Ophthalmology[JOURNAL]
Sun
200 papers
The impact of systemic iron overload on retinal and choroidal microcirculation in transfusion-dependent beta-thalassemia patients.
Bezci Aygün F, Algedik Tokyürek MÖ, Unal Ş … +3 more , Aksu T, Gümrük F, Kadayıfcılar S
BMC Ophthalmol · 2026 Jun · PMID 42271293 · Full text
PURPOSE: This study aimed to evaluate retinal and choroidal microcirculation in transfusion-dependent β-thalassemia (TDβT) patients and to explore associations between systemic iron overload and ocular structural and vas...
PURPOSE: This study aimed to evaluate retinal and choroidal microcirculation in transfusion-dependent β-thalassemia (TDβT) patients and to explore associations between systemic iron overload and ocular structural and vascular changes. METHODS: A total of 66 eyes from 33 TDβT patients and 66 eyes from 33 healthy controls were included in this case-control study. Retinal and choroidal structures were evaluated using Spectral-Domain OCT and OCT-Angiography (OCTA). Systemic iron overload was assessed using serum ferritin and MRI-T2* of the liver and heart. Liver iron load was classified by T2* values into normal, mild, and moderate. Key ocular parameters, including central macular thickness (CMT), subfoveal choroidal thickness (SCT), luminal area (LA), stromal area (SA), total choroidal area (TA), and vessel density (VD) of superficial (SCP), deep (DCP), and choriocapillaris (CC) plexi, were analyzed. RESULTS: Choriocapillaris VD was significantly lower in TDβT patients compared with controls (p < 0.001, p adjusted = 0.004), while ferritin levels showed positive correlations with CMT, SCP VD, and CC VD within the patient group. Patients with moderate liver iron overload showed increased trend toward LA, SA, TA, SCT, and inferior peripapillary VD, but this significance not existed after FDR correction. No significant relationship was found between iron overload and FAZ metrics. CONCLUSION: Liver iron overload may be associated with changes in choroidal structure and perfusion in TDβT patients, although chronic anemia-related hypoxia and compensatory vascular responses may also contribute to these findings.Choroidal parameters may provide useful non-invasive indicators for monitoring ocular effects of systemic iron burden.
Incidence of scleritis requiring surgical repair from subconjunctival triamcinolone acetonide injections in patients with scleritis in TriNetX.
Lama J, Berkenstock M
BMC Ophthalmol · 2026 Jun · PMID 42271290 · Full text
PURPOSE: To estimate the yearly and 15-year cumulative incidence of scleritis requiring surgical repair in patients with a prior diagnosis of scleritis who received a subconjunctival or subTenon triamcinolone acetonide i...
PURPOSE: To estimate the yearly and 15-year cumulative incidence of scleritis requiring surgical repair in patients with a prior diagnosis of scleritis who received a subconjunctival or subTenon triamcinolone acetonide injection (STAI). DESIGN: A retrospective cohort study was conducted using the TriNetX US Collaborative Network. TriNetX is an electronic health records database with anonymized, deidentified encrypted data from 69 healthcare networks. METHODS: Subjects with a history of scleritis were identified using ICD-10 (International Classification of Diseases, 10th Revision) code H15.0X and who subsequently underwent a STAI as identified using the CPT (current procedural terminology) code between January 1, 2009 to December 31, 2024. CPT codes were used to identify STAIs include subconjunctival injection (68200) or subTenon injection (67515) and injection of triamcinolone acetonide 10 mg (J3301). Please note that H15.0X codes specifying posterior scleritis were excluded from this cohort in an attempt to localize anterior scleritis. The time relation was set to ensure all patients in the cohort had an existing diagnosis of scleritis prior to any instance of STAI. The primary outcome measure was the annual and 15-year cumulative incidence of required surgical repair within 4 weeks, and 3, 6, 9, and 12 m after the STAI as best estimated by scleral graft reinforcement and repair of scleral staphyloma with graft, CPT 67255 or 66225. Final data collection ran on April 23, 2026. Possible confounding procedures such as cataracts were also excluded within the time period assessed in order to better localize the STAI for use in cases of scleritis. RESULTS: Out of 113,510,724 patients on the TriNetX database, 36,249 had a diagnosis of scleritis. Of those with a history of scleritis, 176 had a subconjunctival or subTenon triamcinolone injection (STAI). Of this cohort, 0 patients needed surgical interventions requiring a patch graft over the 15-year time period of the study giving an annual and cumulative incidence of 0 per 100,000 persons. The subjects were primarily female (112, 63.64%) with a mean age of 61 years (range 14-90, SD 16). CONCLUSIONS: Surgical intervention requiring a patch graft was not observed post-injection among patients with prior scleritis who received a STAI. Further studies with larger cohorts are necessary to accurately represent the risk profile of STAI in the greater population.
