (medium speed, 30-33 Hz; 10 min per session, 2-3 times daily for 3 consecutive days) used to relieve ocular dryness. Visual acuity was 0.12 OD and 0.2 OS, with intraocular pressure 51 mmHg OD and 49 mmHg OS. Ultrasound biomicroscopy revealed bilateral anterior lens luxation with 360° zonular dehiscence and complete angle closure. Hereditary, pseudoexfoliative, and biometric causes (including microspherophakia and phacomorphic glaucoma) were considered unlikely. Both eyes underwent sequential 25-gauge pars plana vitrectomy with lensectomy and closed four-point scleral fixation of a posterior chamber intraocular lens. At the latest follow-up (12 months postoperatively), best-corrected visual acuity was 1.0 OD and 0.8 OS, intraocular pressure was normal without antiglaucoma medication, and no glaucomatous optic neuropathy was detected on RNFL OCT. CONCLUSIONS: PMG application to the eyelids may be associated with severe bilateral ocular injury, including complete zonular dehiscence and secondary glaucoma, particularly in eyes with predisposing factors such as age-related zonular weakness or diabetes-related extracellular matrix changes. Manufacturers should incorporate explicit safety warnings against periorbital use. Clinicians should proactively guide diabetic patients with dry eye disease toward appropriate ophthalmic care to prevent harmful self-treatment.
Evaluation of the effect of subepithelial infiltrates following adenoviral keratoconjunctivitis on corneal biomechanics: Corvis ST analysis.
Ulutaş HG, Birge Ergün M, Gönültaş Özkan EN … +1 more , Yılmaz S
BMC Ophthalmol · 2026 Jun · PMID 42277729 · Full text
BACKGROUND: The purpose of this study was to evaluate the impact of subepithelial infiltrates (SEIs) developing after adenovirus epidemic keratoconjunctivitis (EKC) on corneal densitometry and biomechanical properties. M...
BACKGROUND: The purpose of this study was to evaluate the impact of subepithelial infiltrates (SEIs) developing after adenovirus epidemic keratoconjunctivitis (EKC) on corneal densitometry and biomechanical properties. METHODS: Patients who were followed up for at least six months after an acute EKC episode and had persistent SEI were included in the study. Ophthalmological examination findings, corneal tomographic and densitometric parameters obtained with the Pentacam AXL Wave, and biomechanical measurements acquired with the Corvis ST were recorded. RESULTS: Twenty-three eyes of 12 patients with SEIs after EKC and 32 eyes of 16 healthy controls were analyzed, with no significant differences in age or sex distribution between groups. The EKC group showed worse BCVA, higher K2 and Kmax values, increased total higher-order aberrations (HOAs), and elevated corneal densitometry, predominantly in the anterior and central zones. Among biomechanical parameters, A1-length was significantly lower in the EKC group, whereas the remaining biomechanical and specular microscopy parameters were similar between groups. Within the EKC group, extensive involvement was associated with thinner corneas, greater HOAs, and higher central corneal densitometry values. CONCLUSION: Eyes with persistent SEIs after EKC exhibited increased corneal densitometry, whereas alterations in selected biomechanical parameters were limited. These findings may reflect post-inflammatory corneal remodeling. Because only A1-length remained significantly associated with EKC after multivariable adjustment, the biomechanical findings should be interpreted cautiously. Careful preoperative corneal evaluation is advisable for refractive surgery candidates with persistent SEIs after EKC.
Preoperative pterygium extension rate predicts postoperative corneal optical recovery after pterygium excision.
Miyakoshi A, Toyoda N, Katayama H … +1 more , Hayashi A
BMC Ophthalmol · 2026 Jun · PMID 42277726 · Full text
BACKGROUND: Pterygium progression induces corneal optical distortion, and delayed surgery may limit postoperative recovery of corneal optics. However, quantitative criteria indicating the latest acceptable timing of surg...
BACKGROUND: Pterygium progression induces corneal optical distortion, and delayed surgery may limit postoperative recovery of corneal optics. However, quantitative criteria indicating the latest acceptable timing of surgery remain unclear. This study aimed to determine extension-rate thresholds predicting postoperative normalization of corneal asymmetry and higher-order irregularity (HOI). METHODS: This retrospective observational study included 134 eyes with primary pterygium that underwent surgical excision. The pterygium extension rate was calculated from slit-lamp photographs as the ratio of the apex-to-limbus distance to the horizontal corneal diameter. Corneal asymmetry and HOI within the central 3-mm zone were measured preoperatively and 1 month postoperatively using swept-source anterior segment optical coherence tomography. Receiver operating characteristic (ROC) analyses were used to determine cutoff values predicting postoperative normalization. RESULTS: The pterygium extension rate correlated significantly with preoperative corneal asymmetry (r = 0.5899, p < 0.001) and HOI (r = 0.5462, p < 0.001). ROC analysis showed good predictive ability for postoperative corneal asymmetry (AUC 0.80; cutoff 0.359; sensitivity 58.0%, specificity 89.3%) and moderate predictive ability for HOI (AUC 0.74; cutoff 0.292; sensitivity 72.3%, specificity 64.7%). Postoperative normalization occurred in 62.7% of eyes for asymmetry and 38.1% for HOI. CONCLUSIONS: The pterygium extension rate is a simple clinical metric that predicts postoperative optical recovery. These extension-rate thresholds may help support clinical estimation of how long pterygium surgery may be deferred while maintaining the possibility of postoperative optical recovery.
