BMC Ophthalmology[JOURNAL]
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200 papers
Hyaluronic acid concentration predictably modulates physicochemical properties and clinical performance in ophthalmic viscosurgical devices: integrated laboratory and prospective clinical assessment.
Melero A, Torrecilla J, Pino A … +10 more , Alonso JM, Coello D, Sáez de Arregui S, Garay-Aramburu G, López-Plandolit S, Guergué O, Henares I, Huguet-Casquero A, Ucelay López de Heredia M, Pérez González R
BMC Ophthalmol · 2026 May · PMID 42163257 · Full text
BACKGROUND: Ophthalmic viscosurgical devices (OVDs) are essential in cataract surgery for maintaining anterior chamber stability and protecting intraocular tissues. This study evaluated the physicochemical and rheologica...
BACKGROUND: Ophthalmic viscosurgical devices (OVDs) are essential in cataract surgery for maintaining anterior chamber stability and protecting intraocular tissues. This study evaluated the physicochemical and rheological properties of three hyaluronic acid-based OVDs (OpHLINE 1.4%, 2%, and 3%) and assessed their clinical performance. METHODS: A two-phase investigation was conducted: (1) characterization of OpHLINE formulations versus four commercial comparators, including cohesive-dispersive analysis and viscosity-shear profiling; and (2) a prospective clinical trial in 68 patients undergoing phacoemulsification with intraocular lens implantation. Primary endpoint was workspace maintenance; secondary endpoints included ease of OVD removal, endothelial cell density (ECD) loss, and intraocular pressure (IOP) changes. RESULTS: By varying HA concentration at constant molecular weight, we achieved direct control of rheological properties and CDI, generating distinct functional profiles: OpHLINE 1.4% behaved cohesively with rapid aspiration, OpHLINE 3% exhibited dispersive-like retention while maintaining space, and OpHLINE 2% combined cohesive handling with the highest shear-resistant viscosity. Clinically, OpHLINE 2% maintained an intermediate behaviour regarding space maintenance, ease of removal, ECD and IOP, while OpHLINE 3% provided the highest full chamber maintenance during all surgical steps. OpHLINE 1.4% enabled the easiest removal (95% adequate) and the lowest ECD loss (12.9%). IOP spikes ≥ 30 mmHg occurred in 13.6%, 20.8%, and 30.4% of eyes at 6 h for 1.4%, 2%, and 3%, respectively, resolving without sequelae. CONCLUSION: This study demonstrates that cohesive-dispersive behaviour and shear-dependent viscosity can be predictably tuned by HA concentration alone, enabling a modular, evidence-based approach to OVD selection. OpHLINE series provide evidence for three distinct behaviours: 1.4% showed optimal removal and endothelial protection; 2% offered balanced rheological and clinical properties; 3% provided the most consistent anterior chamber stability during surgery. These results allow surgeons to tailor intraoperative performance without altering polymer chain length. TRIAL REGISTRATION: This study was retrospectively registered (OpHLINE-PIC01-2020), approved on 8 February 2021 by the Ethics Committee for Research with Medicines of Euskadi (CEIm-E, Spain, code PS2020065). TRIAL REGISTRATION: ClinicalTrials.gov, NCT ID Number NCT07343973, Registered on 07 January 2026.
Active-fluidics versus gravity-fluidics system in phacoemulsification for type 2 diabetes mellitus without diabetic retinopathy: a retrospective observational study.
Wang J, Ma Y
BMC Ophthalmol · 2026 May · PMID 42163192 · Full text
BACKGROUND: The efficacy and safety profile of the active-fluidics system (AFS) in diabetic cataract patients remains inadequately characterized. This study specifically evaluated AFS versus gravity-fluidics system (GFS)...
BACKGROUND: The efficacy and safety profile of the active-fluidics system (AFS) in diabetic cataract patients remains inadequately characterized. This study specifically evaluated AFS versus gravity-fluidics system (GFS) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR), evaluating early visual recovery, corneal edema patterns, and macular thickness changes. PATIENTS AND METHODS: In this retrospective observational study, a total of 105 eyes of 105 T2DM patients without DR undergoing phacoemulsification at Tianjin Union Medical Center (November 2020-June 2024) were enrolled. Patients were stratified into AFS (n = 61) and GFS (n = 44) groups based on intraoperative fluidics availability. Both groups underwent standardized 2.4-mm clear corneal incision phacoemulsification using the Centurion system. Intraoperative parameters including cumulative dissipated energy (CDE), ultrasound time, total aspiration time (AT), irrigation fluid and total surgical time were recorded. Outcome measures included best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), endothelial cell loss (ECL), and central macular thickness (CMT). Cystoid macular edema (CME) was defined as > 30% CMT increase from baseline. RESULTS: Intraoperative parameters were comparable between groups (all P > 0.05). At postoperative week 1, BCVA was statistically lower (better) in the AFS group (0.08 ± 0.11 vs. 0.13 ± 0.13 logMAR, mean difference - 0.05, 95% CI - 0.09 to 0; P = 0.046), though this 0.05 logMAR difference is below the minimal clinically important difference for cataract surgery. CCT was significantly lower in the AFS group at week 1 (577.21 ± 40.01 vs. 594.93 ± 31.40 μm, P = 0.016) and month 1 (562.64 ± 34.74 vs. 580.95 ± 40.79 μm, P = 0.014), with convergence by month 3 (P = 0.534). No intergroup differences were detected in ECD, hexagonal cell percentage, or coefficient of variation at any time point (all P > 0.05). ECL percentages at month 3 showed a numerical trend toward higher loss in the AFS group (12.3% vs. 8.6%), but this did not reach statistical significance (P = 0.092; 95% CI - 0.62 to 8.08). CMT changes were comparable between groups (all P > 0.7), with CME occurring in 2.9% overall. CONCLUSION: In T2DM patients without DR, AFS was associated with statistically earlier but clinically modest visual recovery at week 1 and reduced early corneal edema compared with GFS. However, the modest effect sizes, borderline ECL trend, and retrospective single-center design limit definitive clinical recommendations. These findings contribute to the evidence base for fluidics selection in diabetic cataract surgery but require prospective validation before supporting practice change. CLINICAL TRIAL NUMBER: Not applicable.