Corrigendum.
Ophthalmol Glaucoma · 2026 Jun · PMID 42268174 · Publisher ↗
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Dysregulation of neurovascular unit in the retina after optic nerve injury.
Wu Q, Wang H, Liu H … +2 more , Zhang L, Wei Q
BMC Ophthalmol · 2026 Jun · PMID 42265670 · Full text
PURPOSE: To investigate the changes in the neurovascular unit (NVU) of the retina in rats following optic nerve (ON) injury, and to explore the translational implications for traumatic optic neuropathy (TON). METHODS: Th...
PURPOSE: To investigate the changes in the neurovascular unit (NVU) of the retina in rats following optic nerve (ON) injury, and to explore the translational implications for traumatic optic neuropathy (TON). METHODS: The ON transverse quantitative traction (ONTQT) was performed to establish the model of ON and retinal injury. The rats were divided into the sham operation group (SG) and the model group (MG). At 14th day post-modeling, flash visual evoked potential (FVEP) test was performed to evaluate the visual function. Transmission electron microscopy (TEM) was used to observe the microstructure of retinal NVU. RNA binding protein with multiple splicing (RBPMS) immunofluorescence was applied to detect the survival retinal ganglion cell (RGC). The activity of astrocytes and Müller cells in retina was detected by glial fibrillary acidic protein (GFAP) immunofluorescence. The expression of tight junction proteins (Claudin-1, Claudin-5) and glial end feet markers aquaporin-4 (AQP4) and inwardly rectifying potassium channel subtype 4.1 (Kir4.1) in retinal tissue were test by western blot and Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). RESULTS: At 14th day following ONTQT, the FVEP results exhibited the prolonged peak latency of P2 and the reduced amplitudes of N1-P1 and N2-P2. TEM showed structural changes of the basement membranes in NVU and ultrastructural abnormalities of tight junctions (TJs) after ONTQT. Besides, the expression of RBPMS in ganglion cell layer (GCL) was down-regulated and GFAP was over-expression in the injured retinal sections. The relative expressions of claudin-1and claudin-5 declined and the mRNA levels of AQP4 increased in the retina at 14 days following ONTQT. The mRNA levels of Kir4.1 was downregulated in the retina of MG. CONCLUSIONS: ONTQT can be applied in the model of ON and retina injury. The dysfunction of retinal NVU may promotes the optic degeneration in rats following ONTQT, contributing to the RGC loss and impaired visual function. These findings provide a mechanistic basis for NVU-targeted neuroprotection and identify potential clinical biomarkers for the diagnosis and treatment of TON.
Polarimetric entropy mapping of retinal pigment epithelium in full-thickness macular hole by polarization-sensitive OCT.
Terao R, Yashiro K, Kuriyama T … +8 more , Babaguchi K, Mihara G, Nakajima K, Aoki S, Arai T, Kitamoto K, Azuma K, Ueta T
BMC Ophthalmol · 2026 Jun · PMID 42265628 · Full text
BACKGROUND: This study is aimed to evaluate retinal pigment epithelium (RPE) entropy in eyes with full-thickness macular hole (FTMH) using polarization-sensitive optical coherence tomography (PS-OCT). METHODS: Patients d...
BACKGROUND: This study is aimed to evaluate retinal pigment epithelium (RPE) entropy in eyes with full-thickness macular hole (FTMH) using polarization-sensitive optical coherence tomography (PS-OCT). METHODS: Patients diagnosed with treatment-naïve FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were included. Ophthalmologic examinations, including visual acuity (BCVA), swept-source OCT (SS-OCT), and PS-OCT, were performed. Polarimetric entropy (PE) of RPE was assessed using PS-OCT and compared with affected and fellow eyes and before and after surgery. RESULTS: Fourteen eyes of 14 patients were included (64.5 ± 5.84 years). All eyes achieved complete FTMH closure following the surgery. PE value within the central foveal area (< 200 μm from the foveal center) was significantly lower than that in fellow eyes (p = 0.013), whereas PE in the area surrounding FTMH was significantly higher (p = 0.0402). The interocular difference in foveal PE (affected eye minus fellow eye) was significantly and negatively correlated with baseline BCVA (p = 0.0445). Postoperatively, PE in the surrounding area significantly decreased, whereas foveal PE did not change. Eyes without EZ recovery exhibited significantly greater baseline foveal PE reduction than those with EZ recovery (p = 0.0053). CONCLUSIONS: These findings suggest two spatially distinct RPE responses in FTMH: decreased entropy in the foveal area and increased entropy in the surrounding region. Foveal RPE-PE quantified by PS-OCT is associated with EZ recovery and may reflect postoperative structural outcomes.
Rethinking the Link between Ophthalmic Herpes and Malignancy.
