Sánchez-Vela L, Brosa H, Martin-Pinardel R
… +23 more, Bernal-Morales C, Parrado-Carrillo A, Moll-Udina A, Puzo-Bayod M, Garay-Aramburu G, Arruabarrena C, Sararols-Ramsay L, Calvo-Perez P, Zapata MA, Garrido M, Abraldes M, Ruiz-Moreno JM, Broc-Iturralde L, Velázquez-Villoria D, Escobar-Barranco JJ, Gallego-Pinazo R, Figueroa MS, García-Layana A, Figueras-Roca M, Gillies MC, Casaroli-Marano RP, Zarranz-Ventura J, from the writing committee of the Fight Retinal Blindness Spain (FRB! Spain) Users Group
Can J Ophthalmol
· 2026 May · PMID 42114812
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OBJECTIVE: To evaluate the visual outcomes in neovascular age-related macular degeneration (nAMD) eyes initiating anti-vascular endothelial growth factor treatment with baseline visual acuity (VA) ≥70 letters. METHODS: M...OBJECTIVE: To evaluate the visual outcomes in neovascular age-related macular degeneration (nAMD) eyes initiating anti-vascular endothelial growth factor treatment with baseline visual acuity (VA) ≥70 letters. METHODS: Multicentre, real-world, and national database study. Demographics, VA, number of injections, and patient visit data were collected using a validated online tool. Subgroup analysis included 2 nonoverlapping participant groups defined by baseline VA: Good vision eyes (GVE, "70-100 letters") and non-GVE ("0-69 letters") at 12, 24, and 36 months. RESULTS: A total of 3 138 eyes (2 520 patients) were included in the analysis, followed up for 12 (n = 2 426; 77.3%), 24 (n = 1 793; 57.1%), and 36 months (n = 1 167; 37.2%). GVE had significantly better 24-month final VA (71.0 ± 13.8 vs 52.3 ± 23.2; p < 0.001) than NGVE. Mean VA change (letters) at 12, 24, and 36 months of follow-up was significantly lower in the GVE -2.4 (-3.1, -1.6), -4.5 (-5.6, -3.5), and -7.8 (-9.4, -6.2) than in NGVE +6.7 (5.8, 7.6), +5.0 (3.8, 6.2), and +4.0 (2.5, 5.5) group, respectively. The number of injections and percentage of visits with active lesions were higher in GVE through 36 months. CONCLUSIONS: The mean VA of GVE tends to drop, but it is still much higher than NGVE eyes at 12, 24, and 36 months. Early detection and prompt treatment are key and should be considered in treatment access policies, regulatory frameworks, and clinical guidelines, as defining a threshold to start treatment may have a clear impact on final visual function, patient autonomy and legal blindness rates in nAMD patients.
Lam WY, Ambikkumar A, Li Q
… +4 more, Fung NSK, Fong AHC, Kherani A, Lam WC
Can J Ophthalmol
· 2026 May · PMID 42091102
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OBJECTIVE: To evaluate vitrectomy with membrane peeling across the spectrum of myopic traction maculopathy (MTM) and identify prognostic factors for anatomical and functional success. METHODS: Patients with MTM who under...OBJECTIVE: To evaluate vitrectomy with membrane peeling across the spectrum of myopic traction maculopathy (MTM) and identify prognostic factors for anatomical and functional success. METHODS: Patients with MTM who underwent vitrectomy and membrane peeling between 2018 and 2023 were included. Percentage reduction in mean foveal thickness (MFT) was used as a marker of anatomical outcome, and visual acuity was the primary outcome. The secondary outcomes were factors associated with anatomical success and visual acuity (VA) improvement. RESULTS: Ninety-four eyes from 84 patients were included. For myopic foveoschisis-only (37 eyes), the anatomical success rate was 95% with a mean of an 8-letter gain. For isolated macular detachment (without macular holes) (15 eyes), 93% achieved retinal reattachment with a mean of a 3.5-line gain. Isolated macular holes (22 eyes) achieved macular hole closure in 73% of cases with a mean of a 7-letter gain. Macular hole retinal detachment (20 eyes) achieved retinal reattachment in 80% of cases and simultaneous macular hole closure in 20%, with a mean of 3-letter gain. Higher preoperative MFT (p < 0.001) and more advanced perpendicular staging (p < 0.001) were associated with greater % MFT reduction. Better preoperative VA (p < 0.001), less advanced tangential staging (p = 0.016), and preoperative phakic status (p = 0.004) were predictive of better postoperative VA. For myopic foveschisis-only, the use of long-acting gas was associated with a postoperative VA that was 3 lines worse (p = 0.04). CONCLUSIONS: Vitrectomy with membrane peeling is effective in the management of MTM, especially for myopic foveoschisis-only and isolated macular detachment. Less advanced tangential stages and better preoperative VA are predictive of better postoperative VA.
