Takai Y, Yamagami A, Iwasa M
… +4 more, Inoue K, Yasumoto R, Ishikawa H, Wakakura M
Can J Ophthalmol
· 2026 May · PMID 41833325
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OBJECTIVE: To compare 5-year visual acuity trajectories in Leber hereditary optic neuropathy (LHON) by age at onset. DESIGN: A retrospective single-center cohort study. PARTICIPANTS: Fifty-seven patients (114 eyes) with...OBJECTIVE: To compare 5-year visual acuity trajectories in Leber hereditary optic neuropathy (LHON) by age at onset. DESIGN: A retrospective single-center cohort study. PARTICIPANTS: Fifty-seven patients (114 eyes) with genetically confirmed, bilateral-onset LHON. METHODS: Serial best-corrected visual acuity (BCVA, logMAR) over 5 years was extracted from medical records. The age at onset was grouped as ≤19, 20-49, or ≥50 years. Sex and primary mutation (m.11778G>A vs m.14484T>C) were also assessed. Longitudinal trajectories were analyzed using linear mixed-effects models. Between-group differences were summarized using ΔlogMAR curves, area under the Δ curve (AUCΔ), and model-based probabilities of achieving logMAR ≤1.0. RESULTS: The median age at onset was 30.0 years (range: 8-69): 15 patients (26%) were ≤19 years old, 31 (54%) were 20-49 years old, and 11 (19%) were ≥50 years old. Relative to the 20-49-year reference group, the ≤19-year group had better visual outcomes over 5 years, with a negative AUCΔ and higher probabilities of achieving logMAR ≤1.0 (70.2% vs 13.6% at 60 months). The ≥50-year group showed poorer vision over time, with a positive AUCΔ and low probabilities of recovery. Differences by sex were small. Eyes with m.14484T>C had more favourable Δ trajectories than those with m.11778G>A, although the estimates were imprecise. CONCLUSIONS: In this cohort, onset at ≤19 years was associated with earlier and greater visual recovery, whereas onset at ≥50 years was associated with persistently worse vision. Age at onset is an important modifier of 5-year visual prognosis in bilaterally affected LHON.
Yuan M, Wang T, Liu C
… +7 more, Liu J, Ma J, Deng G, Li L, Mi X, Lu H, Li S
Can J Ophthalmol
· 2026 Jun · PMID 41786297
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OBJECTIVE: To characterize clinical features, management, and outcomes of pediatric macular hole (MH) and to outline an etiology-guided aid. DESIGN: A retrospective, consecutive case series. PARTICIPANTS: Pediatric MH pa...OBJECTIVE: To characterize clinical features, management, and outcomes of pediatric macular hole (MH) and to outline an etiology-guided aid. DESIGN: A retrospective, consecutive case series. PARTICIPANTS: Pediatric MH patients diagnosed, surgically treated, and followed at a tertiary centre (March 2012 to January 2025). METHODS: Clinical data (age, sex, etiology, best-correct visual acuity [BCVA], intraocular pressure, axial length, MH size, and imaging) were reviewed. Etiology was classified as traumatic, secondary, or idiopathic. Vitreoretinal techniques and adjuncts were recorded. RESULTS: Eighty-eight eyes of 88 patients were included: traumatic 51/88 (58%), secondary 25/88 (28%), and idiopathic 12/88 (14%). At baseline, idiopathic MHs had better BCVA than traumatic (p = 0.05) and secondary (p = 0.003), while secondary MHs had longer axial length than traumatic MHs (p = 0.023). Imaging patterns differed by etiology (acute-injury changes in traumatic; proliferative/tractional features in secondary; relatively "pure" in idiopathic). Surgery reflected these patterns: internal limiting membrane flap/covering in 33% of traumatic MH; multiple adjuncts in secondary eyes (laser 56% with anti-vascular endothelial growth factor/steroid/buckle/oil); and primarily inert-gas tamponade in idiopathic MH (75%). Primary complete closure was 82%; final complete closure after reintervention was 84%. Mean final BCVA improved to 0.90 logMAR (≈20/160; p < 0.001), and the proportion with BCVA >20/200 rose from 47% to 68%. Visual gains were greatest in idiopathic and traumatic. CONCLUSIONS: An etiology-informed, size/edge/traction-guided approach was associated with meaningful-though limited-visual improvement and high closure. These practice-informing data support early recognition, tailored surgery, and proactive complication management; a decision aid is provided. Prospective studies are needed to standardize thresholds and validate outcomes.