Outcome and factors affecting prognosis in treat and extend treatment for neovascular age-related macular degeneration-a real world study.
Akkan Aydogmus FS, Gursoy T, Ozdemir O … +2 more , Elalmis OU, Kalayci D
BMC Ophthalmol · 2026 May · PMID 42163181 · Full text
BACKGROUND: To evaluate the outcome of treat and extend (T&E) for neovascular age related macular degeneration (nAMD) at 12, 18 and 24 months and the impact of clinical characteristics on treatment success defined as ext...
BACKGROUND: To evaluate the outcome of treat and extend (T&E) for neovascular age related macular degeneration (nAMD) at 12, 18 and 24 months and the impact of clinical characteristics on treatment success defined as extension of treatment interval to ≥12 weeks and functional improvement or stability. METHODS: Visual and anatomical outcomes evaluated by optical coherence tomography (OCT) and extension of treatment interval to ≥12 weeks were analyzed retrospectively. Clinical factors effective on extension of the treatment interval and visual outcome were evaluated. RESULTS: There were 138 eyes with at least 18 months of follow-up. Patients exhibited a significant improvement in visual acuity and reduction in central subfield thickness (CST), subretinal fluid (SRF), intraretinal fluid (IRF) and pigment epithelial detachment (PED) at both the 12 and 18 months. There was recurrence of IRF and a reduction in gain of visual acuity at 24 months. In 15.2%, 36.2% and 40.6% of eyes, the treatment interval could be extended to ≥12-weeks at 12, 18 and 24 months. Presence of a large PED was found as the only independent variable effecting extension of treatment interval to 12 weeks at 18 months. Baseline BCVA of >20/100 and no IRF at baseline were identified as independent predictive factors for better visual acuity at 18 months. CONCLUSION: Presence of IRF and a visual acuity of ≤20/100 at baseline were found to be negative predictors for visual prognosis, while large PED was a negative predictive factor for less frequent treatment, but it did not affect visual outcome. Treatment interval should be extended cautiously in patients with baseline intraretinal fluid and visual acuity of ≤20/100 in order to balance decreasing the burden of treatment by longer treatment intervals with improvement of visual gain.
Association between corneal edema and corneal astigmatism after Descemet membrane endothelial keratoplasty.
Kim CY, Kim MK
BMC Ophthalmol · 2026 May · PMID 42163151 · Full text
PURPOSE: To evaluate changes in corneal astigmatism after DMEK and determine the predictive value of preoperative central corneal thickness (CCT) for postoperative astigmatic change. METHODS: Fifty-five eyes with Fuchs'...
PURPOSE: To evaluate changes in corneal astigmatism after DMEK and determine the predictive value of preoperative central corneal thickness (CCT) for postoperative astigmatic change. METHODS: Fifty-five eyes with Fuchs' endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) undergoing DMEK were analyzed. Auto kerato-refractometer (ARKRT)-derived anterior corneal astigmatic change was defined as the primary outcome in 55 eyes. Anterior-segment optical coherence tomography (AS-OCT)-derived anterior, posterior, and total corneal parameters were analyzed as secondary outcomes in 25 eyes. Vector analysis assessed magnitude and axis changes. Associations between preoperative CCT and postoperative astigmatic change were evaluated; an exploratory ROC analysis was performed for astigmatic change. RESULTS: Mean preoperative CCT was 738.7 ± 99.7 μm, decreasing to 517.5 ± 37.3 μm postoperatively (P < 0.001). Anterior astigmatism measured by ARKRT decreased significantly after DMEK, whereas anterior and total corneal astigmatism measured by AS-OCT showed a similar decreasing trend without statistical significance. Greater preoperative CCT showed a larger postoperative astigmatic change on ARKRT. In ROC analysis based on ARKRT measurements, a preoperative CCT of 790 μm showed modest discrimination for postoperative astigmatic change > 3.0 D (AUC = 0.749; sensitivity 67%, specificity 81%). PBK eyes showed greater anterior flattening and larger reductions in absolute astigmatism than FED eyes. CONCLUSIONS: Preoperative corneal edema is associated with postoperative astigmatic change after DMEK. The 790 μm CCT cutoff showed modest discrimination. In eyes with marked edema, staged astigmatic correction may improve refractive outcomes.
To compare the efficacy of endoscopic dacryocystorhinostomy and external dacryocystorhinostomy in the treatment of chronic dacryocystitis based on propensity score matching.
Hong J, Tang F, Ren D … +3 more , Yu X, Xia J, He F
BMC Ophthalmol · 2026 May · PMID 42163141 · Full text
BACKGROUND: Chronic dacryocystitis (CD) is mainly treated by surgery. Nasal dacryocystorhinostomy is divided into internal and external approaches. The efficacy and safety are controversial, and clinical studies are susc...