Acharya NR
Ophthalmology · 2026 Jun · PMID 42262295 · Publisher ↗
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Retreatment using LASIK, PRK, or ICL for myopic regression after corneal laser refractive surgery.
Ang RET, Ang MRC, Jacomina JMD … +2 more , Araneta MMQ, Cruz EM
BMC Ophthalmol · 2026 Jun · PMID 42260445 · Full text
PURPOSE: To describe the outcomes of retreatment for myopic regression following primary LASIK or PRK, and to explore factors associated with pre-retreatment refractive error. METHODS: Retrospective cross-sectional study...
PURPOSE: To describe the outcomes of retreatment for myopic regression following primary LASIK or PRK, and to explore factors associated with pre-retreatment refractive error. METHODS: Retrospective cross-sectional study of eyes undergoing retreatment with LASIK, PRK, or ICL implantation after prior LASIK/PRK. Outcomes included UDVA, CDVA, MRSE, and safety and efficacy indices through 6-12 months. Associations between baseline factors and pre-retreatment MRSE were assessed. RESULTS: 158 eyes were included (136 LASIK, 12 PRK, 10 ICL). Early postoperative outcomes improved significantly for LASIK (UDVA 0.37 to 0.04 logMAR; MRSE - 1.28 D to - 0.12 D) and ICL (UDVA 0.68 to 0.03 logMAR; MRSE - 2.72 D to 0.03 D). PRK also produced significant UDVA gains (0.63 to 0.06 logMAR). Efficacy and safety indices were near or above 1.0 across groups. A longer interval since primary surgery was significantly linked to more negative MRSE, consistent with greater regression. Mild correlation between pre-retreatment MRSE and age, initial MRSE, and tissue ablation were observed. Complications were low (7.9%). CONCLUSIONS: Retreatment for myopic regression with LASIK, PRK, or ICL was safe and effective, with stable outcomes through 6-12 months. Regression was multifactorial and not predicted by baseline characteristics, though longer intervals between surgeries were significantly associated with greater myopic regression.
iStent combined with phacoemulsification versus phacoemulsification alone in open-angle glaucoma: a meta-analysis by medication washout status.
Song Z, Li Y, Wang Y … +3 more , Shi J, Zhou L, Ding X
BMC Ophthalmol · 2026 Jun · PMID 42260442 · Full text
PURPOSE: To assess how preoperative medication washout influences the interpretation of intraocular pressure (IOP) outcomes in randomized controlled trials (RCTs) comparing iStent combined with phacoemulsification versus...
PURPOSE: To assess how preoperative medication washout influences the interpretation of intraocular pressure (IOP) outcomes in randomized controlled trials (RCTs) comparing iStent combined with phacoemulsification versus phacoemulsification alone. METHODS: Systematic searches in PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were conducted through December 2025. RCTs comparing combined surgery versus phacoemulsification alone in open-angle glaucoma were included. Random-effects meta-analyses pooled weighted mean differences (WMDs) for IOP and medications, stratified by washout status and follow-up duration. RESULTS: Five RCTs (915 eyes) were included. In short-term follow-up (≤ 15 months), IOP reduction did not differ significantly between groups. In long-term follow-up (> 15 months), combined surgery showed greater IOP reduction in trials with medication washout (WMD = 1.29 mmHg; 95% CI: 0.61 to 1.97) but not in trials without washout (WMD = 0.69 mmHg; 95% CI: -2.25 to 3.63). Combined surgery consistently reduced medication use (WMD = 0.39) and increased the likelihood of medication-free status (RR = 1.31; 95% CI: 1.15 to 1.51). CONCLUSIONS: Preoperative washout status substantially influences IOP outcome quantification. In patients assessed without washout, where baseline IOP is medically controlled, the principal benefit of combined surgery is sustained medication burden reduction rather than additional numerical IOP lowering.
Real-world data analysis of cranial nerve III, IV, and VI palsies: demographics, association factors, and comparative all-cause mortality.
Hsu CA, Hsu MH, Melisa S … +1 more , Yen JC
BMC Ophthalmol · 2026 Jun · PMID 42260440 · Full text
INTRODUCTION: Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascula...