Real-world outcomes of faricimab in treatment-naïve patients with neovascular age-related macular degeneration.
Chang W, Kim J, Jeon J … +1 more , Park S
BMC Ophthalmol · 2026 Jun · PMID 42277682 · Full text
BACKGROUND: To evaluate real-world efficacy, durability, and safety of faricimab in treatment-naïve Asian patients with neovascular age-related macular degeneration (nAMD). METHODS: Retrospective study of treatment-naïve...
BACKGROUND: To evaluate real-world efficacy, durability, and safety of faricimab in treatment-naïve Asian patients with neovascular age-related macular degeneration (nAMD). METHODS: Retrospective study of treatment-naïve nAMD eyes treated with faricimab at a single centre in South Korea. After four monthly loading doses, treatment intervals (Q8W, Q12W, Q16W) were assigned based on disease activity at weeks 20 and 24. Comprehensive assessments included best-corrected visual acuity (BCVA), central subfield thickness (CST), pigment epithelial detachment (PED) height, subfoveal choroidal thickness (SFCT), and intraretinal/subretinal fluid (IRF/SRF) presence. RESULTS: Eighty-eight treatment-naïve eyes were included. Mean age was 72.8 (9.0) years. At week 20, BCVA improved from 62.1 (15.4) to 69.3 (14.6) ETDRS letters (+ 7.1 letters, P < 0.001). CST decreased from 414 (150) to 280 (94) µm (- 134 μm, P < 0.001). PED height decreased from 297 (167) to 171 (116) µm (- 43%, P < 0.001). SFCT decreased from 208 (91) to 184 (83) µm (- 12%, P < 0.001), with PCV eyes showing the greatest reduction (- 32 μm, P < 0.001). IRF presence (1 mm/6 mm) decreased from 33%/34% to 7%/9%, and SRF from 78%/84% to 12%/20% at week 20. At week 60, 52.3% achieved Q16W and 67.0% achieved ≥Q12W intervals. Among 168 eyes in the safety analysis, there was 1 case of mild vitritis and 2 cases of RPE tear, with no cases of endophthalmitis or retinal vasculitis reported. CONCLUSIONS: Initiation of faricimab in treatment-naïve nAMD patients resulted in favourable visual and anatomical outcomes with durable treatment intervals and a low incidence of adverse events in a real-world setting.
Comparison of topical nepafenac 0.1% and 0.3% for the treatment of pseudophakic cystoid macular edema following cataract surgery.
Çakmak S, Söylemez M, Cebeci Z … +3 more , Erdogan G, Altınkurt E, Bayraktar Ş
BMC Ophthalmol · 2026 Jun · PMID 42271301 · Full text
PURPOSE: To compare the effectiveness of topical nepafenac 0.1% and 0.3% in the management of pseudophakic cystoid macular edema (PCME) following cataract surgery. METHODS: In this retrospective comparative study, patien...
PURPOSE: To compare the effectiveness of topical nepafenac 0.1% and 0.3% in the management of pseudophakic cystoid macular edema (PCME) following cataract surgery. METHODS: In this retrospective comparative study, patients with PCME after cataract surgery and a follow-up of at least three months were included. Patients were assigned to two groups according to the topical nepafenac treatment initiated after PCME diagnosis: 0.1% (Group-1) or 0.3% nepafenac (Group-2). Best-corrected visual acuity (BCVA), macular and choroidal parameters assessed by optical coherence tomography (OCT) were evaluated at diagnosis and during follow-up and were compared between the groups. RESULTS: The study included 97 eyes from 78 patients, with a mean age of 71.3 ± 7.1 years. Baseline demographic characteristics and surgical parameters were comparable between the groups. BCVA, macular and choroidal parameters improved in both groups during follow-up. At the third month, Group-1 showed significantly better mean BCVA (0.056 ± 0.082 vs. 0.122 ± 0.135, p = 0.028). At the first month, mean central foveal subfield thickness was significantly thinner in Group-1 (348.0 ± 96.5 vs. 387.9 ± 130.7, p = 0.047). Mean choroidal vascular index (CVI) increased during follow-up in both groups, with a greater increase observed in Group-2 at the first month (0.5 ± 2.7 vs. 2.1 ± 3.7, p = 0.024). Complete anatomical response at the first month was observed more often in Group-1 (60.0% vs. 38.1%, p = 0.033). CONCLUSION: Topical nepafenac 0.1% and 0.3% were both associated with improvement in PCME. Group-1 showed better early anatomical and later visual outcomes, whereas Group-2 showed a greater early CVI increase. However, these findings do not establish the superiority of either regimen.
Multimodal imaging and intravitreal faricimab for polypoidal choroidal vasculopathy associated with a choroidal nevus in genetically confirmed Usher syndrome type 2: a case report.
Kim J, Choi J, Kim K … +1 more , Yu SY
BMC Ophthalmol · 2026 Jun · PMID 42271300 · Full text
BACKGROUND: Usher syndrome is an autosomal recessive disorder characterized by retinitis pigmentosa (RP), sensorineural hearing loss, and vestibular dysfunction. Polypoidal choroidal vasculopathy (PCV) is characterized b...