BACKGROUND: Chronic dacryocystitis (CD) is mainly treated by surgery. Nasal dacryocystorhinostomy is divided into internal and external approaches. The efficacy and safety are controversial, and clinical studies are susceptible to bias due to the baseline characteristics of patients. Therefore, this retrospective, non-randomized study based on propensity score matching (PSM) to compare the therapeutic effects of endoscopic and external dacryocystorhinostomy. METHODS: A total of 98 patients (98 eyes) with CD admitted to our hospital from January 2019 to December 2024 were retrospectively included in the study. According to different surgical plans, they were divided into the endoscopic dacryocystorhinostomy (EN-DCR) group (n = 54) and the external dacryocystorhinostomy (EDCR) group (n = 44). The PSM method was used to match the two groups of patients according to the nearest neighbor matching method 1: 1 (caliper value = 0.05). The therapeutic effect and perioperative indexes of the two groups were recorded. The lacrimal gland secretion function [tear film rupture time (BUT), Schirmer I test (SIT)], epiphora degree score, inflammatory indexes [serum interleukin-1β (IL-1β), matrix metalloproteinase-3 (MMP-3), prostaglandin E2 (PGE2)] and complications before and after operation were compared. RESULTS: After matching, 34 patients in each group were included in the study. The total effective rate, operation time, hospitalization time and intraoperative blood loss in the EN-DCR group were better than those in the EDCR group (P < 0.05). After operation, the BUT of the EN-DCR group was higher than that of the EDCR group, and the SIT, epiphora score, IL-1β, MMP-3 and PGE2 levels of the EN-DCR group were lower than those of the EDCR group (P < 0.05). Compared with the EDCR group, the patency rate of lacrimal duct in the EN-DCR group was significantly increased at 2 and 6 months after operation, and the recurrence rate was significantly decreased (P < 0.05). The total incidence of complications in the EN-DCR group (2.94%) was significantly lower than that in the EDCR group (23.53%) (P < 0.05). CONCLUSIONS: The therapeutic effect of endoscopic dacryocystorhinostomy in CD patients is better than that of external dacryocystorhinostomy. TRIAL REGISTRATION: Retrospectively registered.
Visual outcomes and predictive factors after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment: a retrospective cohort from Southern Thailand.
Jirarattanasopa P, Thongprasit S, Ratanasukon M … +3 more , Bhurayanontachai P, Tsutsumi WD, Tantisarasart T
BMC Ophthalmol · 2026 May · PMID 42157120 · Full text
BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition requiring surgery. Although pars plana vitrectomy (PPV) is the preferred treatment for macula-off RRD, outcomes and visual recovery fa...
BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition requiring surgery. Although pars plana vitrectomy (PPV) is the preferred treatment for macula-off RRD, outcomes and visual recovery factors vary across studies. This study aimed to evaluate the outcomes of PPV for acute macula-off RRD and identify factors associated with a favorable visual outcome in Thailand. METHODS: This retrospective cohort study, we reviewed the electronic medical records of patients with acute macula-off RRD treated with PPV at Songklanagarind Hospital between 2018 and 2021, with a minimum follow-up was 12 months. Data collected included demographics, duration of macular detachment (from onset of central visual loss to surgery), best-corrected visual acuity (BCVA), and intraoperative findings. Anatomical reattachment rates and BCVA improvement were analyzed at 1, 3, 6, and 12 months using percentages and mixed-effects random-intercept linear regression. Factors associated with favorable visual outcomes were assessed using univariate and multivariate logistic regression and receiver operating characteristic curve analysis. RESULTS: In total, 140 eyes from 139 patients were analyzed. Mean logarithm of the minimum angle of resolution BCVA improved significantly from 1.50 (95% confidence interval [CI]: 1.41-1.59) at baseline to 0.78 (95% CI: 0.69-0.87) (p < 0.001), with retinal reattachment achieved in 132 eyes (94.3%). A final BCVA of 20/50 or better (≤ 0.4 LogMAR) was observed in 39 eyes (27.86%). Independent predictors of this outcome were PPV performed within 7 days of symptom onset (area under the receiver operating characteristic curve [AUC], 0.763; OR, 3.40; 95% CI, 1.42-8.19; p = 0.006), age ≤ 60 years (OR, 2.82; 95% CI, 1.20-6.62; p = 0.018), and the use of gas tamponade (OR, 2.59; 95% CI, 1.09-6.14; p = 0.030). CONCLUSIONS: PPV is an effective surgical approach for managing acute macula-off RRD. Early surgical intervention within 7 days of symptom onset, younger patient age ([Formula: see text]60 years), and the use of gas tamponade may be associated with better visual outcomes. These findings may have clinical relevance by supporting risk stratification, optimizing surgical decision-making, and improving patient counseling regarding visual prognosis.
A clinically interpretable deep learning pipeline for diabetic retinopathy classification using EfficientNet, advanced data augmentation and GradCAM.
Ghadai KK, Nayak SK, Senapati BR
BMC Ophthalmol · 2026 May · PMID 42151890 · Full text
BACKGROUND: Early and reliable grading of diabetic retinopathy is important for preventing avoidable vision loss. Although deep learning methods have shown strong performance on retinal fundus images, grading remains dif...