INTRODUCTION: Binocular diplopia is a distressing clinical condition that prompts clinicians to investigate underlying etiologies, particularly cranial nerve (CN) III, IV, or VI palsies. These may arise from microvascular ischemia, inflammation, trauma, compression, or neuromuscular junction disorders. This study aims to explore the association factors of these three ocular motor cranial nerve palsies and to compare their respective all-cause mortality rates using the real-world TriNetX Clinical Research Database (TriNetX CRD). MATERIALS AND METHODS: TriNetX is a global federated administrative database with real-time updates of electronic medical records (EMRs). We used the US Collaborative Network within the TriNetX platform to establish the patient cohorts. This network contains electronic health record data from more than 100 million patients across 68 US healthcare organizations (HCOs). This study utilized TriNetX platform to analyze the demographics and associated factors of ocular motor cranial nerve palsies, including diabetes, hypertension, acute myocardial infarction (AMI), overweight status, blood glucose and lipid profiles, body mass index (BMI), and history of brain aneurysm surgery, through intergroup comparisons using paired t-tests. All-cause mortality was assessed using Cox proportional hazards modeling and Kaplan-Meier survival analysis. RESULTS: The average age at presentation was 63, 57, and 60 years for CN III, IV, and VI palsies, respectively, with a slight male predominance. CN VI palsy was the most common, followed by CN IV and CN III palsies. CN III and CN VI palsy cohorts were more commonly associated with diabetes, hypertension, AMI, overweight, and brain aneurysm surgery, suggesting a microvascular or compressive etiology. In contrast, the CN IV palsy cohort was younger and more similar to the general population in clinical and laboratory characteristics. Regarding all-cause mortality, the CN III palsy cohort had the poorest survival, followed closely by the CN VI group, while the CN IV group exhibited the most favorable survival outcome. DISCUSSION: This study confirmed that CN VI palsy is the most frequent cause of ocular motor nerve palsy leading to binocular diplopia. Notably, CN III and VI palsies shared similar vascular and compressive association factors, while CN IV palsy appeared to be more frequently linked to congenital or traumatic origins. These differences were reflected in the mortality analysis, where CN III palsy showed the worst prognosis, CN VI a slightly better but comparable pattern, and CN IV the best survival outcome. CONCLUSIONS: Using the TriNetX CRD, this study delineated the demographic profiles, associated clinical factors, and survival outcomes of patients with ocular motor cranial nerve palsies. The typical demographic was males in their late 50s to early 60s, with CN VI being the most frequently affected nerve. CN III and VI palsies were more often associated with microvascular and compressive conditions, which correlated with higher mortality. Conversely, CN IV palsy was associated with a younger population and more benign clinical profiles, reflected in better survival outcomes.
Needle bevel-guided standardisation of scleral tunnel formation in intrascleral haptic fixation: a quantitative geometric analysis.
Aytogan H, Ayintap E
BMC Ophthalmol · 2026 Jun · PMID 42260422 · Full text
BACKGROUND: Scleral tunnel formation during Yamane double-needle intrascleral haptic fixation (ISHF) depends on proprioceptive estimation, producing variable tunnel lengths that contribute to intraocular lens (IOL) malal...
BACKGROUND: Scleral tunnel formation during Yamane double-needle intrascleral haptic fixation (ISHF) depends on proprioceptive estimation, producing variable tunnel lengths that contribute to intraocular lens (IOL) malalignment. The aim of this study was to evaluate a needle bevel-guided technique using the innate 2 mm bevel of a 26-gauge needle as a visual endpoint for standardising intrascleral tunnel length, and to assess postoperative IOL positional stability using a quantitative geometric landmark framework. METHODS: Retrospective consecutive case series of 24 eyes undergoing ISHF in the horizontal meridian (3- and 9-o'clock positions) by a single surgeon. During scleral needle advancement, the bevel disappearance point was used to standardise tunnel length to approximately 2 mm at each fixation site. IOL centration was quantified by extracting limbus centre (L) and optic centre (O) from intraoperative and 6-month images, and flange coordinates (F1, F2) from intraoperative images only using Fiji/ImageJ (National Institutes of Health, Bethesda, MD, USA; version 2.14.0/1.54f). The primary outcome was longitudinal Euclidean displacement of the optic centre. RESULTS: Mean best-corrected visual acuity improved from 1.28 ± 0.54 to 0.52 ± 0.47 logMAR (p < 0.001). Mean IOL decentration was 0.401 ± 0.240 mm at baseline and 0.397 ± 0.234 mm at 6 months (mean change - 0.004 mm; p = 0.457). Mean Euclidean displacement was 0.029 ± 0.018 mm; no eye demonstrated displacement exceeding 0.06 mm. No haptic extrusion, IOL dislocation, or sight-threatening complications occurred. CONCLUSIONS: The needle bevel provides a simple, reproducible, and cost-free visual cue for standardising intrascleral tunnel length during ISHF and was associated with excellent longitudinal positional stability. Initial centration, governed by entry angle and chord length symmetry, remains a separate challenge requiring complementary strategies.
Efficacy of different optical zone design with different myopia control for corneal refractive therapy (CRT): a one-year prospective cohort study.
Lai WX, Wang MT, Fu RX … +6 more , Wu X, Hu QM, Jia YY, Zhang YY, Tang DY, Zhang WM
BMC Ophthalmol · 2026 Jun · PMID 42260405 · Full text
PURPOSE: This study aims to compare the one-year myopia control effects of orthokeratology (OK) lenses with different optical zone designs in children with varying degrees of myopia. METHODS: A total of 200 children with...
