Ophthalmology[JOURNAL]
Sun
200 papers
Assessing the risk of diabetic retinopathy progression with GLP-1 receptor agonists: a systematic review and meta-analysis.
Yang Q, Hassan W, Ahmed H … +1 more , Zheng H
BMC Ophthalmol · 2026 Jun · PMID 42380920 · Full text
BACKGROUND: Diabetic retinopathy (DR) is a significant cause of vision impairment in patients with diabetes. The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on the progression of DR remains unclear. Th...
BACKGROUND: Diabetic retinopathy (DR) is a significant cause of vision impairment in patients with diabetes. The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on the progression of DR remains unclear. This systematic review and meta-analysis aimed to evaluate the association between GLP-1RA therapy and DR progression. METHODS: A comprehensive search of electronic databases identified 161 records, of which 11 studies met the inclusion criteria. Included studies comprised randomized controlled trials (RCTs) and retrospective cohort studies conducted in North America, Europe, and East Asia, with sample sizes ranging from 137 to 9,463 participants. The primary GLP-1RAs analyzed were albiglutide, liraglutide, semaglutide, exenatide, and dulaglutide, compared to either placebo or SGLT-2 inhibitors. The primary outcome was DR progression, assessed through pooled relative risk (RR) estimates using a random-effects model. Subgroup analyses were conducted by GLP-1RA type and geographical location. Sensitivity analyses and assessment of publication bias (via funnel plot, Egger's test, and Begg's test) were performed. Risk of bias was evaluated using the Cochrane tool. RESULTS: The meta-analysis indicated no statistically significant association between GLP-1RA use and DR progression (pooled RR = 1.07, 95% confidence interval [CI]: 0.90-1.28). Subgroup analyses by GLP-1RA type and geographical location also showed no significant differences. However, semaglutide demonstrated the highest RR for DR progression in two studies (RR = 1.76 [1.11-2.79] and RR = 6.41 [0.67-61.46]), a unique finding contrasting with the overall results. Sensitivity analyses confirmed the robustness of the findings, and no publication bias was detected (P > 0.05 for Egger's and Begg's tests). Risk of bias analysis revealed a low risk across most domains. CONCLUSION: This meta-analysis suggests that GLP-1RA therapy is not significantly associated with an increased risk of DR progression. However, heterogeneity in outcomes, particularly with semaglutide, warrants further investigation. TRIAL REGISTRATION: PROSPERO CRD420251007882. CLINICAL TRIAL NUMBER: Not applicable.
Custom-made anterior chamber intraocular lens for aphakia: a case report.
Kermani O
BMC Ophthalmol · 2026 Jun · PMID 42380915 · Full text
BACKGROUND: Aphakia without adequate capsular support requires alternative intraocular lens (IOL) fixation strategies. Standard options include sulcus-fixated posterior chamber IOLs and retropupillary iris-claw lenses, b...
BACKGROUND: Aphakia without adequate capsular support requires alternative intraocular lens (IOL) fixation strategies. Standard options include sulcus-fixated posterior chamber IOLs and retropupillary iris-claw lenses, both of which depend on specific anatomical prerequisites. When these are absent, anterior chamber IOLs (AC-IOLs) become one of the few remaining options; however, the only widely available angle-supported model has been the rigid Kelman Multiflex (PMMA), unchanged since its FDA approval in 1980. We describe the development and three-year clinical outcome of a custom-made, foldable, hydrophilic-acrylic, angle-supported AC-IOL implanted in an eye in which neither sulcus nor iris-claw fixation was feasible. CASE PRESENTATION: A 21-year-old woman presented with right-eye aphakia following congenital cataract surgery in early childhood, with contact lens intolerance. Extensive posterior iris-capsule-vitreous synechiae and a maximum pupil diameter of 4.0 mm precluded both sulcus-fixated posterior chamber IOL and retropupillary iris-claw implantation. A custom foldable, three-haptic, angle-supported AC-IOL (VKL Type 37 F, Design Kermani; Morcher GmbH, Stuttgart, Germany) was designed under MDR Article 2(3) for custom-made devices and, after a development period, implanted at 24 years of age through a 2.6 mm incision under topical anaesthesia. Over 36 months, uncorrected distance visual acuity improved from 20/400 to 20/25 and corrected distance visual acuity reached 20/20. Intraocular pressure remained stable at 20 mmHg. Endothelial cell density decreased from 2927 to 2704 cells/mm² (- 7.6%). Scheimpflug imaging confirmed an IOL-to-endothelium distance of 1.68 mm and IOL rotation of less than 5°. No inflammation, pupillary distortion, or secondary glaucoma was observed. CONCLUSIONS: This custom-made, foldable, angle-supported AC-IOL demonstrated stable centration, refractive predictability, and acceptable endothelial cell loss over three years. It may offer a minimally invasive secondary IOL option for selected aphakic eyes in which sulcus or iris-claw fixation is not feasible, and may represent a contemporary alternative to the rigid PMMA designs that have dominated the angle-supported AC-IOL segment since 1980.
Assessment of real-life visual outcomes and treatment efficacy of diabetic macular edema in patients with type 2 diabetes.
Konttinen A, Wirkkala J, Kubin AM … +2 more , Ohtonen P, Hautala N
BMC Ophthalmol · 2026 Jun · PMID 42380906 · Full text
BACKGROUND: Diabetic macular edema (DME) is a major cause of vision loss in individuals with diabetes. This study evaluated the long-term visual prognosis of patients with type 2 diabetes (T2D) by assessing real-world DM...