BACKGROUND: Early and reliable grading of diabetic retinopathy is important for preventing avoidable vision loss. Although deep learning methods have shown strong performance on retinal fundus images, grading remains difficult because of class imbalance, variable image quality, subtle differences between adjacent disease stages, and the need for interpretable predictions. This study developed a clinically interpretable deep learning pipeline for five-class diabetic retinopathy grading. METHODS: A classification framework based on EfficientNet-B1 was developed using contrast-limited adaptive histogram equalization for image enhancement, sample-mixing augmentation, focal loss, and test-time augmentation. Model behavior was further examined using calibration analysis, gradient-weighted class activation mapping, and t-distributed stochastic neighbor embedding. The public APTOS 2019 dataset was used. Under the fixed held-out protocol, 2,930 images were used for training, 364 for validation, and 366 for testing. Robustness was further examined using stratified 5-fold cross-validation on a 3,294-image development set with an independent 366-image test set. Performance was summarized using accuracy, macro F1-score, weighted F1-score, average area under the receiver operating characteristic curve, confusion matrices, and calibration error. No formal hypothesis-testing framework was applied. RESULTS: The best validation accuracy under the fixed split was 84.07%. On the independent test set, the proposed model achieved 83.61% accuracy without test-time augmentation and 84.97% with test-time augmentation. The average area under the receiver operating characteristic curve was 90.40%. Removing contrast-limited adaptive histogram equalization reduced test accuracy to 80.87%, supporting its contribution to performance. The model showed improved robustness to class imbalance and provided clinically meaningful visual explanations, although Severe diabetic retinopathy remained the most challenging category. CONCLUSIONS: The proposed pipeline achieved competitive benchmark performance for five-class diabetic retinopathy grading and combined classification accuracy with supportive calibration and interpretability analyses. The method appears suitable as a research-stage decision-support approach, but the remaining difficulty in advanced disease grading and the use of a single public dataset indicate that external validation is still required before clinical deployment. TRIAL REGISTRATION: This study used a publicly available benchmark dataset and did not involve a randomized controlled trial or prospective enrollment of human participants.
Association between visceral adiposity indices and retinal microvascular parameters stratified by urinary protein status.
Zhang R, Zhou Y, Ni W … +6 more , Wan Y, Li D, Bo X, Jin T, Huang Y, Zhong Y
BMC Ophthalmol · 2026 May · PMID 42151889 · Full text
BACKGROUND: Visceral fat accumulation is a well-established risk factor for both cardiovascular and microvascular diseases. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adipo...
BACKGROUND: Visceral fat accumulation is a well-established risk factor for both cardiovascular and microvascular diseases. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) are recognized tools for assessing visceral obesity. Retinal microvascular parameters serve as non-invasive biomarkers of systemic microvascular health, while qualitatively assessed urinary protein is a marker of early renal injury and endothelial dysfunction. Currently, evidence linking visceral obesity indices to retinal microvasculature is limited, and whether urinary protein status is associated with differences in this association remains unclear. This study aimed to investigate the associations of LAP, VAI, and CVAI with retinal microvascular parameters, and to explore differences in these associations between protein-positive and protein-negative individuals through stratified analysis. METHODS: This study included 3,401 healthy individuals undergoing physical examinations. Participants were categorized into a positive group (n = 1,008) and a negative group (n = 2,393) based on their urine protein result. Demographic data, metabolic indicators, and retinal vascular parameters were collected. Spearman/Pearson correlation analysis was employed to explore the associations among these indicators. Multivariate linear regression analysis stratified by urine protein status was conducted to verify the independent association between the visceral obesity index and arteriole-to-venule ratio (AVR), as well as the differences between the groups RESULTS: Baseline characteristics revealed significantly higher levels of triglycerides (TG), LAP, and VAI in the urinary protein-positive group (all P < 0.05). Overall correlation analysis demonstrated that LAP, VAI, and CVAI were all inversely correlated with AVR (all P < 0.001). Stratified analysis indicated that the negative associations of LAP, VAI, and CVAI with AVR were more pronounced in the urinary protein-positive group. In multiple linear regression analyses, after adjustment for age and sex, LAP, VAI, and CVAI showed stronger negative associations with AVR and contributed more to the model's explanatory power in the protein-positive group than in the protein-negative group. In fully adjusted models, these associations were attenuated but remained statistically significant, and the stronger effects in the protein-positive group persisted. CONCLUSIONS: Visceral adiposity indices are independently associated with retinal microvascular narrowing, and this association differs significantly between individuals with positive and negative urinary protein, with a more pronounced inverse relationship in the protein-positive group.
Short-term treatment outcomes of the ranibizumab biosimilar CKD-701 for vitreous hemorrhage secondary to proliferative diabetic retinopathy.
Yu SH, Cho J, Park SM … +2 more , Kim CG, Kim JH
BMC Ophthalmol · 2026 May · PMID 42151853 · Full text
PURPOSE: To evaluate the short-term clinical outcomes of CKD-701, a ranibizumab biosimilar, in treating vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). METHODS: This retrospective study in...
PURPOSE: To evaluate the short-term clinical outcomes of CKD-701, a ranibizumab biosimilar, in treating vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 64 eyes of 64 patients with VH secondary to PDR who received intravitreal CKD-701 injections and were followed for at least four months. Visual acuity (VA) was assessed at baseline, at the first follow-up (mean 3.8 weeks), and at 2- and 4-months post-treatment. The incidences of recurrent VH and vitrectomy were recorded. The factors associated with the degree of visual improvement were analyzed. RESULTS: The patients received a mean of 1.8 ± 0.9 injections. VA significantly improved over time (mean logMAR VA: 1.29 ± 0.82 at baseline, 1.11 ± 0.84 at first follow-up, 0.94 ± 0.81 at 2 months, and 0.73 ± 0.68 at 4 months; P < 0.001). The proportions of patients achieving 20/40 or better VA at each time point were 18.8%, 25.0%, 29.7%, and 40.6%, respectively. Recurrent VH occurred in 17.2% of patients, and vitrectomy was performed in 12.5%. There was no significant difference in 4-month VA between patients who did and did not undergo vitrectomy (P > 0.999). Baseline VA was significantly associated with the degree of visual improvement (P = 0.010). No severe ocular complications were observed. CONCLUSIONS: In this short-term study, VH secondary to PDR decreased following CKD-701 treatment and was accompanied by visual improvement. Further well-controlled long-term studies are needed to definitively assess the efficacy of CKD-701.
Clinical real-world data evaluation: comparison of central macular thickness after anti-VEGF treatment in diabetic macular edema patients treated with or without topical anti-glaucoma agents.