PURPOSE: This study aims to compare the one-year myopia control effects of orthokeratology (OK) lenses with different optical zone designs in children with varying degrees of myopia. METHODS: A total of 200 children with myopia aged 7-12 years with spherical equivalent refraction (SER) ranging from - 0.50 D to - 6.00 D were enrolled. They were non-randomly divided into four groups based on the baseline refractive power and the final choice on OK lenses type: Low myopia 6.0 group, Mod myopia 6.0 group, Low myopia 5.0 group, and Mod myopia 5.0 group, with 50 children in each group. Data from the right eye were used for analysis. We comparatively analysed the one-year follow-up axial length (AL) and AL elongation between each group. We also analyzed the interaction effect between different optical center designs and different initial myopic refractive powers on AL elongation over 1 year by two-way ANOVA, and compared the proportions of non-progressive myopia among the four groups. RESULTS: At the 1-year follow-up, AL differed significantly across different myopia subgroups, with Mod myopia groups showing longer AL than low myopia groups, but no significant difference was noted between lens design subgroups. For one-year AL elongation, subgroups with small optical zone designs and those with initial moderate myopia had lower values. A slight interaction effect was observed between lens optical center design and initial myopia severity (F = 6.700, P = 0.010, partial η²=0.033). The one-year AL elongation was 0.280 ± 0.170, 0.148 ± 0.167, 0.154 ± 0.121, and 0.141 ± 0.185 in Low Myopia 6.0 group, Mod Myopia 6.0 group, Low Myopia 5.0 group, and Mod Myopia 5.0 group, respectively; the corresponding non-progressive myopia rates were 62%, 36%, 58%, and 64%. The Mod Myopia 5.0 group presented the slowest AL elongation and the highest non-progressive myopia rate, whereas Mod myopia 6.0 group and Low myopia 5.0 group also showed slower AL elongation and higher non-progressive myopia rates than those of the Low myopia 6.0 group. CONCLUSION: CRT lenses with a small optical zone design exhibited better myopia control compared to those with a larger optical zone design, especially in children with low myopia.
Visual outcomes of scleral-fixated posterior chamber intraocular lenses in children with genetic ectopia lentis: long-term follow-up.
Vallotton K, Habra O, Frueh BE
BMC Ophthalmol · 2026 Jun · PMID 42260393 · Full text
BACKGROUND: Ectopia lentis in the pediatric population poses significant surgical challenges given the need for long-term optical rehabilitation. This study evaluated the feasibility and clinical outcomes of lensectomy c...
BACKGROUND: Ectopia lentis in the pediatric population poses significant surgical challenges given the need for long-term optical rehabilitation. This study evaluated the feasibility and clinical outcomes of lensectomy combined with scleral-sutured intraocular lens (IOL) implantation in pediatric patients with genetic ectopia lentis. METHODS: We conducted a retrospective study of pediatric patients with atraumatic (sub)luxation of the crystalline lens who underwent lensectomy, anterior vitrectomy, and scleral-fixated polymethylmethacrylate (PMMA) IOL implantation in the sulcus. Outcome measures included best-corrected distance and near visual acuities (LogMAR), refractive outcomes and complication rates. Mean follow-up duration was 6.5 ± 2.9 years (range: 1.7-11.5 years). RESULTS: Nineteen children (36 eyes; 55% male; mean age 5.1 ± 1.9 years) were included. BCVA improved significantly for near vision (0.72 ± 0.3 to 0.19 ± 0.3; p < 0.001) and distance vision (0.48 ± 0.2 to 0.05 ± 0.2; p = 0.008). The spherical equivalent shifted from - 6.3 ± 4.6 D preoperatively to + 1.5 ± 1.4 D at one month, then to - 0.7 ± 2.6 D at final follow-up, reflecting a mean myopic shift of - 2.26 ± 2.11 D. Vision-threatening IOL subluxation occurred in 5 eyes (14% of eyes; 21% of patients). Kaplan-Meier analysis estimated its cumulative incidence at 7% at 5 years and 16% at 10 years. CONCLUSIONS: Lensectomy combined with scleral-fixated sulcus PMMA IOL implantation is a viable surgical strategy for pediatric ectopia lentis, yielding substantial visual improvement and acceptable refractive outcomes. IOL subluxation remains the primary long-term concern, underscoring the need for sustained postoperative surveillance.
Herpesvirus Retinitis by Immune Status: Clinical Phenotypes and Predictors of Retinal Detachment and Severe Visual Impairment.
Zou Y, Yang M, Zhang J … +2 more , Ohno-Matsui K, Kamoi K
Ophthalmol Retina · 2026 Jun · PMID 42252088 · Publisher ↗
PURPOSE: To evaluate the clinical manifestations, retinal detachment (RD) patterns, treatment strategies, and visual outcomes in herpesvirus retinitis and to identify predictors of RD and severe visual impairment. DESIGN...