BACKGROUND: Diabetic macular edema (DME) is a major cause of vision loss in individuals with diabetes. This study evaluated the long-term visual prognosis of patients with type 2 diabetes (T2D) by assessing real-world DME treatment outcomes. METHODS: Patients with T2D and DME at Oulu University Hospital during 2010-2023 were included. The effect of DME intervention (anti-VEGF-agents, macular laser or both, intravitreal corticosteroids, observation) was evaluated by changes in visual acuity (VA) and residual edema. The dataset comprised additional variables, including age, sex, age at T2D diagnosis, timing of onset for diabetic retinopathy (DR) and DME, DR severity, glucose levels, other comorbidities, occurrences of treatment interruption, and adverse effects related to intravitreal therapy. RESULTS: Of 549 screened patients with T2D, 1145 DME episodes in 355 patients (560 eyes) were included. Mean ages at T2D, DR, and DME diagnosis were 51.0, 61.7, and 66.4 years, respectively. Mean HbA1c at DME treatment initiation was 64.3 mmol/mol; 93.0% had hypertension medication and 47.6% had diabetic nephropathy. DME was most treated with anti-VEGF injections alone (55.3%) or combined with laser (20.4%), yielding mean VA improvements of 3.8 [3.0-4.6] and 3.6 [2.5-4.6] ETDRS letters (both p < 0.001), respectively. Intravitreal corticosteroids (3.1%) resulted in a gain of 4.3 [1.2-7.4] letters (p = 0.014), whereas macular laser alone (12.8%) and observation (8.3%) showed no significant effect. Residual edema occurred in 38.1% (anti-VEGF), 43.2% (combination), 54.7% (observation), and 80.6% (corticosteroid) of cases. Adverse events related to any DME treatment were rare. CONCLUSIONS: Despite recurrent episodes of DME, most patients with T2D experienced improvement in visual acuity. Anti-VEGF agents alone or combined with macular laser appeared to be beneficial in terms of both visual gain and reduction of edema.
Development and preliminary validation of a hybrid three-dimension printed model for glaucoma drainage device surgery training: a prospective simulation-based study.
Al Owaifeer AM, Al-Yahya A, Allubly AM … +4 more , Alalmaee KA, Alqurashi A, AlKaff A, AlShahwan S
BMC Ophthalmol · 2026 Jun · PMID 42380880 · Full text
BACKGROUND: We aimed to develop a three-dimensional (3D) printed glaucoma drainage device (GDD) surgery model and evaluate its realism and procedural performance compared with a commercially available GDD. METHODS: This...
BACKGROUND: We aimed to develop a three-dimensional (3D) printed glaucoma drainage device (GDD) surgery model and evaluate its realism and procedural performance compared with a commercially available GDD. METHODS: This prospective, simulation-based pilot feasibility study assessed preliminary face and content validity evidence for a 3D-printed GDD model. Fourteen glaucoma specialists (eight fellows and six consultants) were recruited using a convenience sample from a single tertiary eye hospital. Participants performed two simulated GDD surgeries on ovine eyes in a surgical training wet lab, first using the 3D-printed model and then using a commercially available Baerveldt glaucoma implant (BGI). Procedure time was measured using a stopwatch for comparative analysis, and participants evaluated technical realism, visual realism, and overall utility relative to the BGI on a 5-point Likert scale (1 = not at all similar/not useful at all to 5 = extremely similar/extremely useful). The study was non-randomized, and participant blinding was not feasible because of visible differences between the devices. RESULTS: Total procedure duration was longer for the 3D-printed model than for the BGI (median interquartile range [IQR], 530.5 [302.5] vs. 342 [132.5] s; p < 0.001), with significantly longer times for plate insertion (p = 0.039), tube insertion (p = 0.001), and tube fixation (p = 0.025), except for plate fixation (p = 0.078). Technical realism was rated highest for plate and tube fixation, with median [IQR] scores of 4.00 [1] and 4.00 [0], respectively, and overall model utility was rated 4.00 [1]. When comparing consultants and glaucoma fellows, only BGI plate fixation time differed significantly (112.5 [101] vs. 180 [94] s; p = 0.023). CONCLUSIONS: Although procedure times were longer with the 3D-printed model than with the commercial implant, the model demonstrated acceptable moderate-to-high ratings for realism and high overall utility, supporting its potential role as a feasible simulation-based training tool for GDD surgery.
Foldable capsular buckle scleral buckling as an approach to retinal detachment in a pregnant patient.
Wu S, Deng X, Zhang S … +3 more , Shen L, Mao J, Mao JB
BMC Ophthalmol · 2026 Jun · PMID 42380809 · Full text
BACKGROUND: Reports on RRD surgery in pregnant women remain limited, highlighting the need for a safe, effective technique that does not compromise pregnancy or fetal health. CASE PRESENTATION: This report presents a 36-...
BACKGROUND: Reports on RRD surgery in pregnant women remain limited, highlighting the need for a safe, effective technique that does not compromise pregnancy or fetal health. CASE PRESENTATION: This report presents a 36-year-old, 28-week pregnant myopic female with macular-involved RRD in the left eye (best-corrected visual acuity [BCVA] 20/40). Due to the risks of prolonged supine positioning and anesthesia with traditional scleral buckling (SB), we performed foldable capsular buckle (FCB) scleral buckling under subconjunctival anesthesia. The retina was reattached, and BCVA recovered to 20/20. Intraocular pressure and refractive status remained stable throughout follow-up. The patient delivered a healthy female via Cesarean section at 38 weeks. CONCLUSION: FCB scleral buckling may represent a promising alternative in selected pregnant patients with uncomplicated RRD; however, larger studies are needed to establish safety and efficacy.
Nanophthalmos presenting with acute refractory angle-closure glaucoma: acute-phase histopathological evidence and bilateral comparative findings.
Chen C, Li M, Liu Z … +4 more , Qin C, Sun W, Zhu S, Cai J
BMC Ophthalmol · 2026 Jun · PMID 42380789 · Full text
BACKGROUND: Nanophthalmos is a rare congenital ocular disorder characterized by a microphthalmic eye with abnormally thickened sclera. Although scleral histopathology has been described in elective surgical cases with no...