Can J Ophthalmol
· 2026 May · PMID 42069343
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PURPOSE: Within the past few decades, several studies have reported intraocular pressure (IOP)-lowering effects associated with tetrahydrocannabinol (THC) compounds as an alternative or complementary agent to conventiona...PURPOSE: Within the past few decades, several studies have reported intraocular pressure (IOP)-lowering effects associated with tetrahydrocannabinol (THC) compounds as an alternative or complementary agent to conventional glaucoma therapies. The purpose of this study is to generate pooled estimates on the IOP-lowering effects of THC. METHODS: This systematic review and meta-analysis article was registered a priori on PROSPERO (CRD420251007916). MEDLINE, EMBASE, and Web of Science were searched for studies reporting IOP reduction following THC administration. Two reviewers independently performed screening, data extraction, and risk of bias assessments. A random-effects meta-analysis of mean differences was performed to estimate the overall pooled peak percentage reduction in IOP following THC administration, stratified by route of THC administration. RESULTS: Five studies were included, consisting of a total of 99 patients and 69 with THC exposure/intervention. Overall, the pooled peak percentage reduction in IOP after THC administration was 14.66% (95% CI: [3.38%, 25.93%]; p < 0.005). By route of THC delivery, the pooled peak percentage reduction in IOP was 33.27% (95% CI: [20.36%, 46.17%]; p < 0.0001) with the IV route. It was 10.65% (95% CI: [-7.60%, 28.89%]) with the oral route and 9.36% (95% CI: [-8.89%, 27.6%]) with the topical route. Four studies reported the peak percentage reduction in IOP after THC and control administration. From these studies, the pooled peak percentage reduction in IOP after THC was 6.88% (95% CI: [-9.56%, 23.33%]; p = 0.41) and nonsignificantly different from control. CONCLUSIONS: Our study generated literature-pooled estimates of the overall and route-stratified peak percentage reduction in IOP following THC administration. THC significantly reduced IOP, although comparatively less significant to the control group.
Can J Ophthalmol
· 2026 May · PMID 42061823
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OBJECTIVE: To quantify 30-year visual-acuity outcomes after ruthenium 106 or iodine 125 plaque brachytherapy for posterior uveal melanoma and identify independent predictors of best-corrected visual acuity (BCVA) <20/200...OBJECTIVE: To quantify 30-year visual-acuity outcomes after ruthenium 106 or iodine 125 plaque brachytherapy for posterior uveal melanoma and identify independent predictors of best-corrected visual acuity (BCVA) <20/200. DESIGN: A retrospective single-centre cohort study. PARTICIPANTS: Participants were 1 785 consecutive patients treated at St. Erik Eye Hospital (Stockholm, Sweden) from 1979 to 2024 (median follow-up 12.4 years). METHODS: Visual-acuity survival was estimated using Kaplan-Meier curves. Cumulative-incidence functions and multivariable Fine-Gray competing-risk regression modelled the risk of acuity <20/200. A 3-level FIT (fovea-isotope-thickness) score was derived and validated to stratify eyes into low-, medium-, and high-risk groups. RESULTS: Mean visual acuity declined from 0.34 logMAR (20/44) at diagnosis to 0.82 logMAR (20/132) at the last follow-up. Probabilities of maintaining acuity ≥20/200 were 64% (95% CI: 61-66) at 5 years, 40% (95% CI: 37-44) at 10 years, 18% (95% CI: 14-23) at 20 years, and 4% (95% CI: 1-11) at 30 years. Among eyes beginning with ≥20/40, corresponding probabilities were 73%, 52%, 26%, and 8%. Iodine 125 plaques (sHR [subdistribution hazard ratio]: 3.57 vs ruthenium 106; 95% CI: 2.43-5.23) independently predicted vision <20/200, while each additional millimetre of tumour-fovea distance was protective (sHR 0.90; 95% CI: 0.86-0.95). Neither prescribed apex dose nor anti-vascular endothelial growth factor-era treatment was associated with BCVA prognosis. Ten-year incidences of BCVA <20/200 were 24%, 49%, and 77% in low-, medium-, and high-risk FIT categories. CONCLUSIONS: Three decades after plaque brachytherapy, fewer than 1 in 20 eyes retained useful vision. Iodine 125 plaques and tumours abutting the macula carried the greatest risk. The FIT score may assist clinicians in counselling and selecting sight-preserving strategies.