BACKGROUND: Usher syndrome is an autosomal recessive disorder characterized by retinitis pigmentosa (RP), sensorineural hearing loss, and vestibular dysfunction. Polypoidal choroidal vasculopathy (PCV) is characterized by branching neovascular networks and polypoidal lesions. While typically classified within the pachychoroid spectrum, PCV can also manifest in eyes without choroidal thickening. Conversely, RP is usually associated with choroidal thinning, which may lead to underdiagnosis of PCV. To the best of our knowledge, PCV has not previously been reported in patients with Usher syndrome. Here, we present the first genetically confirmed case of Usher syndrome type 2 complicated by PCV that was successfully managed with intravitreal faricimab. CASE PRESENTATION: A 63-year-old man presented with night blindness. The diagnosis of Usher syndrome type 2 was confirmed based on bilateral RP features, moderate sensorineural hearing loss, and two pathogenic USH2A variants. Six years after the initial diagnosis, the patient developed visual disturbance in the left eye, with the best-corrected visual acuity (BCVA) declining to 20/80. Multimodal imaging, including spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and swept-source optical coherence tomography angiography, confirmed the diagnosis of PCV. An amelanotic choroidal nevus was also identified on SD-OCT. After five intravitreal faricimab injections, the BCVA improved to 20/30, with a 75% reduction in pigment epithelial detachment height and complete subretinal fluid resolution without adverse effects. CONCLUSIONS: To our knowledge, this is the first reported case of PCV associated with a choroidal nevus in a patient with genetically confirmed Usher syndrome type 2. PCV should not be excluded in patients with RP despite characteristic choroidal thinning. Intravitreal faricimab was effective and well-tolerated, suggesting its therapeutic potential in such cases.
The impact of systemic iron overload on retinal and choroidal microcirculation in transfusion-dependent beta-thalassemia patients.
Bezci Aygün F, Algedik Tokyürek MÖ, Unal Ş … +3 more , Aksu T, Gümrük F, Kadayıfcılar S
BMC Ophthalmol · 2026 Jun · PMID 42271293 · Full text
PURPOSE: This study aimed to evaluate retinal and choroidal microcirculation in transfusion-dependent β-thalassemia (TDβT) patients and to explore associations between systemic iron overload and ocular structural and vas...
PURPOSE: This study aimed to evaluate retinal and choroidal microcirculation in transfusion-dependent β-thalassemia (TDβT) patients and to explore associations between systemic iron overload and ocular structural and vascular changes. METHODS: A total of 66 eyes from 33 TDβT patients and 66 eyes from 33 healthy controls were included in this case-control study. Retinal and choroidal structures were evaluated using Spectral-Domain OCT and OCT-Angiography (OCTA). Systemic iron overload was assessed using serum ferritin and MRI-T2* of the liver and heart. Liver iron load was classified by T2* values into normal, mild, and moderate. Key ocular parameters, including central macular thickness (CMT), subfoveal choroidal thickness (SCT), luminal area (LA), stromal area (SA), total choroidal area (TA), and vessel density (VD) of superficial (SCP), deep (DCP), and choriocapillaris (CC) plexi, were analyzed. RESULTS: Choriocapillaris VD was significantly lower in TDβT patients compared with controls (p < 0.001, p adjusted = 0.004), while ferritin levels showed positive correlations with CMT, SCP VD, and CC VD within the patient group. Patients with moderate liver iron overload showed increased trend toward LA, SA, TA, SCT, and inferior peripapillary VD, but this significance not existed after FDR correction. No significant relationship was found between iron overload and FAZ metrics. CONCLUSION: Liver iron overload may be associated with changes in choroidal structure and perfusion in TDβT patients, although chronic anemia-related hypoxia and compensatory vascular responses may also contribute to these findings.Choroidal parameters may provide useful non-invasive indicators for monitoring ocular effects of systemic iron burden.
Incidence of scleritis requiring surgical repair from subconjunctival triamcinolone acetonide injections in patients with scleritis in TriNetX.
Lama J, Berkenstock M
BMC Ophthalmol · 2026 Jun · PMID 42271290 · Full text
PURPOSE: To estimate the yearly and 15-year cumulative incidence of scleritis requiring surgical repair in patients with a prior diagnosis of scleritis who received a subconjunctival or subTenon triamcinolone acetonide i...
PURPOSE: To estimate the yearly and 15-year cumulative incidence of scleritis requiring surgical repair in patients with a prior diagnosis of scleritis who received a subconjunctival or subTenon triamcinolone acetonide injection (STAI). DESIGN: A retrospective cohort study was conducted using the TriNetX US Collaborative Network. TriNetX is an electronic health records database with anonymized, deidentified encrypted data from 69 healthcare networks. METHODS: Subjects with a history of scleritis were identified using ICD-10 (International Classification of Diseases, 10th Revision) code H15.0X and who subsequently underwent a STAI as identified using the CPT (current procedural terminology) code between January 1, 2009 to December 31, 2024. CPT codes were used to identify STAIs include subconjunctival injection (68200) or subTenon injection (67515) and injection of triamcinolone acetonide 10 mg (J3301). Please note that H15.0X codes specifying posterior scleritis were excluded from this cohort in an attempt to localize anterior scleritis. The time relation was set to ensure all patients in the cohort had an existing diagnosis of scleritis prior to any instance of STAI. The primary outcome measure was the annual and 15-year cumulative incidence of required surgical repair within 4 weeks, and 3, 6, 9, and 12 m after the STAI as best estimated by scleral graft reinforcement and repair of scleral staphyloma with graft, CPT 67255 or 66225. Final data collection ran on April 23, 2026. Possible confounding procedures such as cataracts were also excluded within the time period assessed in order to better localize the STAI for use in cases of scleritis. RESULTS: Out of 113,510,724 patients on the TriNetX database, 36,249 had a diagnosis of scleritis. Of those with a history of scleritis, 176 had a subconjunctival or subTenon triamcinolone injection (STAI). Of this cohort, 0 patients needed surgical interventions requiring a patch graft over the 15-year time period of the study giving an annual and cumulative incidence of 0 per 100,000 persons. The subjects were primarily female (112, 63.64%) with a mean age of 61 years (range 14-90, SD 16). CONCLUSIONS: Surgical intervention requiring a patch graft was not observed post-injection among patients with prior scleritis who received a STAI. Further studies with larger cohorts are necessary to accurately represent the risk profile of STAI in the greater population.