BACKGROUND: Nanophthalmos is a rare congenital ocular disorder characterized by a microphthalmic eye with abnormally thickened sclera. Although scleral histopathology has been described in elective surgical cases with normal intraocular pressure (IOP), scleral architecture during acute IOP elevation exceeding 60 mmHg remains unclear. This article reports unique histopathological findings obtained during an episode of refractory acute angle-closure glaucoma. CASE PRESENTATION: A 63-year-old man with lifelong high hyperopia (corrected with + 10.25 D spectacles) presented with acute severe ocular pain, headache, nausea, and blurred vision in the right eye for 2 days. Best-corrected visual acuity was 20/2000 in the right eye and 20/70 in the left eye; IOP was > 60 mmHg and 18 mmHg, respectively. Examination revealed extremely shallow anterior chamber (2.15 mm), corneal edema, and nuclear cataract in the right eye; the fellow eye showed similar anterior chamber depth (2.23 mm) with slit-like angle opening, remaining in a preclinical state as an internal control. Axial lengths were 16.3 mm and 16.5 mm, with markedly thickened sclera in both eyes on B-scan ultrasonography. Despite maximal medical therapy, IOP remained > 60 mmHg. Combined lamellar sclerectomy with full-thickness sclerostomy, phacoemulsification with intraocular lens implantation, and posterior capsulotomy was performed, with scleral tissue obtained for histopathological examination. On the first postoperative day, IOP decreased to 17 mmHg, with inflammation resolving within 1 week and scattered superficial retinal hemorrhages completely resolving within 6 weeks. At 8-month follow-up, best-corrected visual acuity improved to 20/80 (with spectacles correcting residual hyperopia of + 10.5 D) with IOP stabilized at 15-18 mmHg without medication. The left eye remained stable (visual acuity 20/70, IOP 16-19 mmHg). Histopathological analysis revealed disorganized collagen architecture in nanophthalmic sclera, showing irregular fiber bundles and loosely arranged connective tissue; in contrast, normal control sclera showed dense, regularly layered collagen with uniform tissue structure. CONCLUSIONS: This case provides the first acute-phase histopathological evidence that characteristic scleral abnormalities in nanophthalmos persist during IOP elevation >60 mmHg, supporting their congenital etiology. Combined sclerostomy and cataract surgery successfully treated refractory nanophthalmos-associated glaucoma in the acute setting, and bilateral findings provide valuable comparative data supporting prophylactic surgical intervention in the fellow eye.
Timing of anti-VEGF therapy and postoperative macular edema after cataract surgery in eyes with retinal vein occlusion: a retrospective cohort study.
Dahlan K, Oganov A, Fazio N … +1 more , Chaudhary KM
BMC Ophthalmol · 2026 Jun · PMID 42380785 · Full text
BACKGROUND: Patients with retinal vein occlusion (RVO) undergoing cataract extraction are at increased risk of postoperative macular edema (pME), however, optimal perioperative management strategies remain unclear. This...
BACKGROUND: Patients with retinal vein occlusion (RVO) undergoing cataract extraction are at increased risk of postoperative macular edema (pME), however, optimal perioperative management strategies remain unclear. This study evaluated the incidence of pME in patients with prior RVO undergoing cataract extraction and assessed the effect of anti-VEGF timing on pME outcomes. METHODS: A retrospective cohort study at a single institution was conducted by chart review (2013-2023) using ICD-10 codes for RVO and CPT codes for subsequent cataract extraction in the same eye. Exclusion criteria included diabetic macular edema, lack of perioperative optical coherence tomography, and complex cataract extraction. A total of 53 eyes from 51 patients met study criteria. Data collected included demographics, medical history, ocular history, pre- and postoperative central subfield thickness, average cube thickness, timing of anti-VEGF relative to cataract extraction, fluorescein angiography, and postoperative topical medications. pME was defined as a > 30% increase in CST from baseline. Univariate and multivariate logistic regression were performed to identify independent risk factors for pME. RESULTS: The cohort had a mean age of 74.3 ± 9.9 years; 56.6% of eyes had branch RVO and 43.4% had central RVO. The overall incidence of pME was 26.1%, with mean time to development of 48.1 ± 25.1 days. A total of 38 eyes (71.7%) had previously received anti-VEGF therapy. Eyes receiving anti-VEGF within 35 days prior to cataract extraction had a significantly lower incidence of pME (12.5%, n = 24) compared with those treated more than 35 days before surgery (57.1%, n = 14; p = 0.033). Among eyes with ischemic RVO on fluorescein angiography, none receiving anti-VEGF within 35 days developed pME, whereas 80.0% of those treated outside this interval developed pME (p = 0.002). On multivariate logistic regression, pretreatment with anti-VEGF remained the only significant independent factor (adjusted OR 0.041, 95% CI 0.004-0.466, p = 0.010), after adjustment for ischemic status and diabetes. CONCLUSIONS: Patients with RVO have a higher risk of developing postoperative macular edema after cataract extraction. Anti-VEGF pretreatment within 35 days before cataract extraction was associated with lower incidence of pME, particularly in cases of ischemic RVO. These findings suggest that perioperative anti-VEGF timing may influence postoperative outcomes, warranting further prospective investigation.
Avacincaptad Pegol Slows Progressive Ellipsoid Zone Degradation/Loss in Eyes With Geographic Atrophy.
Ehlers JP, Cetin H, Amine R … +9 more , Matar K, Indurkar A, Mamone J, Della Vecchia L, Tang A, Reese J, Luo D, Abulon DJK, Talcott KE
Ophthalmology · 2026 Jun · PMID 42379522 · Publisher ↗
PURPOSE: Ellipsoid zone (EZ) integrity as measured by spectral-domain optical coherence tomography (SD-OCT) is a key biomarker and surrogate for photoreceptor health, including in age-related macular degeneration (AMD)....