Baybora H, Özal E, Özal SA
BMC Ophthalmol · 2026 May · PMID 42151845 · Full text
BACKGROUND: There are research findings suggesting that antiglaucoma agents may reduce aqueous humor outflow and decrease the elimination of intravitreally administered anti-vascular endothelial growth factor agents, pro...
BACKGROUND: There are research findings suggesting that antiglaucoma agents may reduce aqueous humor outflow and decrease the elimination of intravitreally administered anti-vascular endothelial growth factor agents, prolonging their effect. The aim of this study was to evaluate central macular thickness (CMT) after repeated injections, using real-world data, to provide insight into how this phenomenon may affect clinical outcomes. METHODS: One hundred forty-seven patients with diabetic macular edema (DME) were included in the study;66 patients received topical therapy due to pre-existing glaucoma, either primary open- angle or pseudoexfoliative glaucoma, and 81 patients without glaucoma. CMT values were evaluated before treatment, 1 month after the first three injections, 1 month after the subsequent four injections, and at the end of the first year. RESULTS: No significant differences were detected with respect to HbA1c levels, the presence of SRF, or prior photocoagulation (p = 0.085, p = 0.24, and p = 0.3, respectively). There was no difference between anti-glaucoma agent users and control group in CMT measurements 1 month after the first three injections (p = 0.6, p > 0.05). However, measurements taken 1 month after the subsequent four injections were significantly lower in patients using topical anti-glaucoma agents (p = 0.001, p < 0.05). At the 1-year measurement interval, although the values remained lower, the significant difference had disappeared (p = 0.11, p > 0.05). The presence of hyper reflective dots (HRD) was also greater in this group (p = 0.021, p < 0.05). At the 1-year measurement interval, although the values remained lower, the significant difference had disappeared (p = 0.11, p > 0.05). The presence of HRD and the combined presence of SRF and HRD had a significant effect on the changes in the measurements (F (4.412), p = 0.006, Eta = 0.103 and F (4.51), p = 0.001, Eta = 0.106, respectively). CONCLUSION: Although the use of topical anti-glaucoma therapy may have a partial effect on reduction of CMT in DME patients receiving anti-vascular endothelial growth factor (anti-VEGF) treatment.
Resolution of disc oedema in nonarteritic anterior ischaemic optic neuropathy versus optic neuritis: a retrospective, cross-sectional study.
Moon JW, Yoon SH, Lee GW … +1 more , Lee D
BMC Ophthalmol · 2026 May · PMID 42144605 · Full text
BACKGROUND: The common causes of unilateral disc oedema include nonarteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON). As prolonged disc oedema may affect visual function, early differentiation...
BACKGROUND: The common causes of unilateral disc oedema include nonarteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON). As prolonged disc oedema may affect visual function, early differentiation is crucial. Therefore, this study compared the resolution time and rate of disc oedema between NAION and ON cases and identified correlated clinical factors. METHODS: In this retrospective, cross-sectional comparison study, unilateral NAION or ON cases, in which disc oedema was confirmed through fundus photography, were reviewed. Optical coherence tomography data, such as structural changes in the peripapillary retinal nerve fibre layer thickness (pRNFLT), ganglion cell layer thickness at two time points of the first diagnosis, and stable states with subsided disc oedema, were analysed. The severity, resolution rate, and duration of disc oedema were compared between the two groups. RESULTS: This study included 33 eyes each with NAION and ON (mean age: NAION, 69.1 ± 11.8 years; ON, 61.7 ± 15.7 years). No significant differences were observed in sex, visual acuity at diagnosis, colour vision, or visual field defect severity. Mean periods of disc oedema were 1.5 ± 0.6 months in NAION and 1.3 ± 0.7 months in ON cases. At diagnosis, the mean pRNFLT in NAION cases (215.7 ± 57.6 μm) was not different from that in ON cases (199.1 ± 60.4 μm); the resolution rate of disc oedema was not significantly different between the two diseases. CONCLUSION: The resolution rate of disc oedema-which did not differ significantly-cannot be used to distinguish between NAION and ON. In both diseases, greater initial disc oedema was associated with a longer duration of oedema, but the rate of oedema resolution was faster, resulting in a narrower gap in total resolution time between mild and severe cases. TRIAL REGISTRATION: Clinical trial number: not applicable. This retrospective study was approved by the Daegu Catholic University Hospital Institutional Review Board (IRB) for Human Studies (IRB number: 2025-03-012). All procedures adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained verbally from all participants, with their guardians and residents as witnesses.
Recurrence rate, time to recurrence, and associated factors after primary pterygium excision with conjunctival-limbal autograft: a prospective cohort study.
Pardo-Bayona M, Méndez-Rodríguez LM, Benavides-Cruz J … +2 more , Buchheim-Duarte AM, Rincón-López JV
BMC Ophthalmol · 2026 May · PMID 42143290 · Full text
BACKGROUND: Pterygium recurrence remains a major postoperative challenge in equatorial regions with high ultraviolet (UV) exposure. Although several clinical and inflammatory factors have been proposed as predictors, evi...