PURPOSE: To evaluate the clinical manifestations, retinal detachment (RD) patterns, treatment strategies, and visual outcomes in herpesvirus retinitis and to identify predictors of RD and severe visual impairment. DESIGN: Retrospective longitudinal cohort study. PARTICIPANTS: Among 1175 patients screened for suspected viral retinitis (2013-2025), 120 patients (144 eyes) with acute retinal necrosis (ARN) or cytomegalovirus retinitis (CMVR) were included. METHODS: Demographic, clinical, imaging, and treatment data were reviewed. Diagnosis was based on the Standardization of Uveitis Nomenclature classification criteria, irrespective of polymerase chain reaction (PCR) status. Multivariable regression, generalized estimating equation modeling, Kaplan-Meier survival analysis, and Cox regression were performed to compare ARN and CMVR phenotypes and identify predictors of RD and severe visual impairment (<20/200). Polymerase chain reaction testing was recorded, and subgroup analyses were performed according to PCR status. MAIN OUTCOME MEASURES: Ocular and systemic characteristics between CMVR and ARN and risk factors for RD and severe visual impairment. RESULTS: Mean follow-up was 5.5 years. Cytomegalovirus retinitis occurred mainly in patients with lymphoma (P = 0.022) and prior immunosuppressive therapy (P = 0.027), whereas ARN more commonly showed unilateral involvement (P = 0.012), peripheral necrosis (B = 1.91; P = 0.046), and a more fulminant course (B = -0.06; P < 0.001). Retinal detachment developed earlier and more frequently in ARN (log-rank P < 0.001). In multivariable Cox analysis, ARN (hazard ratio [HR], 11.52; 95% confidence interval [CI], 1.93-68.86; P = 0.007) and worse baseline visual acuity (HR, 2.06; 95% CI, 1.23-3.44; P = 0.006) were independently associated with an increased risk of RD. Surgical intervention (B = -2.50; 95% CI, -4.72 to -0.20; P = 0.033) and concurrent RD (B = -1.28; 95% CI, -2.55 to -0.02; P = 0.047) were independently associated with lower odds of severe visual impairment. Polymerase chain reaction-based subgroup analyses showed broadly similar clinical and outcome patterns. CONCLUSIONS: Host immune status was associated with distinct clinical phenotypes and outcome patterns in herpesvirus retinitis. Cytomegalovirus retinitis occurred in immunocompromised patients and showed a more indolent course. ARN showed broader retinal involvement and earlier RD. Retinal detachment timing and surgical intervention were associated with visual outcomes. These findings highlight distinct disease patterns and may improve early recognition and management. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
CoCl-induced alterations in antioxidative and inflammatory marker expression in an siRNA-based in vitro model of aniridia-associated limbal epithelial dysfunction.
Hsu SL, Szentmáry N, Fries FN … +6 more , Li Z, Chai N, Seitz B, Amini M, Suiwal S, Stachon T
BMC Ophthalmol · 2026 Jun · PMID 42251340 · Full text
BACKGROUND: Congenital aniridia is a rare disease, accompanied by aniridia associated keratopathy (AAK) in most cases. Oxidative stress and inflammation are involved in the progression of AAK. We aimed to evaluate antiox...
BACKGROUND: Congenital aniridia is a rare disease, accompanied by aniridia associated keratopathy (AAK) in most cases. Oxidative stress and inflammation are involved in the progression of AAK. We aimed to evaluate antioxidative and inflammatory gene and protein expression in a small interfering RNA (siRNA) paired box 6 (PAX6) knockdown limbal epithelial cell (LEC) model of aniridia under cobalt chloride (CoCl)-induced stress. METHODS: To mimic PAX6 haploinsufficiency in congenital aniridia, PAX6 expression was knocked down by 24-hour siRNA treatment in primary human LECs. Hypoxia-mimetic conditions were induced by 50 µM or 75 µM CoCl₂ for 48 h following siRNA transfection. Messenger RNA (mRNA) expression levels were analyzed by quantitative polymerase chain reaction (qPCR), while protein expression levels were assessed by enzyme-linked immunosorbent assay (ELISA) or western blotting. RESULTS: Vascular endothelial growth factor A (VEGFA) protein levels were significantly increased in PAX6 knockdown LECs compared with control siRNA-treated cells (p = 0.007). In contrast, hypoxia-inducible factor 2-alpha (HIF-2α) and interleukin-6 (IL-6) mRNA levels (p = 0.031, p = 0.001), as well as interleukin-1 beta (IL-1β), IL-6, and interleukin-8 (IL-8) protein levels (p = 0.049, p < 0.001, p < 0.001, respectively), were significantly reduced in PAX6 knockdown cells compared with control siRNA-treated LECs. CoCl₂ treatment (50 and 75 µM) reduced hypoxia-inducible factor 1-alpha (HIF-1α) mRNA expression in both groups (p = 0.019 and p = 0.007; p < 0.001 and p = 0.046, respectively). In control cells, 75 µM CoCl₂ increased IL-1β and IL-8 mRNA expression (p = 0.022, p = 0.019) as well as IL-1β protein levels (p = 0.024), whereas IL-8 protein levels decreased at both concentrations (p = 0.002 and p < 0.001). No other analyzed genes showed significant expression changes in response to CoCl₂ treatment in either the control or PAX6 knockdown groups. CONCLUSIONS: Our study demonstrates altered expression of hypoxia-related (HIF-1α, HIF-2α) and inflammatory (IL-1β, IL-6, IL-8) genes in response to CoCl₂ treatment or PAX6 haploinsufficiency. Further investigation is needed to elucidate the effects of PAX6 knockdown and its interaction with inflammatory pathways. This research may contribute to better understanding of congenital aniridia.