PURPOSE: Ellipsoid zone (EZ) integrity as measured by spectral-domain optical coherence tomography (SD-OCT) is a key biomarker and surrogate for photoreceptor health, including in age-related macular degeneration (AMD). The objectives of this study were to determine (1) the association of baseline EZ measures with geographic atrophy (GA) progression and photoreceptor loss, and (2) the impact of avacincaptad pegol (ACP), a complement inhibitor, on EZ integrity over the first year of treatment. DESIGN: Post hoc analysis of pooled data from the phase 2/3 GATHER1 and phase 3 GATHER2 trials. PARTICIPANTS: Patients ≥50 years of age with non‒center point involving GA in the study eye. METHODS: SD-OCT images were evaluated using advanced multilayer segmentation with certified reader validation for EZ integrity, measuring total EZ attenuation or loss (EZ to retinal pigment epithelium [RPE] thickness of 0 μm; i.e., total loss of EZ) and partial EZ attenuation or degradation (EZ-RPE thickness of ≤20 μm). GA lesion growth was assessed through fundus autofluorescence. MAIN OUTCOME MEASURES: (1) Natural history assessment of progression of GA and total EZ attenuation in sham-treated eyes based on quartiles of baseline EZ measures, and (2) the impact of ACP treatment vs sham on progression of total and partial EZ attenuation over 12 months were evaluated. RESULTS: This study included 292 ACP 2 mg and 332 sham eyes. In sham-treated eyes, mean GA growth and progression of total EZ attenuation were substantially greater in higher quartiles of baseline total EZ attenuation and partial EZ attenuation measures over 12 months. ACP 2 mg significantly reduced mean growth in total EZ attenuation by 19.5% (P=0.0009) and mean growth in percentage of partial EZ attenuation by 55.3% (P<0.0001) vs sham over 12 months. CONCLUSIONS: Greater baseline total and partial EZ attenuation were associated with higher rates of GA lesion growth and progressive EZ loss over time, establishing these EZ measures as important predictors of future GA growth and photoreceptor loss. Treatment with ACP reduced EZ loss and degradation over 12 months vs sham. EZ measures may enhance identification of patients at high risk of disease progression who would benefit from early therapeutic intervention.
Laser Maculopathy with OCT Follow-Up.
Lv X, Niu J, Liang Y
Ophthalmol Retina · 2026 Jun · PMID 42376713 · Publisher ↗
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Focal Epithelial Bullae at the Air-Cornea Interface After Glaucoma Surgery.
Manchanda S, Thakur A, Kaushik S
Ophthalmol Glaucoma · 2026 Jun · PMID 42376711 · Publisher ↗
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Distribution characteristics and influencing factors of three-dimensional lens parameters in patients with age-related cataracts.
Jiang H, Tu B, Tong Y … +2 more , Zhu Z, Wang Y
BMC Ophthalmol · 2026 Jun · PMID 42374329 · Full text
BACKGROUND: To characterize the three-dimensional lens parameters in age-related cataract patients and examine their associations with age, sex, and ocular biometrics. METHODS: In this retrospective cohort study, we cons...
BACKGROUND: To characterize the three-dimensional lens parameters in age-related cataract patients and examine their associations with age, sex, and ocular biometrics. METHODS: In this retrospective cohort study, we consecutively enrolled patients aged ≥ 40 years who underwent cataract surgery at the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital) between January 2023 and December 2024. Three-dimensional lens parameters were acquired using swept-source anterior segment optical coherence tomography (SS-AS-OCT), including: anterior lens surface curvature radius (RAL), lens posterior surface curvature radius (RPL), lens thickness (LT), anterior lens thickness (LT), lens diameter (LD), and lens volume (LV). Correlations with age, sex, and ocular biometrics were analyzed. RESULTS: The study included 356 patients (140 males and 216 females) with a mean ± SD age of 66.48 ± 9.60 years. No significant sex-related differences were found in any lens parameters (all p > 0.05). RAL demonstrated a significant negative linear correlation with age (r = -0.142, p = 0.007), decreasing at a rate of 0.019 mm/year. In contrast, LT, LT, and LV showed positive linear correlations with age, increasing at rates of 0.013 mm/year, 0.007 mm/year, and 1.052 mm³/year, respectively (all p < 0.05). Age stratification showed LT increased faster in ≤ 60 years (0.022 mm/year vs. 0.010 mm/year). RAL was negatively correlated with LT and LT, but positively with RPL and LD. RPL, LT, LT, LD, and LV were positively intercorrelated. Ocular biometrics showed that RAL correlated positively with ACD, AL, and WTW but negatively with K. RPL positively correlated only with AL. LT, LT, LD, and LV exhibited negative correlations with ACD, while LD and LV positively correlated with AL (all p < 0.05). CONCLUSIONS: In cataract patients aged ≥ 40 years, the anterior lens surface convexity, LT, and LV increased significantly with age, with more rapid progression rates before age 60 than thereafter. Multivariable analysis revealed that smaller ACD was associated with more pronounced anterior lens surface convexity and greater lens thickness. LT, LT, and RAL showed nonlinear relationships with AL, where RAL was maximal and LT was thinnest at approximately 25 mm AL.
Payer-perspective direct medical costs during observed postoperative follow-up after gonioscopy-assisted transluminal trabeculotomy versus mitomycin-augmented trabeculectomy in Turkey.
Yuksel Elgin C, Erol MA
BMC Ophthalmol · 2026 Jun · PMID 42374288 · Full text
BACKGROUND: Glaucoma surgery has payer-budget implications when postoperative medication and procedure use differ between care pathways. This study compared direct medical costs after gonioscopy-assisted transluminal tra...