BACKGROUND: Pterygium recurrence remains a major postoperative challenge in equatorial regions with high ultraviolet (UV) exposure. Although several clinical and inflammatory factors have been proposed as predictors, evidence remains inconsistent. This study aimed to estimate the recurrence rate after primary pterygium excision with conjunctival-limbal autograft and to explore potential demographic, clinical, surgical, and systemic inflammatory factors associated with recurrence in a Colombian cohort. METHODS: This prospective cohort study included patients ≥ 18 years undergoing primary pterygium excision with conjunctival-limbal autograft at a high-complexity ophthalmology center in Bogotá, Colombia, between January and August 2024. Patients were followed until recurrence or last ophthalmologic follow-up, up to 10 months postoperatively. Recurrence rate was calculated and exploratory bivariate analyses were performed. Kaplan-Meier survival curves were generated. RESULTS: Ninety-one patients completed follow-up. The mean age was 50.9 years ± 13.0 years, and 59.3% (n = 54) were female. The recurrence rate was 13.2%, with a median follow-up of 197 days. Younger age was significantly associated with recurrence in bivariate analysis (mean difference - 11.2 years, p = 0.005). No statistically significant detectable associations were observed between recurrence and sex, laterality, pterygium grade, surgeon experience, or systemic inflammatory indices (NLR, PLR, SII, LMR, CRP, and ESR) (all p > 0.05). CONCLUSIONS: In this prospective cohort from a high-UV equatorial setting, the recurrence rate after primary pterygium excision was 13.2%. Younger age was associated with recurrence in exploratory analyses. The absence of statistically significant associations for systemic inflammatory markers and other variables should be interpreted cautiously, as the study may be underpowered to detect moderate effect sizes. These findings should be interpreted as hypothesis-generating and require confirmation in larger, adequately powered studies.
Efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of diabetic macular edema (DME): a systematic review and meta-analysis.
AlShimali R, Jamal L, Khorsheed S … +3 more , Maqwar Z, AlKandari A, AlAli A
BMC Ophthalmol · 2026 May · PMID 42143275 · Full text
OBJECTIVE: To assess the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with Diabetic Macular Edema (DME). METHODS: A systematic review and meta-analysis were conducted following the Prefer...
OBJECTIVE: To assess the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with Diabetic Macular Edema (DME). METHODS: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, including MEDLINE, EMBASE, PubMED, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL), were comprehensively searched for relevant studies published by December 2023 using key words such as 'diabetic macular edema', 'topical NSAIDS', and 'anti-VEGF'. All studies focusing on the treatment diabetic macular edema using NSAIDS versus anti-VEGF were considered, including interventional, observational, pilot, and randomized controlled trials, and the data from the selected studies were pooled for analysis. The primary outcome measured was best-corrected visual acuity (BCVA), while secondary outcomes included central macular thickness (CMT), macular volume, and complications. RESULTS: Six studies, with a total sample size of 446 patients and 892 eyes, were included. The findings showed a statistically significant improvement in BCVA favoring the NSAIDs group (mean difference: 1.82, 95% CI: 0.12 to 3.53) with moderate heterogeneity (I^2 = 60%, P = 0.08). CMT showed a favorable trend towards the NSAIDs group with a mean difference of 51.84 μm (95% CI: -15.23 to 118.91), although this was not statistically significant, with high heterogeneity (I^2 = 91%, P < 0.0001). Macular volume analysis showed no statistically significant difference in macular volume between the groups (mean difference: 0.29, 95% CI: -0.36 to 0.95), with high heterogeneity observed (I^2 = 77%, P = 0.04). CONCLUSION: This study showed that topical NSAIDs, alone or combined with anti-VEGF therapy significantly improved BCVA; however, the reduction in CMT was not significant. Evidence for macular volume reduction remains insufficient.
Maximal levator resection as a revision strategy following failed silicone frontalis sling: outcomes on eyelid position, ocular surface and patient satisfaction.
Ulas MG, Semizoglu I, Topcu H … +3 more , Efe AC, Karademir FP, Cabuk KS
BMC Ophthalmol · 2026 May · PMID 42135690 · Full text
BACKGROUND: Frontalis sling surgery (FSS) is the standard treatment for congenital blepharoptosis with poor levator function; however, long-term failure and material-related complications are common, particularly with si...
BACKGROUND: Frontalis sling surgery (FSS) is the standard treatment for congenital blepharoptosis with poor levator function; however, long-term failure and material-related complications are common, particularly with silicone slings. Evidence regarding optimal revision strategies after failed silicone FSS remains limited. This study evaluated the anatomical outcomes, ocular surface safety, and patient satisfaction following maximal levator resection surgery (MLRS) performed after silicone frontalis sling removal. METHODS: This retrospective study included 20 eyes of 17 patients who underwent MLRS following silicone frontalis sling removal between 2019 and 2023. Preoperative and postoperative assessments included best-corrected visual acuity, margin reflex distance-1 (MRD-1), levator function, lagophthalmos, corneal fluorescein staining, punctate epithelial keratopathy, and patient satisfaction. Postoperative evaluations were performed at 1 week, 1 month, 3 months, and 6 months. Statistical analyses were conducted using paired and repeated-measures tests, with a significance level set at p < 0.05. RESULTS: The mean age at the time of MLRS was 11.05 ± 5.94 years, and the mean preoperative levator function was 4.85 ± 2.49 mm. Revision surgery was indicated for undercorrection in 18 eyes (90%) and conjunctival complications in 2 eyes (10%). Mean MRD-1 increased significantly from 0.25 ± 0.85 mm preoperatively to 2.55 ± 0.60 mm at 6 months postoperatively (p < 0.001), with stable values across follow-up visits. Lagophthalmos increased slightly postoperatively but did not differ significantly from preoperative measurements (p > 0.05). Mild corneal surface changes were observed in the early postoperative period and were successfully managed with medical treatment. Additional revision surgery was required in 2 eyes (10%). Most patients and their parents reported high satisfaction, with dissatisfaction primarily related to insufficient postoperative eyelid elevation. CONCLUSIONS: MLRS following silicone frontalis sling removal is associated with significant and stable improvement in eyelid position, with acceptable ocular surface safety and high patient satisfaction in selected patients across a range of levator function values. However, given the retrospective design, small sample size, and lack of a comparative control group, these findings should be interpreted with caution. MLRS may be considered as a potential revision option rather than a definitive or superior approach.