Liu J, Nassrallah W, Quan-Nguyen C
… +6 more, El Mounji L, Durr G, Agoumi Y, Goldberg JL, Di Polo A, Wang Q
Can J Ophthalmol
· 2026 May · PMID 42061822
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OBJECTIVE: The progression of glaucoma despite adequate intraocular pressure (IOP) control highlights the need for neuroprotective and neuroregenerative therapies. Preclinical studies suggest insulin promotes retinal gan...OBJECTIVE: The progression of glaucoma despite adequate intraocular pressure (IOP) control highlights the need for neuroprotective and neuroregenerative therapies. Preclinical studies suggest insulin promotes retinal ganglion cell survival and regeneration, but its safety in higher concentrations (100 and 500 units/mL), administered topically, has been poorly characterized in humans. We aim to assess the safety and tolerability of these two concentrations of insulin eye drops in patients with open-angle glaucoma (OAG). DESIGN: A phase I, randomized, double-blind, placebo-controlled, single-centre clinical trial. PARTICIPANTS: Patients with mild to moderate OAG were randomized 2:2:1 to receive once-daily topical insulin U-100, U-500, or placebo in 1 eye for 5 days, with follow-up visits at 1, 3, and 6 months. The primary safety outcomes include glycemia, serum potassium, ocular adverse events (AEs), and ocular tolerability scores. Secondary outcomes included IOP, best-corrected visual acuity (BCVA), retinal nerve fibre layer thickness, ganglion cell complex, visual field, and OCT angiography. RESULTS: Eighteen open-angle glaucoma patients were enrolled (mean age: 66.2 ± 10.1 years). No serious AEs related to insulin were observed. One asymptomatic, transient near-hypoglycemia event occurred in a fasting participant (3.9 mmol/L), with no recurrence after dietary adjustment. No significant changes were found in serum potassium, IOP, BCVA, visual fields, or OCT. Ocular symptoms in the insulin groups were limited to transient, mild burning sensation upon application. One participant experienced cystoid macular edema at 3 months, which was attributed to pre-existing ocular pathology. CONCLUSION: Topical insulin at 100 and 500 units/mL concentrations was well tolerated in patients for short-term use and did not result in significant systemic or ocular toxicity.
OBJECTIVE: Chiari malformation (CM) comprises congenital or acquired hindbrain herniations (>5-mm cerebellar tonsillar descent below the foramen magnum) that disrupt cerebrospinal fluid flow and compress neural structure...OBJECTIVE: Chiari malformation (CM) comprises congenital or acquired hindbrain herniations (>5-mm cerebellar tonsillar descent below the foramen magnum) that disrupt cerebrospinal fluid flow and compress neural structures. While neurological symptoms are well recognized, ophthalmic manifestations, such as papilledema, diplopia, and nystagmus, which are uncommon in the overall CM population but may serve as important diagnostic clues when present, remain undersynthesized. This systematic review summarizes the ophthalmic manifestations of CM to identify symptom patterns, mechanisms, and implications for early diagnosis and interdisciplinary management. METHODS: EMBASE and MEDLINE databases were searched in June 2024, following PRISMA guidelines. English-language articles describing ophthalmic findings in patients with CM, presented as case study/series, or literature review were included. RESULTS: Thirty-two articles met the inclusion criteria, representing 41 individual patient cases. The most common ophthalmic symptoms were diplopia (37%), decreased visual acuity (22%), and visual field loss (28%). Diplopia often resulted from esotropia secondary to 6th nerve palsy, whereas visual acuity and field loss were secondary to papilledema. Among reported cases, the most frequently reported ophthalmic signs were papilledema (44%), nystagmus (32%), and esotropia (29%). In pediatric patients (n = 15), the symptoms of diplopia occurred in 53% of the cases and the sign of esotropia occurred in 53%; usually from the 6th nerve palsy. Papilledema was reported in 27% of the pediatric cases but was the predominating finding among adults (n = 26). CONCLUSIONS: CM demonstrates distinct age-related ophthalmic patterns. In symptomatic patients, targeted neuro-ophthalmic evaluation may aid earlier diagnosis and guide management. Further prospective studies are needed to clarify pathophysiology and optimize interdisciplinary management.