Dysregulation of neurovascular unit in the retina after optic nerve injury.
Wu Q, Wang H, Liu H … +2 more , Zhang L, Wei Q
BMC Ophthalmol · 2026 Jun · PMID 42265670 · Full text
PURPOSE: To investigate the changes in the neurovascular unit (NVU) of the retina in rats following optic nerve (ON) injury, and to explore the translational implications for traumatic optic neuropathy (TON). METHODS: Th...
PURPOSE: To investigate the changes in the neurovascular unit (NVU) of the retina in rats following optic nerve (ON) injury, and to explore the translational implications for traumatic optic neuropathy (TON). METHODS: The ON transverse quantitative traction (ONTQT) was performed to establish the model of ON and retinal injury. The rats were divided into the sham operation group (SG) and the model group (MG). At 14th day post-modeling, flash visual evoked potential (FVEP) test was performed to evaluate the visual function. Transmission electron microscopy (TEM) was used to observe the microstructure of retinal NVU. RNA binding protein with multiple splicing (RBPMS) immunofluorescence was applied to detect the survival retinal ganglion cell (RGC). The activity of astrocytes and Müller cells in retina was detected by glial fibrillary acidic protein (GFAP) immunofluorescence. The expression of tight junction proteins (Claudin-1, Claudin-5) and glial end feet markers aquaporin-4 (AQP4) and inwardly rectifying potassium channel subtype 4.1 (Kir4.1) in retinal tissue were test by western blot and Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). RESULTS: At 14th day following ONTQT, the FVEP results exhibited the prolonged peak latency of P2 and the reduced amplitudes of N1-P1 and N2-P2. TEM showed structural changes of the basement membranes in NVU and ultrastructural abnormalities of tight junctions (TJs) after ONTQT. Besides, the expression of RBPMS in ganglion cell layer (GCL) was down-regulated and GFAP was over-expression in the injured retinal sections. The relative expressions of claudin-1and claudin-5 declined and the mRNA levels of AQP4 increased in the retina at 14 days following ONTQT. The mRNA levels of Kir4.1 was downregulated in the retina of MG. CONCLUSIONS: ONTQT can be applied in the model of ON and retina injury. The dysfunction of retinal NVU may promotes the optic degeneration in rats following ONTQT, contributing to the RGC loss and impaired visual function. These findings provide a mechanistic basis for NVU-targeted neuroprotection and identify potential clinical biomarkers for the diagnosis and treatment of TON.
Polarimetric entropy mapping of retinal pigment epithelium in full-thickness macular hole by polarization-sensitive OCT.
Terao R, Yashiro K, Kuriyama T … +8 more , Babaguchi K, Mihara G, Nakajima K, Aoki S, Arai T, Kitamoto K, Azuma K, Ueta T
BMC Ophthalmol · 2026 Jun · PMID 42265628 · Full text
BACKGROUND: This study is aimed to evaluate retinal pigment epithelium (RPE) entropy in eyes with full-thickness macular hole (FTMH) using polarization-sensitive optical coherence tomography (PS-OCT). METHODS: Patients d...
BACKGROUND: This study is aimed to evaluate retinal pigment epithelium (RPE) entropy in eyes with full-thickness macular hole (FTMH) using polarization-sensitive optical coherence tomography (PS-OCT). METHODS: Patients diagnosed with treatment-naïve FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were included. Ophthalmologic examinations, including visual acuity (BCVA), swept-source OCT (SS-OCT), and PS-OCT, were performed. Polarimetric entropy (PE) of RPE was assessed using PS-OCT and compared with affected and fellow eyes and before and after surgery. RESULTS: Fourteen eyes of 14 patients were included (64.5 ± 5.84 years). All eyes achieved complete FTMH closure following the surgery. PE value within the central foveal area (< 200 μm from the foveal center) was significantly lower than that in fellow eyes (p = 0.013), whereas PE in the area surrounding FTMH was significantly higher (p = 0.0402). The interocular difference in foveal PE (affected eye minus fellow eye) was significantly and negatively correlated with baseline BCVA (p = 0.0445). Postoperatively, PE in the surrounding area significantly decreased, whereas foveal PE did not change. Eyes without EZ recovery exhibited significantly greater baseline foveal PE reduction than those with EZ recovery (p = 0.0053). CONCLUSIONS: These findings suggest two spatially distinct RPE responses in FTMH: decreased entropy in the foveal area and increased entropy in the surrounding region. Foveal RPE-PE quantified by PS-OCT is associated with EZ recovery and may reflect postoperative structural outcomes.
Retreatment using LASIK, PRK, or ICL for myopic regression after corneal laser refractive surgery.