Bernal-Morales C, Burgos Herrera S, Giralt L
… +10 more, Alforja S, Romero-Núñez B, Catalan-Coronado S, Bilbao V, Sala-Puigdollers A, Pelegrin-Colas L, Zarranz-Ventura J, Adan A, Casaroli-Marano R, Figueras-Roca M
Can J Ophthalmol
· 2026 Mar · PMID 41780904
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OBJECTIVE: To evaluate anatomical and functional outcomes following a switch to intravitreal faricimab in patients with active, recalcitrant neovascular age-related macular degeneration (nAMD) previously treated with afl...OBJECTIVE: To evaluate anatomical and functional outcomes following a switch to intravitreal faricimab in patients with active, recalcitrant neovascular age-related macular degeneration (nAMD) previously treated with aflibercept in a real-life setting. DESIGN: A retrospective, observational, single-centre study. METHODS: Demographic data and prior intravitreal treatment (IVT) history were collected. Best-corrected visual acuity (BCVA) and disease activity were assessed using optical coherence tomography (OCT), including fluid compartments: intraretinal fluid, subretinal fluid (SRF), pigment epithelial detachment, and subretinal hyperreflective material. RESULTS: A total of 161 eyes from 145 patients (mean age: 80.1 ± 7.8 years) were included. Mean prior IVT duration was 2.9 ± 2.5 years. All eyes were active at the time of switching, with 82.0% showing persistent SRF. Disease inactivation occurred in 42.9% of eyes after the switch, more frequently in eyes with shorter prior treatment duration. BCVA remained stable throughout the follow-up. SRF resolved in 50.8% of eyes, with 52.2% achieving resolution after a single injection. Mean treatment intervals increased significantly in inactivated eyes (+4.9 ± 5 weeks). Disease relapse occurred in 54.6% of the initially inactivated eyes. No adverse events were reported. CONCLUSIONS: Switching to faricimab may offer a valuable therapeutic option for recalcitrant nAMD, particularly in eyes with persistent SRF, providing improved anatomical outcomes while maintaining visual acuity in real-life practice. Prospective studies are warranted to better define response profiles and guide personalized treatment strategies.
Nudelman NT, Ibrahim Z, Scallon S
… +5 more, Bheemireddy S, Feustel PJ, Salandy J, Storey NA, Barry GP
Can J Ophthalmol
· 2026 Mar · PMID 41771513
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OBJECTIVE: Recognition of factors associated with a greater need for treatment may be useful in managing retinopathy of prematurity (ROP). We aim to assess the relationship between nasal and temporal ROP on initial prese...OBJECTIVE: Recognition of factors associated with a greater need for treatment may be useful in managing retinopathy of prematurity (ROP). We aim to assess the relationship between nasal and temporal ROP on initial presentation and an infant's eventual need for treatment. METHODS: All patients screened for ROP between January 2018 and December 2020 were retrospectively reviewed. Data were collected on all patients (n = 286) with stage 1 or higher ROP. Eyes were classified as either nasal ROP or temporal-only ROP at initial presentation of ROP. Data from all ROP screening exams until treatment or completion of screening were reviewed. The primary outcome was treatment-required ROP. Additional data collected included birth weight, patient age, and laterality. Outcomes were compared using univariable and multivariable logistic regression analyses. RESULTS: Five hundred forty-two eyes were included for analysis. Eyes with nasal ROP on initial presentation were more likely to ultimately require treatment (63/197 [32%]) than eyes with temporal-only ROP on initial presentation (13/345 [4%]; odds ratio [OR]: 12.0, 95% CI: 6.40-22.54) using a univariable logistic regression analysis. A separate multivariable regression analysis demonstrated that eyes with nasal ROP remain more likely to require treatment (OR: 3.28, 95% CI: 1.54-6.99), even when also accounting for birth weight (OR: 0.40/100 g, 95% CI: 0.32-0.51), patient sex, and laterality. CONCLUSIONS: Eyes with nasal ROP at initial presentation are more likely to eventually require treatment than those with temporal-only ROP at initial presentation, even when accounting for other risk factors. Nasal ROP at initial presentation should prompt particular attention when monitoring for progression of ROP.