BACKGROUND: Glaucoma surgery has payer-budget implications when postoperative medication and procedure use differ between care pathways. This study compared direct medical costs after gonioscopy-assisted transluminal trabeculotomy (GATT) and mitomycin-C-augmented trabeculectomy (MMC-trabeculectomy) from the Turkish Social Security Institution (SGK) payer perspective. METHODS: This single-centre retrospective cohort used patient-level chart, operating-room, and medication-cost data from sequentially reviewed surgery-naive adults with primary open-angle or pseudoexfoliation glaucoma who underwent GATT (n = 40) or MMC-trabeculectomy (n = 20). Surgical outcome was not an enrollment criterion. Costs were valued in 2025 Turkish Lira using SUT tariffs and the 11 June 2025 SGK drug price list. The primary base-case cost included the index glaucoma-surgery tariff, postoperative ophthalmology visits, dispensed glaucoma medications, and glaucoma-related non-routine postoperative procedures. Routine optical coherence tomography and visual-field testing were excluded from the primary surgical cost comparison and reported descriptively. Patient-level Gamma generalized linear models with log link estimated procedure-associated cost ratios. RESULTS: Mean observed postoperative follow-up was 11.45 ± 8.28 months after GATT (range 2-30) and 13.85 ± 6.91 months after MMC-trabeculectomy (range 3-25). Mean primary base-case direct medical cost was 3188.6 ± 1955.9 TRY after GATT and 6835.8 ± 4674.5 TRY after MMC-trabeculectomy. Medication cost was the largest incremental driver (924.0 vs. 3305.7 TRY per patient), accounting for 65.3% of the mean difference. Glaucoma-related non-routine procedure costs were 0.0 TRY per GATT patient and 271.1 TRY per MMC-trabeculectomy patient. In the fully adjusted Gamma model, MMC-trabeculectomy was associated with higher mean primary base-case cost (cost ratio 2.01; 95% CI, 1.50-2.70). CONCLUSIONS: In this Turkish SGK payer-perspective analysis, MMC-trabeculectomy was associated with higher observed direct medical costs than GATT during available postoperative follow-up. The findings are limited by the retrospective single-centre design, imbalanced groups, nonrandomized surgical selection, no propensity-score matching or inverse-probability weighting, and short follow-up for long-term durability. They should not be interpreted as a long-term cost-utility analysis or causal evidence of economic superiority. TRIAL REGISTRATION: Not applicable.
Okra eyelid patch versus sodium hyaluronate combined with ofloxacin eye drop in the treatment of meibomian gland dysfunction: a randomized controlled trial.
Wu Y, Ma X, Li M … +1 more , Ma J
BMC Ophthalmol · 2026 Jun · PMID 42374237 · Full text
BACKGROUND: To evaluate the clinical efficacy of okra eyelid patch versus sodium hyaluronate combined with ofloxacin eye drop in the treatment of patients suffering from meibomian gland dysfunction (MGD). METHODS: 40 pat...
BACKGROUND: To evaluate the clinical efficacy of okra eyelid patch versus sodium hyaluronate combined with ofloxacin eye drop in the treatment of patients suffering from meibomian gland dysfunction (MGD). METHODS: 40 patients included were randomly divided into 2 groups: okra eyelid patch group (n = 20) and control group (n = 20). Before treatment, on the 14th and 28th day of treatment, the following ophthalmic examinations were performed: symptoms and signs score, Schirmer I test (SIT), tear film break-up time (TBUT), corneal fluorescein staining (CFS), optical quality analysis system (OQAS II) and ocular surface interferometer examination. Ocular surface disease index (OSDI) questionnaire score and in vivo confocal microscopy (IVCM) were performed before treatment and on the 28th day of treatment. Adverse effects were reported during the treatment period. Results were analyzed by SPSS 25.0 software. p < 0.05 was considered a statistically significant difference. RESULTS: On day 28, okra eyelid patch group had a better curative effect in symptoms score, signs score, total score, OSDI questionnaire score, TBUT, and CFS score, lipid layer thickness and MASD compared with control group (p < 0.05). During the 28-day treatment, one patient in okra eyelid patch group reported eyelid redness, while the difference between the two groups was not statistically significant (p > 0.05). CONCLUSIONS: Okra eyelid patch has a more significant effect on MGD, especially in improving symptoms and signs, increasing lipid layer thickness, improving tear film stability, maintaining corneal epithelial integrity, and improving the quality of meibomian gland acini compared with artificial tears combining ofloxacin eye drops. It has few side effects, and provides a new therapeutic option for MGD associated with dry eye.
Evidence and Consensus Based Guidelines for Imaging in Tubercular Choroiditis. Multimodal imaging in Uveitis (MUV) Taskforce: Report 17.
Janetos TM, Agarwal A, Biswas J … +16 more , Basu S, Nguyen QD, Or C, Shoughy S, Invernizzi A, La Distia Nora R, Gangaputra S, Agrawal R, Jabs DA, Davis JL, de Smet MD, Goldstein DA, Thorne JE, Sarraf D, Gupta V, Multimodal Imaging in Uveitis (MUV) Taskforce
Ophthalmol Retina · 2026 Jun · PMID 42372875 · Publisher ↗
PURPOSE: To develop imaging-based statements and consensus recommendations for the application of multimodal imaging in tubercular choroiditis (TBC). DESIGN: International expert committee-led consensus agreement using a...