Ang RET, Ang MRC, Jacomina JMD … +2 more , Araneta MMQ, Cruz EM
BMC Ophthalmol · 2026 Jun · PMID 42260445 · Full text
PURPOSE: To describe the outcomes of retreatment for myopic regression following primary LASIK or PRK, and to explore factors associated with pre-retreatment refractive error. METHODS: Retrospective cross-sectional study...
PURPOSE: To describe the outcomes of retreatment for myopic regression following primary LASIK or PRK, and to explore factors associated with pre-retreatment refractive error. METHODS: Retrospective cross-sectional study of eyes undergoing retreatment with LASIK, PRK, or ICL implantation after prior LASIK/PRK. Outcomes included UDVA, CDVA, MRSE, and safety and efficacy indices through 6-12 months. Associations between baseline factors and pre-retreatment MRSE were assessed. RESULTS: 158 eyes were included (136 LASIK, 12 PRK, 10 ICL). Early postoperative outcomes improved significantly for LASIK (UDVA 0.37 to 0.04 logMAR; MRSE - 1.28 D to - 0.12 D) and ICL (UDVA 0.68 to 0.03 logMAR; MRSE - 2.72 D to 0.03 D). PRK also produced significant UDVA gains (0.63 to 0.06 logMAR). Efficacy and safety indices were near or above 1.0 across groups. A longer interval since primary surgery was significantly linked to more negative MRSE, consistent with greater regression. Mild correlation between pre-retreatment MRSE and age, initial MRSE, and tissue ablation were observed. Complications were low (7.9%). CONCLUSIONS: Retreatment for myopic regression with LASIK, PRK, or ICL was safe and effective, with stable outcomes through 6-12 months. Regression was multifactorial and not predicted by baseline characteristics, though longer intervals between surgeries were significantly associated with greater myopic regression.
iStent combined with phacoemulsification versus phacoemulsification alone in open-angle glaucoma: a meta-analysis by medication washout status.
Song Z, Li Y, Wang Y … +3 more , Shi J, Zhou L, Ding X
BMC Ophthalmol · 2026 Jun · PMID 42260442 · Full text
PURPOSE: To assess how preoperative medication washout influences the interpretation of intraocular pressure (IOP) outcomes in randomized controlled trials (RCTs) comparing iStent combined with phacoemulsification versus...
PURPOSE: To assess how preoperative medication washout influences the interpretation of intraocular pressure (IOP) outcomes in randomized controlled trials (RCTs) comparing iStent combined with phacoemulsification versus phacoemulsification alone. METHODS: Systematic searches in PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were conducted through December 2025. RCTs comparing combined surgery versus phacoemulsification alone in open-angle glaucoma were included. Random-effects meta-analyses pooled weighted mean differences (WMDs) for IOP and medications, stratified by washout status and follow-up duration. RESULTS: Five RCTs (915 eyes) were included. In short-term follow-up (≤ 15 months), IOP reduction did not differ significantly between groups. In long-term follow-up (> 15 months), combined surgery showed greater IOP reduction in trials with medication washout (WMD = 1.29 mmHg; 95% CI: 0.61 to 1.97) but not in trials without washout (WMD = 0.69 mmHg; 95% CI: -2.25 to 3.63). Combined surgery consistently reduced medication use (WMD = 0.39) and increased the likelihood of medication-free status (RR = 1.31; 95% CI: 1.15 to 1.51). CONCLUSIONS: Preoperative washout status substantially influences IOP outcome quantification. In patients assessed without washout, where baseline IOP is medically controlled, the principal benefit of combined surgery is sustained medication burden reduction rather than additional numerical IOP lowering.
Real-world data analysis of cranial nerve III, IV, and VI palsies: demographics, association factors, and comparative all-cause mortality.
Hsu CA, Hsu MH, Melisa S … +1 more , Yen JC
BMC Ophthalmol · 2026 Jun · PMID 42260440 · Full text
INTRODUCTION: Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascula...
INTRODUCTION: Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascular ischemia, inflammation, trauma, compression, or neuromuscular junction disorders. This study aims to explore the association factors of these three ocular motor cranial nerve palsies and to compare their respective all-cause mortality rates using the real-world TriNetX Clinical Research Database (TriNetX CRD). MATERIALS AND METHODS: TriNetX is a global federated administrative database with real-time updates of electronic medical records (EMRs). We used the US Collaborative Network within the TriNetX platform to establish the patient cohorts. This network contains electronic health record data from more than 100 million patients across 68 US healthcare organizations (HCOs). This study utilized TriNetX platform to analyze the demographics and associated factors of ocular motor cranial nerve palsies, including diabetes, hypertension, acute myocardial infarction (AMI), overweight status, blood glucose and lipid profiles, body mass index (BMI), and history of brain aneurysm surgery, through intergroup comparisons using paired t-tests. All-cause mortality was assessed using Cox proportional hazards modeling and Kaplan-Meier survival analysis. RESULTS: The average age at presentation was 63, 57, and 60 years for CN III, IV, and VI palsies, respectively, with a slight male predominance. CN VI palsy was the most common, followed by CN IV and CN III palsies. CN III and CN VI palsy cohorts were more commonly associated with diabetes, hypertension, AMI, overweight, and brain aneurysm surgery, suggesting a microvascular or compressive etiology. In contrast, the CN IV palsy cohort was younger and more similar to the general population in clinical and laboratory characteristics. Regarding all-cause mortality, the CN III palsy cohort had the poorest survival, followed closely by the CN VI group, while the CN IV group exhibited the most favorable survival outcome. DISCUSSION: This study confirmed that CN VI palsy is the most frequent cause of ocular motor nerve palsy leading to binocular diplopia. Notably, CN III and VI palsies shared similar vascular and compressive association factors, while CN IV palsy appeared to be more frequently linked to congenital or traumatic origins. These differences were reflected in the mortality analysis, where CN III palsy showed the worst prognosis, CN VI a slightly better but comparable pattern, and CN IV the best survival outcome. CONCLUSIONS: Using the TriNetX CRD, this study delineated the demographic profiles, associated clinical factors, and survival outcomes of patients with ocular motor cranial nerve palsies. The typical demographic was males in their late 50s to early 60s, with CN VI being the most frequently affected nerve. CN III and VI palsies were more often associated with microvascular and compressive conditions, which correlated with higher mortality. Conversely, CN IV palsy was associated with a younger population and more benign clinical profiles, reflected in better survival outcomes.