Can J Ophthalmol
· 2026 Mar · PMID 41747762
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OBJECTIVE: To evaluate the outcomes of cyanoacrylate tissue adhesive (CTA) in the management of corneal perforation and thinning based on underlying etiology. METHODS: This retrospective cohort study included eyes underg...OBJECTIVE: To evaluate the outcomes of cyanoacrylate tissue adhesive (CTA) in the management of corneal perforation and thinning based on underlying etiology. METHODS: This retrospective cohort study included eyes undergoing CTA application for corneal perforation or thinning treated at a tertiary care centre. Eligible cases were categorized into infectious, immune-mediated, ocular surface disease, neurotrophic, or trauma-related etiologies. The primary outcomes were the need for repeat CTA applications and progression to penetrating keratoplasty (PK). Kaplan-Meier survival analysis was conducted to evaluate the time to PK. Multivariable logistic regression was performed to examine associations between etiology and outcomes, adjusting for clinical covariates. RESULTS: A total of 174 eyes were included (56.9% male, mean age: 66.1 ± 18.7 years). Over a median follow-up of 12.5 months (interquartile range [IQR]: 4.1-20.2), an average of 1.7 ± 0.8 CTA applications were performed per eye, with neurotrophic cases requiring the highest number (2.0 ± 0.8; p = 0.038). Overall, 58 eyes (33.3%) progressed to PK, most commonly in the neurotrophic group (43.5%; p = 0.019). Trauma cases had the most favourable PK-free survival (log rank p = 0.033). In multivariable regression, trauma was associated with lower odds of requiring multiple CTA applications (odds ratio [OR]: 0.22; 95% CI: 0.07-0.70; p = 0.010) and of progressing to PK (OR: 0.19; 95% CI: 0.05-0.74; p = 0.016), whereas neurotrophic cases were associated with increased odds of PK (OR: 1.65; 95% CI: 1.06-3.80; p = 0.031) compared with infectious cases. CONCLUSIONS: Rates of repeat gluing and progression to PK varied by the underlying etiology. Incorporating etiology into prognostication and management decisions may help identify patients at highest risk for early surgical intervention.
Fogel Levin M, Hostovsky A, Feo A
… +7 more, Yao M, Santina A, Estawro R, Jung JY, Abraham N, Pineles SL, Sarraf D
Can J Ophthalmol
· 2026 Mar · PMID 41734881
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OBJECTIVE: To characterize the spectral-domain optical coherence tomography (SD-OCT) features of flame-shaped epiretinal membranes (ERMs) in patients with and without neurofibromatosis type 2 (NF2). METHODS: This retrosp...OBJECTIVE: To characterize the spectral-domain optical coherence tomography (SD-OCT) features of flame-shaped epiretinal membranes (ERMs) in patients with and without neurofibromatosis type 2 (NF2). METHODS: This retrospective study included 9 patients (13 eyes) with flame-shaped ERMs from 3 tertiary centres. Multimodal imaging and clinical data were systematically analyzed. RESULTS: Six of 9 subjects with flame-shaped ERM were confirmed NF2 patients. Among the NF2 cohort of 12 eyes, SD-OCT revealed flame-shaped ERMs in 10 eyes (83%). Flame-shaped ERMs were bilateral in 4 patients (8 eyes) and unilateral in 2 patients (2 eyes). The fellow eyes of these 2 unilateral patients demonstrated combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) and a retinal tuft, respectively. Isolated CHRRPE was noted in 3 eyes (25%) and a retinal tuft in 2 eyes (17%). Multiple retinal findings within the same eye occurred in 3 NF2 patients. By contrast, all 3 non-NF2 patients exhibited unilateral flame-shaped ERMs: 2 with CHRRPE and 1 isolated. OCT angiography performed in 4 patients revealed hyper-reflective foci anterior to the retinal nerve fibre layer in all 3 NF2 patients. During mean follow-up of 6.2 ± 3.4 years, findings remained stable in 78% of patients. One NF2 patient developed intraretinal cysts, while 1 non-NF2 patient underwent vitrectomy. CONCLUSIONS: Flame-shaped ERMs are strongly associated with NF2, and bilateral retinal lesions were present in all NF2 patients. However, they can also occur unilaterally with or without CHRRPE in non-NF2 cases. Early recognition of flame-shaped ERMs enables timely and systematic NF2 evaluation.