Personalized orbital decompression surgery for thyroid-associated orbitopathy: a comprehensive retrospective analysis of efficacy, safety, and surgical strategy.
Wang P, Han Z, Li X … +4 more , Lin R, Xun Y, Sang Z, Yuan H
BMC Ophthalmol · 2026 Jun · PMID 42251332 · Full text
OBJECTIVE: This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to opt...
OBJECTIVE: This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to optimize surgical strategies accordingly. METHODS: A retrospective cohort study included 199 TAO patients (263 eyes) who underwent orbital decompression between September 2021 and June 2025. Patients were stratified into four groups by surgical modality: transconjunctival fat decompression, endoscopic transnasal medial wall decompression, combined transconjunctival medial-lateral wall decompression, and combined endoscopic transnasal medial-lateral wall decompression. Primary outcomes were changes in LogMAR best-corrected visual acuity (BCVA), proptosis, and intraocular pressure (IOP); secondary outcomes included ocular motility, diplopia, and postoperative complication rates. RESULTS: All surgical strategies resulted in significant clinical improvements. Overall mean proptosis was reduced from 21.16 ± 2.75 mm to 15.01 ± 1.86 mm (p < 0.0001). Mean BCVA improved from 0.67 ± 0.68 LogMAR to 0.34 ± 0.42 LogMAR (p < 0.0001), with the most significant improvement seen in patients with preoperative Dysthyroid Optic Neuropathy (DON). DON was present in 46.4% of eyes, with the highest prevalence in Groups 2 (76.6%) and 4 (62.2%). Combined bony wall decompression (Groups 3 & 4) yielded the greatest proptosis reduction (7.67 mm and 7.29 mm, respectively), significantly more than single-modality decompression (p < 0.0001). The overall complication rate was 9.1%, with new-onset or worsening diplopia being the most common, but often transient or successfully managed with subsequent strabismus surgery. Endoscopic medial wall decompression (Group 2) was associated with the lowest complication rate (4.3%). CONCLUSION: In this large single-centre retrospective cohort, individualized orbital decompression was associated with significant improvements in proptosis, visual function, IOP, ocular motility, and diplopia-related outcomes in patients with TAO. Combined medial-lateral wall decompression achieved greater proptosis reduction, whereas procedures involving medial wall decompression were associated with visual improvement in eyes with DON. These findings support an indication-driven approach to surgical selection, while the retrospective design, baseline differences among groups, and eye-level analysis should be considered when interpreting comparative results.
Variations in post-operative cataract surgery instructions among eye health workers in Tanzania: a cross-sectional survey.
Dhalla KA, Kassamali SS, Mbezi T … +2 more , Teferi K, Rugabela EG
BMC Ophthalmol · 2026 Jun · PMID 42251285 · Full text
PURPOSE: To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. METHODS: A cross-sectional survey was conducted among...
PURPOSE: To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. METHODS: A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70). RESULTS: Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%). CONCLUSIONS: Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.
Retinal Arterial Macroaneurysms: Clinical Features, Management, and Outcomes.
Zhang C, Bowers KE, Khan S … +6 more , AbouKasm G, Ersan S, Nuesi R, Williams BK, Yannuzzi NA, Flynn HW
Ophthalmol Retina · 2026 Jun · PMID 42250603 · Publisher ↗
PURPOSE: To describe baseline characteristics, management patterns, and long-term outcomes in a contemporary cohort of eyes with retinal arterial macroaneurysms (RAM) managed with observation versus treatment. DESIGN: Re...