Needle bevel-guided standardisation of scleral tunnel formation in intrascleral haptic fixation: a quantitative geometric analysis.
Aytogan H, Ayintap E
BMC Ophthalmol · 2026 Jun · PMID 42260422 · Full text
BACKGROUND: Scleral tunnel formation during Yamane double-needle intrascleral haptic fixation (ISHF) depends on proprioceptive estimation, producing variable tunnel lengths that contribute to intraocular lens (IOL) malal...
BACKGROUND: Scleral tunnel formation during Yamane double-needle intrascleral haptic fixation (ISHF) depends on proprioceptive estimation, producing variable tunnel lengths that contribute to intraocular lens (IOL) malalignment. The aim of this study was to evaluate a needle bevel-guided technique using the innate 2 mm bevel of a 26-gauge needle as a visual endpoint for standardising intrascleral tunnel length, and to assess postoperative IOL positional stability using a quantitative geometric landmark framework. METHODS: Retrospective consecutive case series of 24 eyes undergoing ISHF in the horizontal meridian (3- and 9-o'clock positions) by a single surgeon. During scleral needle advancement, the bevel disappearance point was used to standardise tunnel length to approximately 2 mm at each fixation site. IOL centration was quantified by extracting limbus centre (L) and optic centre (O) from intraoperative and 6-month images, and flange coordinates (F1, F2) from intraoperative images only using Fiji/ImageJ (National Institutes of Health, Bethesda, MD, USA; version 2.14.0/1.54f). The primary outcome was longitudinal Euclidean displacement of the optic centre. RESULTS: Mean best-corrected visual acuity improved from 1.28 ± 0.54 to 0.52 ± 0.47 logMAR (p < 0.001). Mean IOL decentration was 0.401 ± 0.240 mm at baseline and 0.397 ± 0.234 mm at 6 months (mean change - 0.004 mm; p = 0.457). Mean Euclidean displacement was 0.029 ± 0.018 mm; no eye demonstrated displacement exceeding 0.06 mm. No haptic extrusion, IOL dislocation, or sight-threatening complications occurred. CONCLUSIONS: The needle bevel provides a simple, reproducible, and cost-free visual cue for standardising intrascleral tunnel length during ISHF and was associated with excellent longitudinal positional stability. Initial centration, governed by entry angle and chord length symmetry, remains a separate challenge requiring complementary strategies.
Efficacy of different optical zone design with different myopia control for corneal refractive therapy (CRT): a one-year prospective cohort study.
Lai WX, Wang MT, Fu RX … +6 more , Wu X, Hu QM, Jia YY, Zhang YY, Tang DY, Zhang WM
BMC Ophthalmol · 2026 Jun · PMID 42260405 · Full text
PURPOSE: This study aims to compare the one-year myopia control effects of orthokeratology (OK) lenses with different optical zone designs in children with varying degrees of myopia. METHODS: A total of 200 children with...
PURPOSE: This study aims to compare the one-year myopia control effects of orthokeratology (OK) lenses with different optical zone designs in children with varying degrees of myopia. METHODS: A total of 200 children with myopia aged 7-12 years with spherical equivalent refraction (SER) ranging from - 0.50 D to - 6.00 D were enrolled. They were non-randomly divided into four groups based on the baseline refractive power and the final choice on OK lenses type: Low myopia 6.0 group, Mod myopia 6.0 group, Low myopia 5.0 group, and Mod myopia 5.0 group, with 50 children in each group. Data from the right eye were used for analysis. We comparatively analysed the one-year follow-up axial length (AL) and AL elongation between each group. We also analyzed the interaction effect between different optical center designs and different initial myopic refractive powers on AL elongation over 1 year by two-way ANOVA, and compared the proportions of non-progressive myopia among the four groups. RESULTS: At the 1-year follow-up, AL differed significantly across different myopia subgroups, with Mod myopia groups showing longer AL than low myopia groups, but no significant difference was noted between lens design subgroups. For one-year AL elongation, subgroups with small optical zone designs and those with initial moderate myopia had lower values. A slight interaction effect was observed between lens optical center design and initial myopia severity (F = 6.700, P = 0.010, partial η²=0.033). The one-year AL elongation was 0.280 ± 0.170, 0.148 ± 0.167, 0.154 ± 0.121, and 0.141 ± 0.185 in Low Myopia 6.0 group, Mod Myopia 6.0 group, Low Myopia 5.0 group, and Mod Myopia 5.0 group, respectively; the corresponding non-progressive myopia rates were 62%, 36%, 58%, and 64%. The Mod Myopia 5.0 group presented the slowest AL elongation and the highest non-progressive myopia rate, whereas Mod myopia 6.0 group and Low myopia 5.0 group also showed slower AL elongation and higher non-progressive myopia rates than those of the Low myopia 6.0 group. CONCLUSION: CRT lenses with a small optical zone design exhibited better myopia control compared to those with a larger optical zone design, especially in children with low myopia.