Dhungana A, Vargas P, Moir J
… +3 more, Smith S, La Riviere P, Skondra D
Can J Ophthalmol
· 2026 Feb · PMID 41679722
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OBJECTIVE: Texture analysis extracts high-order mathematical features from an image with the potential to reveal subtle image differences. Although racial variations have been demonstrated in traditional optical coherenc...OBJECTIVE: Texture analysis extracts high-order mathematical features from an image with the potential to reveal subtle image differences. Although racial variations have been demonstrated in traditional optical coherence tomography angiography (OCTA) parameters, texture analysis has not been well explored. METHODS: This is a retrospective, cross-sectional study of 226 eyes from 127 nondiabetic subjects (60 Black, 67 White). We collected 3 × 3 mm en face OCTA images of the superficial choriocapillaris (CC), which were processed using computerized texture analysis to extract the following features: average grey level, grey level 30% threshold, grey level 70% threshold, balance, skewness, energy, entropy, contrast, mean gradient, root-mean-square (RMS) variation, and first moment of power spectrum. RESULTS: There were no significant baseline differences in the demographics and clinical characteristics of the 2 racial groups, other than a higher rate of diagnosed hypertension in Black subjects (20% in Black vs 6% in White subjects; p = 0.017). Using a mixed-effects linear regression model, we found statistically significant differences in the absolute value of the grey level, skewness, and root-mean-square variation, which remained significant in a subgroup of nonhypertensive patients (p < 0.001 for all). CONCLUSIONS: These findings demonstrate racial variation in CC texture features, underscoring the importance of diversity when building clinical datasets. Future studies may better explore how these differences correlate with underlying chorioretinal pathogenesis.
Stephenson KAJ, Alsalamah AK, Tumber A
… +7 more, Mercer GD, Ballios BG, Muni RH, Tavares E, Kertes PJ, Vincent A, Héon E
Can J Ophthalmol
· 2026 Jun · PMID 41679721
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OBJECTIVES: RPE65-associated Leber's congenital amaurosis (RPE65-LCA) is now treatable with a subretinal injection of voretigene neparvovec-rzyl (VN). Outcomes specific to young patients are not often reported. We presen...OBJECTIVES: RPE65-associated Leber's congenital amaurosis (RPE65-LCA) is now treatable with a subretinal injection of voretigene neparvovec-rzyl (VN). Outcomes specific to young patients are not often reported. We present outcomes of young patients ≤21 years old with RPE65-LCA who have received VN. DESIGN: A single-centre, retrospective review of 18 patients ≤21 years old (mean age: 14.6 ± 3.4 years, 10 females) with biallelic RPE65-LCA treated with VN (mean follow-up: 14.8 ± 7.6 months). METHODS: Outcomes studied include best-corrected visual acuity (BCVA), Goldmann visual field (GVF), white full-field stimulus test (FST), and central retinal thickness (CRT) and ellipsoid zone width from optical coherence tomography (OCT). Thresholds for significant change were BCVA ≥0.3 logMAR, GVF ≥30%, FST ≥5 dB, and CRT ≥10%. RESULTS: While significant improvement in BCVA, GVF V4e, and III4e isopters were noted in 11%, 11%, and 39%, respectively, FSTw values improved significantly in 100%. (mean -2.8 ± 1 log, i.e., 256X). Chorioretinal atrophy (CRA) at baseline was observed in 38%, while at the last visit, some CRA was observed in all patients. The presence of nummular and/or perifoveal atrophy at baseline correlated with poorer functional outcomes. Neither postoperative elevated intraocular pressure nor return of inflammation after cessation of steroids affected functional outcomes; however, inflammation was associated with the development of nummular atrophy. CONCLUSIONS: VN treatment is safe and effective in improving retinal sensitivity in patients 21 years old or less with RPE65-LCA despite the occurrence of CRA post-treatment.