PURPOSE: To develop imaging-based statements and consensus recommendations for the application of multimodal imaging in tubercular choroiditis (TBC). DESIGN: International expert committee-led consensus agreement using a modified nominal group technique (NGT) with further refinement from literature review and full taskforce voting. PARTICIPANTS: International expert committee of uveitis and retina specialists from the Multimodal Imaging in Uveitis (MUV) taskforce. METHODS: The MUV taskforce convened a group of international experts to develop a set of standardized imaging criteria for TBC. Cases with focus on tubercular serpiginous-like choroiditis (TB SLC) and tuberculomas/tubercles were provided by expert members to develop a review case portfolio of both active and inactive disease with longitudinal follow-up. Cases included color fundus photography (CFP), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA). The case portfolio was reviewed by all members and through a structured NGT and guided by literature review, the group refined descriptive statements characterizing active, evolving, and inactive lesions until consensus was achieved. MAIN OUTCOME MEASURES: Imaging statements and consensus guidelines describing features of TB-SLC and tuberculoma/tubercle in relation to diagnosis, monitoring, and detection of disease complications. RESULTS: The case portfolio included 31 cases, and the group achieved consensus on defining distinct imaging features of TB SLC and choroidal tuberculomas/tubercles. For TB SLC, key features of active lesions included yellow-white multifocal or placoid lesion with hyper-autofluorescent edges on FAF, outer retinal hyper-reflectivity and focal choroidal thickening on OCT. Both ICGA and OCTA highlight lesions that are often more extensive than seen clinically. Choroidal tuberculomas were defined as solitary, lobulated masses often associated with subretinal fluid and retinal neovascularization, whereas tubercles appear as multiple small lesions associated with disseminated tuberculosis. Consensus-based guidelines were established to utilize these multimodal imaging features for diagnosis, monitoring response to treatment, and detecting complications. CONCLUSIONS: The MUV imaging guidelines for TBC extend existing diagnostic frameworks by systematically integrating multimodal imaging features for disease characterization and monitoring. These consensus-based recommendations enhance phenotypic classification, improve assessment of disease activity, and provide clinically relevant endpoints for evaluating treatment response.
Increasing Familial Retinoblastoma in High-Income Countries Despite Stable Overall Incidence, 2017-2024.
Lustig-Barzelay Y, Ademola-Popoola DS, Al-Jadiry MF … +15 more , Bansal R, Benvenuto F, Bowman R, Cassoux N, Chaudhry S, Chawla B, Comsa C, Dalvin LA, Essuman VA, Sandri L, Staffieri SE, Stathopoulos C, Susanty A, Fabian ID, Global Retinoblastoma Study Group
Ophthalmol Retina · 2026 Jun · PMID 42372874 · Publisher ↗
PURPOSE: To reassess retinoblastoma (RB) incidence in high-income countries (HICs) participating in the Global Retinoblastoma Study and evaluate temporal changes in the proportion of familial RB between 2017 and 2024. DE...
PURPOSE: To reassess retinoblastoma (RB) incidence in high-income countries (HICs) participating in the Global Retinoblastoma Study and evaluate temporal changes in the proportion of familial RB between 2017 and 2024. DESIGN: Multicenter repeated cross-sectional study. SUBJECTS: Treatment-naïve children diagnosed with RB from 33 HICs that participated in both the 2017 and 2024 Global Retinoblastoma Study with complete or likely complete national case ascertainment (538 children in 2017; 434 in 2024). METHODS: Country-level RB incidence and familial RB proportions were compared between study years using Poisson generalized estimating equation models to account for paired observations within HICs. Country-specific live births served as the offset for overall and sporadic RB incidence analyses, and total RB cases for analysis of familial RB proportion. MAIN OUTCOME MEASURES: Overall and sporadic RB incidence rates in HICs, and the proportion of familial RB in 2017 versus 2024. RESULTS: In HICs, the overall RB incidence remained stable between 2017 and 2024 (1:15,408 vs 1:16,399; p=0.257), as did sporadic RB incidence (p=0.101). In contrast, country-level paired analyses demonstrated a significant increase in the proportion of familial RB in HICs from 7.1% in 2017 to 10.4% in 2024 (p=0.017), representing a 46.5% relative increase. CONCLUSIONS: In HICs, overall RB incidence remained stable over the seven-year period. However, the proportion of familial RB increased significantly, suggesting an evolving hereditary contribution to disease burden with implications for genetic counseling and surveillance strategies.
Systemic Statin Use and Reduced Risk of Repeat Retinal Detachment Repair: A Retrospective Cohort Study.
Bantounou MA, Foteinou D, Baroutis KG … +5 more , Emfietzoglou M, Bordbar DD, Brant AR, Miller JW, Vavvas DG
Ophthalmol Retina · 2026 Jun · PMID 42372873 · Publisher ↗
OBJECTIVE: Recurrent retinal detachment (RD) is a major determinant of vision loss following primary RD repair, largely driven by proliferative vitreoretinopathy, a fibroinflammatory wound-healing process in which hypoxi...
OBJECTIVE: Recurrent retinal detachment (RD) is a major determinant of vision loss following primary RD repair, largely driven by proliferative vitreoretinopathy, a fibroinflammatory wound-healing process in which hypoxia-inducible factor (HIF)-regulated transcriptional programs have been implicated. Statins possess anti-inflammatory and anti-fibrotic properties and are indirect HIF inhibitors. Our aim was to evaluate whether preoperative statins reduced the risk of recurrent RD repair within one year after primary repair. DESIGN: Single health system propensity-matched retrospective cohort study. PARTICIPANTS: Using the Complete Patient Data Science Repository, we identified patients ≥30 years old who underwent primary RD repair between 2005-2025. A 1:1 propensity score-matched control group was generated based on age, sex, race, smoking, hypertension, diabetes, obesity, myopia, uveitis, cataract surgery, open globe injury. METHODS: Statin exposure was defined as >90 cumulative days of use within the 12 months preceding primary RD repair. MAIN OUTCOME MEASURES: Repeat RD repair within 1 year of primary RD surgery was evaluated using Cox proportional hazards models to estimate cause-specific hazard ratios (HRs). Sensitivity analyses included a negative-control [proton pump inhibitors (PPIs) vs unexposed], active-comparator (statins vs PPIs), and analyses by statin subclass and individual agents. RESULTS: We identified 1,232 statin-exposed patients and 1,232 matched controls. At 1 year, repeat RD repair occurred in 16.1% of statin users vs. 21.1% of controls (HR=0.75; 95%-CI, 0.62-0.89; P=0.0014), an absolute risk difference of 5.0%. The negative-control showed no difference (17.2% vs 18.0%; HR=0.95; 95%-CI, 0.74-1.22; P=0.685). In the active-comparator analysis (PPI n=370 vs Statin n=681), recurrent RD occurred in 14.5% of statin users vs 19.7% of PPI users (HR=0.71; 95%-CI, 0.54-0.95; P=0.0224). After Bonferroni correction, only simvastatin (Simvastatin n=42/284 [14.8%] vs. Control n=67/284 [23.6%]) among statin subclass and individual agent comparisons was significantly associated with a reduced risk of repeat RD repair (HR=0.59; 95%-CI, 0.41-0.86; P=0.0059, Bonferroni-adjusted P=0.0356). CONCLUSIONS: Statin use was associated with lower risk of repeat RD repair, with the clearest signal observed with simvastatin. Prospective studies are needed to confirm causality and explore optimized delivery approaches to further reduce recurrence risk.