OBJECTIVE: Glaucoma is the leading cause of irreversible blindness worldwide. No postmarketing study has comprehensively assessed Food and Drug Administration (FDA)-approved drugs for glaucoma risk by subtype, therapeuti...OBJECTIVE: Glaucoma is the leading cause of irreversible blindness worldwide. No postmarketing study has comprehensively assessed Food and Drug Administration (FDA)-approved drugs for glaucoma risk by subtype, therapeutic class, and sex. This study sought to identify systemic and ophthalmic drugs associated with glaucoma-related adverse events (AEs). DESIGN: Population-based pharmacovigilance analysis of FDA Adverse Event Reporting System (FAERS) reports (January 2004-December 2024). PARTICIPANTS: All glaucoma-related AEs, including normal-tension glaucoma (NTG), open-angle glaucoma (OAG), and angle-closure glaucoma (ACG). METHODS: Events were identified with the Medical Dictionary for Regulatory Activities Preferred Terms. Disproportionality was assessed using reporting odds ratios (RORs; 95% CI), Evans' criteria (n > 2; χ² > 4, Proportional reporting ratio > 2) and Bayesian confirmation (information component, lower 95% bound [IC] > 0). Analyses were stratified by subtype and sex. RESULTS: Among 13,237,811 FAERS reports, 2 165 involved glaucoma-related events: 67 NTG, 372 OAG, and 1 726 ACG. Ranibizumab showed the strongest NTG signal (ROR = 83.73; 95% confidence interval [CI] = 38.20-183.66), especially in females (ROR = 162.36; 95% CI = 62.14-424.21). In OAG, significant signals were found for ranibizumab (ROR = 27.13; 95% CI = 15.60-47.19), topiramate (ROR = 21.58; 95% CI = 12.14-38.37), duloxetine (ROR = 9.09; 95% CI = 4.85-17.03), alendronate (ROR = 13.52; 95% CI = 8.78-20.82), and female-specific methylphenidate (ROR = 42.57; 95% CI = 20.94-86.51). In ACG, top signals included tropicamide (ROR = 166.10; 95% CI = 105.18-262.30), topiramate (ROR = 109.19; 95% CI = 98.54-121.00), imipramine (ROR = 33.96; 95% CI = 20.05-57.53), phentermine (ROR = 25.25; 95% CI = 16.73-38.13), and chlorpromazine (ROR = 13.93; 95% CI = 7.69-25.21). Tropicamide, topiramate, and imipramine showed stronger ACG signals in males. All associations were statistically significant (p < 0.0001; IC > 0). CONCLUSIONS: This large-scale FAERS analysis provides the most comprehensive assessment of drug-associated glaucoma risk to date. It confirms known associations and identifies novel signals across anti-vascular endothelial growth factor, cardiovascular, psychiatric, and respiratory drugs. Subtype- and sex-specific patterns underscore the need for individualized risk assessment, targeted postmarketing surveillance, and cautious prescribing to reduce preventable glaucoma-related vision loss.
Balas M, Jhaveri A, Huang RS
… +3 more, Popovic MM, Kertes PJ, Muni RH
Can J Ophthalmol
· 2026 May · PMID 41962919
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OBJECTIVE: To investigate associations between intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and adverse respiratory events. METHODS: A comprehensive search was conducted in Ovid Medline, Embase...OBJECTIVE: To investigate associations between intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and adverse respiratory events. METHODS: A comprehensive search was conducted in Ovid Medline, Embase, and the Cochrane Library from January 2005 to February 2024. The search included peer-reviewed randomized controlled trials (RCTs) involving adult patients treated with intravitreal anti-VEGF that reported respiratory adverse events. Meta-analysis employed random-effects modeling to generate risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Of 24,506 studies initially identified, 11 RCTs comprising 9 718 patients were included. Chronic obstructive pulmonary disease (COPD) events were reported at the following rates: 2.2% (bevacizumab), 0.9% (faricimab), 0.8% (brolucizumab), 0.7% (sham), 0.5% (aflibercept), and 0.3% (ranibizumab). There was an increased risk of lower respiratory events with bevacizumab compared with aflibercept (RR = 1.69; 95% CI = 1.18-2.44; p < 0.01), and faricimab compared with aflibercept (RR = 1.50; 95% CI = 1.01-2.23; p < 0.05). These differences were primarily driven by rates of bronchitis: 11.9% (bevacizumab), 3.3% (faricimab), 2.8% (aflibercept), 1.3% (sham), and 0.4% (ranibizumab); however, these estimates were influenced by heterogeneity in reporting and were driven primarily by individual trials. No significant differences were found in COPD, acute respiratory emergencies, upper respiratory events, or patient-reported respiratory symptoms among the anti-VEGF agents. CONCLUSIONS: Intravitreal anti-VEGF agents do not appear to significantly increase the risk of COPD compared with sham injections. Differences observed across respiratory events should be interpreted cautiously given heterogeneous reporting across RCTs and highlight the need for further research with standardized safety reporting.