Mechleb N, Panthier C, Fabro F
… +4 more, Elahi S, Stephan S, Saad A, Gatinel D
Can J Ophthalmol
· 2026 Feb · PMID 41679720
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OBJECTIVE: The aim of this study was to evaluate the short-term results of a comatic aberration-based nomogram of intrastromal corneal ring segments in different keratoconus patterns and stages. SETTING: Hospital Foundat...OBJECTIVE: The aim of this study was to evaluate the short-term results of a comatic aberration-based nomogram of intrastromal corneal ring segments in different keratoconus patterns and stages. SETTING: Hospital Foundation Adolphe de Rothschild-Noémie de Rothschild Institute. DESIGN: A retrospective observational single-center study. METHODS: This study includes patients who underwent intracorneal ring segment implantation with Kc Solutions rings from January 2018 to December 2022. A complete ocular examination was performed preoperatively: uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), slit lamp anterior segment, and fundus examination. Corneal topography was performed with the Pentacam HR system. RESULTS: Ninety-one eyes of 68 patients were included. Both UDVA and CDVA improved significantly from 0.47 ± 0.23 logMAR and 0.39 ± 0.25 logMAR at baseline to 0.34 ± 0.32 logMAR and 0.17 ± 0.19 logMAR after 3 months. A significant decrease of 2.13 ± 2.44 D in cylinder and 2.12 ± 3.06 D in SE was observed (p < 0.001). The Astigmatic Index of Success (AIS) was 0.43 ± 0.49, and 49 eyes (53.8%) had a decrease in cylinder of more than 50%. The flattest (K1) and steepest (K2) meridians, and maximum keratometry (Kmax) decreased at 3 months. The y value of the steepest point showed a significant upper shift (p = 0.007). Total RMS, higher-order aberration (HOA) RMS, and comatic aberrations all decreased significantly postoperatively (p < 0.001). CONCLUSIONS: The present study demonstrates that targeting vertical coma can reduce total RMS and HOA aberrations in addition to improving topographic and refractive outcomes.
Can J Ophthalmol
· 2026 Feb · PMID 41655967
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OBJECTIVE: To analyze the pathological composition ratio of orbital space-occupying lesions in a large single-center cohort and to assess differences across age groups and decades. DESIGN: A retrospective observational s...OBJECTIVE: To analyze the pathological composition ratio of orbital space-occupying lesions in a large single-center cohort and to assess differences across age groups and decades. DESIGN: A retrospective observational study. PARTICIPANTS: A total of 7 515 patients with histopathologically confirmed orbital space-occupying lesions who underwent surgical excision at Zhongshan Ophthalmic Center from January 2000 to March 2021. METHODS: Demographic and histopathological data were reviewed. Lesions were classified by biological behavior (benign/borderline vs malignant), tissue origin, and age group (0-14, 15-59, and ≥60 years). Temporal trends were compared between 2000-2009 and 2010-2021. RESULTS: Among 7 515 patients, 3 717 (49.5%) were male. Benign or borderline lesions comprised 78.0%, and malignant lesions comprised 22.0%, with mean ages of 36 and 49 years, respectively (p < 0.05). The leading histopathologic types were vasculogenic (22.3%), lymphoproliferative (16.4%), inflammatory (16.0%), and cystic (11.9%) lesions. Idiopathic orbital inflammatory pseudotumour was the most common benign entity, and mucosa-associated lymphoid tissue (MALT) lymphoma was the most frequent malignancy. Malignancy increases with age, reaching 43.6% in the elderly. Over 2 decades, vasculogenic lesions declined, while lymphoproliferative and malignant lesions rose. CONCLUSIONS: The pathological spectrum of orbital space-occupying lesions in southern China is dominated by inflammatory and vascular lesions in younger patients and by lymphoproliferative malignancies in the elderly. Over the past two decades, vascular lesions have decreased, whereas lymphoproliferative and malignant lesions have become more prevalent, reflecting demographic aging and advances in diagnostic pathology. These findings provide updated epidemiologic evidence to guide the differential diagnosis and management of orbital tumours.