Access to Intravitreal Anti-VEGF Drugs in Persons with Medicare Advantage Compared with Medicare Fee-For-Service.
Chan J, Repka MX, Williams GA … +5 more , Vail D, Lum F, Begaj T, Friedman S, Parikh R
Ophthalmology · 2026 Jun · PMID 42372829 · Publisher ↗
PURPOSE: To investigate intravitreal anti-VEGF drug use among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries. DESIGN: Retrospective, cross-sectional analysis of de-identified healthcare data fro...
PURPOSE: To investigate intravitreal anti-VEGF drug use among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries. DESIGN: Retrospective, cross-sectional analysis of de-identified healthcare data from the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) for patient encounters between January 2017 to December 2022. PARTICIPANTS: Medicare beneficiaries 65 years and older with FFS or MA coverage with continuous insurance enrollment for at least12 months. METHODS: Unique FFS and MA beneficiaries receiving intravitreal anti-VEGF were included. Patients were considered to be treated with a particular drug if more than 50% of their injections for at least 12 months were with that drug. For each anti-VEGF drug, we compared proportions of patients treated (more than 50% of their injections) with that drug between FFS and MA and calculated the difference in use between the two Medicare health care programs. MAIN OUTCOME MEASURES: Differences in anti-VEGF drug utilization between FFS and MA. RESULTS: 930,411 beneficiaries underwent 12,942,057 intravitreal injections. In the FFS group, aflibercept 2mg was used most frequently (43.8%; n = 4,271,050), followed by bevacizumab (34.7%; n = 3,382,439), ranibizumab (20.6%; n = 2,008,791), brolucizumab (0.6%; n = 56,728) and faricimab (0.4%; n = 40,729). In the MA group, bevacizumab was used most frequently (45.1%; n = 1,436,151), followed by aflibercept 2mg (37.8%; n = 1,201,311), ranibizumab (6.5%; n = 524,758), brolucizumab (0.4%; n = 13,406), and faricimab (0.2%; n = 6,694). Repackaged bevacizumab (lower cost) was more common in the MA group compared with the FFS group (60.0% vs. 47.0%; difference (diff) = 13.0%, 95% CI:12.8, 13.3%; P<.001). Higher cost drugs were used significantly less often among persons with MA compared with FFS, respectively (aflibercept 2mg (28.9 vs. 36.6%; diff = -7.7%; 95% CI -7.9%, -7.4%; P<.001), ranibizumab (11.9% vs. 16.8%; diff = -4.9%; 95% CI -5.03%, -4.7%; P<.001), faricimab (0.06% vs. 0.24%; diff = -0.18%; 95% CI -0.19%, -0.16%); P<.001, and brolucizumab (0.12% vs. 0.19%; diff = -0.07%; 95% CI -0.09%, -0.05%; P<.001). CONCLUSIONS: Beneficiaries enrolled in MA were less likely to receive higher cost, anti-VEGF drugs, raising concerns about reduced beneficiary access to newer more expensive anti-VEGF drugs in MA.
Comparative efficacy and safety of Ranibizumab and Aflibercept for neovascular age-related macular degeneration: a systematic review and meta-analysis.
Zhao X, Yang Y
BMC Ophthalmol · 2026 Jun · PMID 42366374 · Full text
BACKGROUND: Ranibizumab and Aflibercept are widely used anti-VEGF agents for treating neovascular age-related macular degeneration (nAMD). This meta-analysis compares their efficacy, anatomical outcomes, treatment burden...
BACKGROUND: Ranibizumab and Aflibercept are widely used anti-VEGF agents for treating neovascular age-related macular degeneration (nAMD). This meta-analysis compares their efficacy, anatomical outcomes, treatment burden, and safety profiles. METHODS: A systematic search of PubMed, Cochrane, and Google Scholar yielded 1,734 unique records. After screening and applying eligibility criteria, 11 studies were included. Primary outcomes were changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), proportion of dry retina, and injection frequency. Subgroup analyses and funnel plots assessed heterogeneity and publication bias. RESULTS: Aflibercept showed a trend toward greater BCVA improvement compared with Ranibizumab, although the difference did not reach statistical significance (MD: 3.87 letters; 95% CI: -0.47 to 8.21; p = 0.07; I = 97%). Similarly, CRT reduction tended to favor Aflibercept (MD: -85.35 µm; 95% CI: -178.45 to 7.75; p = 0.09), but with substantial heterogeneity. The proportion of dry retina was significantly higher with Aflibercept (MD: 18.74%; 95% CI: 15.20 to 22.28; p < 0.001), with no heterogeneity (I = 0%). Although Aflibercept was associated with fewer injections (MD: -0.91; 95% CI: -1.67 to -0.15; p = 0.02), this finding was accompanied by substantial heterogeneity (I = 93%) and should be interpreted cautiously given the variability in study design, patient populations, and treatment regimens across included studies. Moreover, although the reduction in injection frequency was statistically significant, its magnitude was modest and its clinical importance remains uncertain given the high heterogeneity and very low certainty of evidence. CONCLUSIONS: Both agents demonstrated comparable visual efficacy for nAMD. No statistically significant differences were observed for BCVA improvement or CRT reduction, and the available evidence does not establish clear superiority of either treatment. Although differences in dry retina outcomes and injection frequency were observed, these findings should be interpreted cautiously because of substantial heterogeneity, mixed study designs, and predominantly low-certainty evidence. Further standardized head-to-head studies are required to clarify the clinical relevance of these observations. CLINICAL TRIAL NUMBER: Not applicable.