The efficiency of 0.01% topical atropine on the myopia prevention in low refractive error population with different refractive errors: a retrospective cohort study.
Lee CY, Yang SF, Chang YL … +3 more , Huang JY, Huang PH, Chang CK
BMC Ophthalmol · 2026 May · PMID 42135675 · Full text
BACKGROUND: The aim of this study was to investigate the effectiveness of 0.01% topical atropine (ATR) on myopic prevention in a population with different low refractive errors. METHODS: A retrospective cohort study was...
BACKGROUND: The aim of this study was to investigate the effectiveness of 0.01% topical atropine (ATR) on myopic prevention in a population with different low refractive errors. METHODS: A retrospective cohort study was conducted on children with low refractive error. They were classified according to the application of 0.01% ATR, and 55 and 67 eyes constituted the ATR and non-ATR groups, respectively. The primary outcomes were changes in spherical equivalent refraction (SER) and axial length (AXL) after a one-year interval. Statistical analysis was carried out using the independent T test and generalized linear model. RESULTS: The SER change and AXL elongation were significantly lower in the ATR group compared to the non-ATR group (P < 0.001 for both). For different initial SERs, SER and AXL progression in the individuals with plus initial SER were significantly lower than those with minus initial SER after ATR treatment (both P < 0.05). High outdoor activity was inversely correlated with myopic progression in the ATR group (P = 0.006). For the non-ATR population, young initial age, minus initial SER, and high near-work activity were related to myopic progression, while high solar exposure and high outdoor activity were inversely correlated with the development of myopic progression (all P < 0.05). CONCLUSIONS: Application of 0.01% ATR might relates to myopic prevention effect in a population with low refractive error, especially for plus initial SER.
When Coats' disease meets a retinal break: adult-onset presentation with rhegmatogenous retinal detachment.
Zeng Q, Xiong Y, Zhao Z … +3 more , Li H, Chen S, Zhang G
BMC Ophthalmol · 2026 May · PMID 42135658 · Full text
BACKGROUND: Adult-onset Coats' disease is an uncommon, vision-threatening disorder characterized by exudation and vascular abnormalities in the peripheral and macular regions. Retinal detachment is typically exudative, w...
BACKGROUND: Adult-onset Coats' disease is an uncommon, vision-threatening disorder characterized by exudation and vascular abnormalities in the peripheral and macular regions. Retinal detachment is typically exudative, while rhegmatogenous retinal detachment (RRD) in this context is rare. Here, we describe a case of adult-onset Coats' disease presenting with retinal detachment associated with an identifiable retinal break. CASE PRESENTATION: A 34-year-old man presented with a one-day history of decreased vision and a sensation of shadowing in his left eye. Dilated funduscopy of the left eye revealed telangiectatic and aneurysmal vessels in the superior quadrant, along with intraretinal exudation. A retinal break was identified in the periphery, along with retinal detachment in the superotemporal quadrant. Pars plana vitrectomy (PPV) with silicone oil tamponade achieved successful retinal reattachment. Silicone oil was removed three months later. During follow-up, best-corrected visual acuity (BCVA) in the left eye improved from 6/15 to 6/10; the postoperative course was uneventful. CONCLUSION: This case demonstrates the occurrence of retinal breaks in adult-onset Coats' disease, particularly in areas of peripheral retinal ischemia. Clinicians should maintain a high index of suspicion for this rare possibility to facilitate timely diagnosis and surgical intervention.
The association between lower extremity physical performance and diabetic retinopathy among patients with type 2 diabetes in Shaoguan City, China.
Zhou G, Wang Y, Lin X … +3 more , Deng J, Fu H, Yu H
BMC Ophthalmol · 2026 May · PMID 42129732 · Full text
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of visual impairment among patients with type 2 diabetes mellitus (T2DM). Evidence regarding the association between lower extremity physical performance and DR re...
BACKGROUND: Diabetic retinopathy (DR) is a leading cause of visual impairment among patients with type 2 diabetes mellitus (T2DM). Evidence regarding the association between lower extremity physical performance and DR remains limited; therefore, this study aimed to investigate this relationship among patients with T2DM in China. METHODS: A cross-sectional study was conducted among adult patients with diagnosed T2DM attending community health centers in Shaoguan. Lower extremity physical performance was assessed using the balance status, chair stand time, and gait speed. DR was determined through retinal photography. Multivariable logistic regression models were used to assess the association between lower extremity physical performance and the presence of DR. RESULTS: Among 3079 participants with type 2 diabetes, 999 (32.3%) were diagnosed with DR. Compared to non-DR individuals, participants with DR had lower BMI, poorer balance, longer diabetes duration, and higher HbA1c levels. Multivariable logistic regression showed that better balance was associated with lower odds of DR [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.45-0.96], while longer chair stand times were associated with higher odds of DR (OR = 1.04, 95% CI: 1.02-1.06). Gait speed was not significantly associated with DR (OR = 1.03, 95% CI: 0.96-1.09). In exploratory ROC analysis, the fully adjusted model showed modest discrimination for DR, with an AUC of 0.682 (95% CI: 0.660-0.704). CONCLUSION: In this community-based sample of Chinese patients with T2DM, poorer lower extremity physical performance was associated with the presence of DR. These findings suggest that physical function assessment may provide complementary information on overall health status, but its role in DR risk assessment requires prospective validation.
Efficacy and safety of 577 nm subthreshold laser treatment in acute central serous chorioretinopathy.