Visual outcomes of scleral-fixated posterior chamber intraocular lenses in children with genetic ectopia lentis: long-term follow-up.
Vallotton K, Habra O, Frueh BE
BMC Ophthalmol · 2026 Jun · PMID 42260393 · Full text
BACKGROUND: Ectopia lentis in the pediatric population poses significant surgical challenges given the need for long-term optical rehabilitation. This study evaluated the feasibility and clinical outcomes of lensectomy c...
BACKGROUND: Ectopia lentis in the pediatric population poses significant surgical challenges given the need for long-term optical rehabilitation. This study evaluated the feasibility and clinical outcomes of lensectomy combined with scleral-sutured intraocular lens (IOL) implantation in pediatric patients with genetic ectopia lentis. METHODS: We conducted a retrospective study of pediatric patients with atraumatic (sub)luxation of the crystalline lens who underwent lensectomy, anterior vitrectomy, and scleral-fixated polymethylmethacrylate (PMMA) IOL implantation in the sulcus. Outcome measures included best-corrected distance and near visual acuities (LogMAR), refractive outcomes and complication rates. Mean follow-up duration was 6.5 ± 2.9 years (range: 1.7-11.5 years). RESULTS: Nineteen children (36 eyes; 55% male; mean age 5.1 ± 1.9 years) were included. BCVA improved significantly for near vision (0.72 ± 0.3 to 0.19 ± 0.3; p < 0.001) and distance vision (0.48 ± 0.2 to 0.05 ± 0.2; p = 0.008). The spherical equivalent shifted from - 6.3 ± 4.6 D preoperatively to + 1.5 ± 1.4 D at one month, then to - 0.7 ± 2.6 D at final follow-up, reflecting a mean myopic shift of - 2.26 ± 2.11 D. Vision-threatening IOL subluxation occurred in 5 eyes (14% of eyes; 21% of patients). Kaplan-Meier analysis estimated its cumulative incidence at 7% at 5 years and 16% at 10 years. CONCLUSIONS: Lensectomy combined with scleral-fixated sulcus PMMA IOL implantation is a viable surgical strategy for pediatric ectopia lentis, yielding substantial visual improvement and acceptable refractive outcomes. IOL subluxation remains the primary long-term concern, underscoring the need for sustained postoperative surveillance.
CoCl-induced alterations in antioxidative and inflammatory marker expression in an siRNA-based in vitro model of aniridia-associated limbal epithelial dysfunction.
Hsu SL, Szentmáry N, Fries FN … +6 more , Li Z, Chai N, Seitz B, Amini M, Suiwal S, Stachon T
BMC Ophthalmol · 2026 Jun · PMID 42251340 · Full text
BACKGROUND: Congenital aniridia is a rare disease, accompanied by aniridia associated keratopathy (AAK) in most cases. Oxidative stress and inflammation are involved in the progression of AAK. We aimed to evaluate antiox...
BACKGROUND: Congenital aniridia is a rare disease, accompanied by aniridia associated keratopathy (AAK) in most cases. Oxidative stress and inflammation are involved in the progression of AAK. We aimed to evaluate antioxidative and inflammatory gene and protein expression in a small interfering RNA (siRNA) paired box 6 (PAX6) knockdown limbal epithelial cell (LEC) model of aniridia under cobalt chloride (CoCl)-induced stress. METHODS: To mimic PAX6 haploinsufficiency in congenital aniridia, PAX6 expression was knocked down by 24-hour siRNA treatment in primary human LECs. Hypoxia-mimetic conditions were induced by 50 µM or 75 µM CoCl₂ for 48 h following siRNA transfection. Messenger RNA (mRNA) expression levels were analyzed by quantitative polymerase chain reaction (qPCR), while protein expression levels were assessed by enzyme-linked immunosorbent assay (ELISA) or western blotting. RESULTS: Vascular endothelial growth factor A (VEGFA) protein levels were significantly increased in PAX6 knockdown LECs compared with control siRNA-treated cells (p = 0.007). In contrast, hypoxia-inducible factor 2-alpha (HIF-2α) and interleukin-6 (IL-6) mRNA levels (p = 0.031, p = 0.001), as well as interleukin-1 beta (IL-1β), IL-6, and interleukin-8 (IL-8) protein levels (p = 0.049, p < 0.001, p < 0.001, respectively), were significantly reduced in PAX6 knockdown cells compared with control siRNA-treated LECs. CoCl₂ treatment (50 and 75 µM) reduced hypoxia-inducible factor 1-alpha (HIF-1α) mRNA expression in both groups (p = 0.019 and p = 0.007; p < 0.001 and p = 0.046, respectively). In control cells, 75 µM CoCl₂ increased IL-1β and IL-8 mRNA expression (p = 0.022, p = 0.019) as well as IL-1β protein levels (p = 0.024), whereas IL-8 protein levels decreased at both concentrations (p = 0.002 and p < 0.001). No other analyzed genes showed significant expression changes in response to CoCl₂ treatment in either the control or PAX6 knockdown groups. CONCLUSIONS: Our study demonstrates altered expression of hypoxia-related (HIF-1α, HIF-2α) and inflammatory (IL-1β, IL-6, IL-8) genes in response to CoCl₂ treatment or PAX6 haploinsufficiency. Further investigation is needed to elucidate the effects of PAX6 knockdown and its interaction with inflammatory pathways. This research may contribute to better understanding of congenital aniridia.