PURPOSE: To describe baseline characteristics, management patterns, and long-term outcomes in a contemporary cohort of eyes with retinal arterial macroaneurysms (RAM) managed with observation versus treatment. DESIGN: Retrospective cohort study. SUBJECTS: Adult patients (aged ≥18 years) diagnosed with RAM at Bascom Palmer Eye Institute between January 2013 and December 2025. METHODS: Baseline demographics, ocular findings, ancillary optical coherence tomography imaging, treatments, and visual outcomes were recorded. Continuous variables were compared using two-tailed Student t-tests and Wilcoxon signed-rank tests, as appropriate. Categorical variables were compared using chi-square or Fisher exact tests. Statistical significance was defined as P < 0.05. MAIN OUTCOME MEASURES: Resolution of RAM, time to resolution, and changes in best-corrected visual acuity (BCVA) at final follow-up. RESULTS: A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years (range 19-97), and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 110 eyes (68%) were managed with observation, and 51 eyes (32%) were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50, P < 0.0001) and more frequently reported macula-involving hemorrhage (78% vs. 52%; P = 0.0024) at the initial visit. In the observation cohort, 6% of eyes developed symptomatic hemorrhage prompting treatment, which occurred an average of 250 days after the initial diagnosis. In the treatment cohort, 59% of eyes were treated with antivascular endothelial growth factor monotherapy, 22% were treated with focal laser monotherapy, 16% were treated with combination therapy, and 4% were treated with vitrectomy with tissue plasminogen activator. Resolution of RAM, defined as fibrosis of the RAM with resorption of surrounding hemorrhage and/or edema, occurred in 100% of eyes in both cohorts of patients. BCVA at last follow-up was not statistically different between groups (20/50 observation vs. 20/70 treatment, P = 0.0730). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days; P = 0.0170). CONCLUSIONS: This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously; however, selective treatment of eyes with more severe initial presentation may be beneficial. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Histological findings after subretinal implantation of the PRIMA photovoltaic array in patients with geographic atrophy due to AMD.
Herwig-Carl MC, Loeffler KU, Liermann YN … +9 more , Bulirsch LM, Liegl R, Hornig R, Palanker D, Kilani A, Ach T, Sahel JA, Wolf A, Holz FG
Ophthalmol Retina · 2026 Jun · PMID 42250602 · Publisher ↗
OBJECTIVE: To describe the histological findings 7 weeks and 18 months after subretinal implantation of the PRIMA photovoltaic array in eyes with geographic atrophy. DESIGN: Comparative case series SUBJECTS: and controls...
OBJECTIVE: To describe the histological findings 7 weeks and 18 months after subretinal implantation of the PRIMA photovoltaic array in eyes with geographic atrophy. DESIGN: Comparative case series SUBJECTS: and controls: Four globes of two deceased study participants from the prospective PRIMAvera study were analyzed. METHODS: The subretinal implant was removed after horizontal sectioning of the globe. Serial sections were performed and stained with hematoxylin-eosin, Masson trichrome as well as periodic acid Schiff for histopathologic analysis. Selected sections were immunohistochemically stained for CD68, CD163, GFAP, CD31, CK18, ARR3, RPBMS, and TRPM1. Both study and fellow eyes were analyzed. MAIN OUTCOME MEASURES: The histopathological analysis focused on the anatomical implant localization, wound healing processes, potential inflammatory reactions adjacent to the implant and at the retinotomy site, the development of retinal gliosis and retinal atrophy as well as a potential encapsulation. RESULTS: Both implants could be removed in toto without obvious retinal trauma. Histologically, the implants were located at the level of the outer plexiform layer, as intended, close to the inner nuclear layer. A tissue layer was identified beneath the implant, consisting of a basement membrane deposit and cellular components. A small rupture of Bruch's membrane was detected (in the globe with an 18 months follow-up) associated with localized subretinal fibrosis. At the implant-retina interface, there was only a minimal tissue response without pseudocapsule formation. Furthermore, no significant inflammatory response was detected. The retina overlying the implant was comparable to the fellow eyes in most areas, with limited focal atrophy of the inner retina 18 months after PRIMA implantation. At the retinotomy site, a full thickness scar was noted with mild atrophic changes in the implant insertion area. CONCLUSIONS: The wireless subretinal PRIMA implant demonstrated good biocompatibility with no significant encapsulation or surrounding inflammatory response. At seven weeks and eighteen months after implantation, retina overlying the implant was viable and layered as in control areas. Histopathologic analysis following innovative surgical techniques can provide important information in addition to in vivo findings.
Class 2 PRAME-Positive Ciliochoroidal Melanoma Metastasis to Fellow Eye.
Yanagihara RT, Schefler AC
Ophthalmol Retina · 2026 Jun · PMID 42249863 · Publisher ↗
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Novel TEAD1 Gene Mutation in Sveinsson Chorioretinal Atrophy.
Sharma M, Gautam N, Singh SR
Ophthalmol Retina · 2026 Jun · PMID 42249862 · Publisher ↗
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