Estimation of cycloplegic spherical refraction from non-cycloplegic clinical and biometric data in children using machine learning: a retrospective pilot study for screening triage.
Hua H, Kang D, Shi C … +5 more , Qi F, Grzybowski A, Sun W, Jin K, Zhang B
BMC Ophthalmol · 2026 Jun · PMID 42365287 · Full text
OBJECTIVE: To develop and evaluate non-cycloplegic clinical and biometric models for estimating cycloplegic spherical power (DS), spherical equivalent (SE), and astigmatic power-vector components (J0 and J45) in children...
OBJECTIVE: To develop and evaluate non-cycloplegic clinical and biometric models for estimating cycloplegic spherical power (DS), spherical equivalent (SE), and astigmatic power-vector components (J0 and J45) in children, and to assess their utility as a preliminary screening-triage aid rather than a substitute for cycloplegic refraction. METHODS: This retrospective pilot study included 590 children aged 2.4-14.8 years who underwent cycloplegic refraction at the Children's Hospital, Zhejiang University School of Medicine. The children were randomly divided at the patient level into training and held-out test sets at a ratio of 7:3, ensuring that both eyes from the same child remained in the same set. Astigmatism was expressed using J0 and J45. Power-vector components were calculated separately for non-cycloplegic and post-cycloplegic refraction, and post-cycloplegic J0/J45 served as prediction targets. Seven algorithms were screened; DT, BPNN, GPR, and LR were selected for clinically oriented evaluation using regression metrics, error thresholds, screening indices, subgroup analyses, GEE analysis, and Bland-Altman plots. RESULTS: Age, axial length, corneal astigmatism, corneal power, and UCVA were the main predictors for spherical refraction. After patient-level splitting, DT, BPNN, GPR, and LR showed moderate performance for DS and SE. DT achieved RMSE/R values of 0.776 D/0.819 for DS and 0.781 D/0.823 for SE; BPNN achieved 0.752 D/0.802 for DS and 0.759 D/0.798 for SE. GPR achieved 0.921 D/0.806 for DS and 0.941 D/0.800 for SE, while LR achieved 0.876 D/0.824 for DS and 0.949 D/0.797 for SE. The vector-based analysis showed interpretable J0 outputs for several models, including GPR (R = 0.671), but J45 was weak across models (R approximately - 0.08 to 0.06). For SE-based screening, GPR achieved sensitivity/specificity of 94.09%/86.46% for myopia and 80.00%/98.20% for hyperopia. Only 53.75% of GPR SE estimates were within +/-0.50 D. CONCLUSIONS: Non-cycloplegic clinical and biometric variables provided moderate estimates of cycloplegic DS and SE after patient-level data partitioning. The J0/J45 vector analysis indicated partial predictability of J0, whereas J45 prediction was clinically unreliable. This approach should be regarded as an exploratory triage aid for spherical refractive estimation rather than a substitute for cycloplegic refraction.
Comparable myopia control efficacy of highly aspherical lenslets and diffusion optics technology spectacle lenses: a one-year real-world cohort study.
Pan S, Zhang P, Song D … +3 more , Yao J, Lou B, Jing J
BMC Ophthalmol · 2026 Jun · PMID 42365264 · Full text
PURPOSE: To compare the real-world efficacy of Highly Aspherical Lenslets (HAL) spectacles, Diffusion Optics Technology (DOT) spectacles, and single vision lenses (SVL) for controlling myopia progression in children and...
PURPOSE: To compare the real-world efficacy of Highly Aspherical Lenslets (HAL) spectacles, Diffusion Optics Technology (DOT) spectacles, and single vision lenses (SVL) for controlling myopia progression in children and adolescents. METHODS: A total of 159 participants aged 6 to 13 years were enrolled from the Ophthalmology Clinic of Nanjing Children's Hospital between April 2024 and September 2025, comprising 53 subjects each in the HAL, DOT, and SVL groups. Participants were further stratified into a younger subgroup (6 to < 10 years) and an older subgroup (10 to13 years). One-way analysis of variance was used to compare changes in spherical equivalent (SE) and axial length(AL) after one year. RESULTS: Both HAL and DOT groups were associated with significantly slower progression in SE and AL than the SVL group (all P < 0.001), with no statistically significant differences between the two treatment groups (P = 0.35 for SE; P = 0.22 for AL). In both age subgroups, axial elongation was similar between HAL and DOT (P = 0.52 and P = 0.15), and both were significantly slower than SVL in the older subgroup (both P < 0.001). In the younger subgroup, HAL also slowed axial elongation significantly compared with SVL (P = 0.003), whereas the difference between DOT and SVL did not reach statistical significance after Bonferroni correction (P = 0.02), although the observed absolute difference of 0.11 mm per year may still be clinically meaningful. Pearson correlation analysis showed that only age was significantly correlated with AL elongation in both the HAL (r= - 0.35, P = 0.024) and DOT groups (r= - 0.48, P = 0.001). CONCLUSION: In this real-world cohort, both HAL and DOT lenses were linked to slower myopia progression, with similar progression rates between HAL and DOT. However, the efficacy of DOT in younger children (aged 6 to < 10 years) requires further investigation with larger sample sizes.
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