Personalized orbital decompression surgery for thyroid-associated orbitopathy: a comprehensive retrospective analysis of efficacy, safety, and surgical strategy.
Wang P, Han Z, Li X … +4 more , Lin R, Xun Y, Sang Z, Yuan H
BMC Ophthalmol · 2026 Jun · PMID 42251332 · Full text
OBJECTIVE: This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to opt...
OBJECTIVE: This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to optimize surgical strategies accordingly. METHODS: A retrospective cohort study included 199 TAO patients (263 eyes) who underwent orbital decompression between September 2021 and June 2025. Patients were stratified into four groups by surgical modality: transconjunctival fat decompression, endoscopic transnasal medial wall decompression, combined transconjunctival medial-lateral wall decompression, and combined endoscopic transnasal medial-lateral wall decompression. Primary outcomes were changes in LogMAR best-corrected visual acuity (BCVA), proptosis, and intraocular pressure (IOP); secondary outcomes included ocular motility, diplopia, and postoperative complication rates. RESULTS: All surgical strategies resulted in significant clinical improvements. Overall mean proptosis was reduced from 21.16 ± 2.75 mm to 15.01 ± 1.86 mm (p < 0.0001). Mean BCVA improved from 0.67 ± 0.68 LogMAR to 0.34 ± 0.42 LogMAR (p < 0.0001), with the most significant improvement seen in patients with preoperative Dysthyroid Optic Neuropathy (DON). DON was present in 46.4% of eyes, with the highest prevalence in Groups 2 (76.6%) and 4 (62.2%). Combined bony wall decompression (Groups 3 & 4) yielded the greatest proptosis reduction (7.67 mm and 7.29 mm, respectively), significantly more than single-modality decompression (p < 0.0001). The overall complication rate was 9.1%, with new-onset or worsening diplopia being the most common, but often transient or successfully managed with subsequent strabismus surgery. Endoscopic medial wall decompression (Group 2) was associated with the lowest complication rate (4.3%). CONCLUSION: In this large single-centre retrospective cohort, individualized orbital decompression was associated with significant improvements in proptosis, visual function, IOP, ocular motility, and diplopia-related outcomes in patients with TAO. Combined medial-lateral wall decompression achieved greater proptosis reduction, whereas procedures involving medial wall decompression were associated with visual improvement in eyes with DON. These findings support an indication-driven approach to surgical selection, while the retrospective design, baseline differences among groups, and eye-level analysis should be considered when interpreting comparative results.
Variations in post-operative cataract surgery instructions among eye health workers in Tanzania: a cross-sectional survey.
Dhalla KA, Kassamali SS, Mbezi T … +2 more , Teferi K, Rugabela EG
BMC Ophthalmol · 2026 Jun · PMID 42251285 · Full text
PURPOSE: To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. METHODS: A cross-sectional survey was conducted among...
PURPOSE: To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. METHODS: A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70). RESULTS: Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%). CONCLUSIONS: Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.
The association between objective visual quality, retinal structure, and dynamic visual acuity.
Li R, Wang Z, Wang Y
BMC Ophthalmol · 2026 Jun · PMID 42249354 · Full text
BACKGROUND: The dynamic visual acuity (DVA) is crucial to assess dynamic visual function in clinical ophthalmology. The impact of objective ocular parameters on DVA remained unknown, which limits the clinical applicabili...
BACKGROUND: The dynamic visual acuity (DVA) is crucial to assess dynamic visual function in clinical ophthalmology. The impact of objective ocular parameters on DVA remained unknown, which limits the clinical applicability and interpretability of the DVA test. Thus, the present research aims to investigate the impact of objective visual quality and retinal structure on DVA. METHODS: Healthy young myopic adults aged 18 to 35 years were recruited. Binocular dynamic visual acuity (DVA) was evaluated at a 1-meter distance with habitual spectacles. The test comprised four sequential assessments of horizontal motion DVA at increasing velocities of 20, 40, 60, and 80 degrees per second (dps). Modulation transfer function (MTF) and higher-order aberrations (HOA) were measured to evaluate visual quality. Retinal structure, including retinal thickness and capillary density in the optic disc and macula was measured with optical coherence tomography angiography (OCTA). RESULTS: Thirty participants were enrolled with a mean age of 23.0 ± 3.7 years. DVA differed significantly across velocities (P < 0.001). DVA at 20 dps (r = -0.537, P = 0.002) and 60 dps (r = -0.430, P = 0.018) were negatively correlated with the binocular mean sphere. DVA at 20 and 60 dps was significantly associated with MTF value from 5 to 30 cycle/degree (c/d), and 80 dps DVA was associated with MTF value at spatial frequencies from 10 to 20 c/d (P < 0.05, respectively). The Z9 aberration showed a positive association with DVA at 20 dps (P = 0.047), and the Z7 aberration showed a significant positive association with DVA at 80 dps (P = 0.030). Limited associations were observed between DVA and retinal thickness or capillary density in the optic disc and macula. CONCLUSIONS: In healthy myopic adults, better objective visual quality, as measured by MTF, might be associated with better DVA at both low and high speeds, whereas retinal structural parameters had a limited association with DVA. The conclusions are limited by applicating habitual spectacle during the DVA test, which precludes full quantification of optical confounding.
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