Akçay G, Kanar HS, Kivrak U … +2 more , Uslubas I, Arsan AK
BMC Ophthalmol · 2026 May · PMID 42129708 · Full text
PURPOSE: To assess the subthreshold micropulse laser (SML) treatment in patients with acute central serous chorioretinopathy (CSC). MATERIALS AND METHODS: This retrospective study included 46 eyes from 46 patients with a...
PURPOSE: To assess the subthreshold micropulse laser (SML) treatment in patients with acute central serous chorioretinopathy (CSC). MATERIALS AND METHODS: This retrospective study included 46 eyes from 46 patients with acute CSC. Twenty-five patients were treated with SML, while 21 were observed without intervention. Outcomes evaluated included best corrected visual acuity (BCVA), outer nuclear layer thickness (ONLT), subfoveal choroidal thickness (SFCT), and subretinal fluid (SRF) height. SML was applied using a 577 nm yellow wavelength laser. RESULTS: In the SML group, BCVA improved significantly from 0.33 ± 0.13 LogMAR at baseline to 0.07 ± 0.05 LogMAR at 6 months (p < 0.001). The observation group showed improvement from 0.29 ± 0.13 LogMAR to 0.14 ± 0.16 LogMAR (p = 0.011). SFCT decreased significantly in the SML group (460.36 ± 67.91 μm at baseline to 407.44 ± 60.18 μm at 6 months, p = 0.013), with no significant change in the observation group. The SML group also showed a significant increase in ONLT (p < 0.001), and complete SRF resorption was achieved in all patients, compared to 23.8% in the observation group. CONCLUSION: SML treatment is a safe and effective option for managing acute CSC. TRIAL REGISTRATION NUMBER: 2024/010.99/2/21-27.03.2024, retrospective design.
An evaluation of anatomical and functional outcomes in patients undergoing retinectomy for proliferative vitreoretinopathy.
Uzlu D, Erdöl H, Bulanık ÖB … +3 more , Günay M, Köse B, Kola M
BMC Ophthalmol · 2026 May · PMID 42129684 · Full text
BACKGROUND: The objective of this study was to evaluate the anatomical and functional outcomes of patients who underwent relaxing retinotomy or retinectomy for retinal detachment complicated by proliferative vitreoretino...
BACKGROUND: The objective of this study was to evaluate the anatomical and functional outcomes of patients who underwent relaxing retinotomy or retinectomy for retinal detachment complicated by proliferative vitreoretinopathy. METHODS: The medical records of all patients who underwent retinectomy for retinal detachment complicated with proliferative vitreoretinopathy between 2015 and 2023 were reviewed retrospectively. RESULTS: The patients' mean age was 60.83 ± 16.4 (21-90) years. The study population consisted of 28 male (42.4%) and 38 female (57.6%). The mean follow-up period was 21.72 ± 13.44 (12-65) months. The mean initial visual acuity was 2.1 ± 0.63 logMAR, while the mean final visual acuity was 1.94 ± 0.69 logMAR (p = 0.094). Twenty-one patients presented with rhegmatogenous retinal detachment (31.8%), 36 with tractional retinal detachment due to diabetes (54.5%), and nine with retinal detachment secondary to trauma (13.6%). Visual acuity increased in 30 patients (45.45%), decreased in 10 patients (15.15%), and did not change in 26 patients (39.39%). Mean intraocular pressure (IOP) values were 13.25 ± 4.67 mmHg (range 5-28) at baseline and 12.98 ± 4.75 mmHg (range 4-25) at the final examination. Twenty-seven patients underwent 90-degree retinectomy (40.9%), 18 underwent 180-degree retinectomy (27.3%), 6 underwent 270-degree retinectomy (9.1%), and 15 underwent 360-degree retinectomy (22.7%). When evaluating proliferative retinal detachment by etiology (rhegmatogenous, traumatic, diabetic), no statistically significant differences were observed in baseline and final visual acuity or intraocular pressure (p > 0.05), nor in recurrence rates (p = 0.42). CONCLUSION: The findings of this study indicate that retinectomy is a beneficial treatment for cases of difficult retinal detachment, particularly when there is a need for both functional vision and retinal stabilization.
Effects of metabolic and bariatric surgery on corneal and lens densitometry.
Kaya H, Aykota MR
BMC Ophthalmol · 2026 May · PMID 42129682 · Full text
BACKGROUND: To investigate the effects of laparoscopic sleeve gastrectomy (LSG), a common subtype of metabolic and bariatric surgery (MBS), on corneal densitometry (CD) and lens densitometry (LD). METHODS: This prospecti...
BACKGROUND: To investigate the effects of laparoscopic sleeve gastrectomy (LSG), a common subtype of metabolic and bariatric surgery (MBS), on corneal densitometry (CD) and lens densitometry (LD). METHODS: This prospective, single-center study included 58 eyes of 58 obese participants. Preoperative and 6-month postoperative CD, LD, and anterior segment parameters were evaluated using Pentacam topography. The primary outcomes were changes in CD and LD six months after surgery. RESULTS: A total of 58 eyes from 58 participants, with a mean age of 36.76 ± 10.79 years, were evaluated. Six months following LSG, the average body mass index (BMI) decreased from 43.4 ± 6.6 kg/m2 to 31.54 ± 5.13 kg/m2 (p < 0.001). Central corneal thickness (CCT), intraocular pressure (IOP), CD, and LD decreased significantly six months after LSG (p < 0.001). The anterior chamber depth (ACD) and angle (ACA) significantly increased six months after LSG (p < 0.001 for all parameters). Correlation analyses showed a moderate positive association between changes in CD and LD, whereas only weak correlations were observed between changes in ocular and metabolic parameters. CONCLUSIONS: LSG was associated with significant changes in CD, LD, and anterior segment parameters, suggesting a positive effect on ocular tissue transparency. TRIAL REGISTRATION: Not applicable.
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