BMC Ophthalmol [JOURNAL]
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200 papers
Longitudinal changes in vessel density and retinal nerve fiber layer thickness after acute primary angle closure.
Hao Q, Qin Y, Yan L … +3 more , Wang Y, Li J, Fan F
BMC Ophthalmol · 2026 Jul · PMID 42401889 · Full text
OBJECTIVE: To evaluate the initial and longitudinal alterations of peripapillary optic disc vessel index in eyes with a history of acute primary angle closure (APAC) and to explore the better predictor of glaucoma progre...
OBJECTIVE: To evaluate the initial and longitudinal alterations of peripapillary optic disc vessel index in eyes with a history of acute primary angle closure (APAC) and to explore the better predictor of glaucoma progression. METHODS: Twenty-one consecutive Chinese patients who were successfully treated for a unilateral episode of APAC were included in the study. The observation group consisted of eyes with the history of acute episode, while the contralateral eyes without an attack served as the control group. All APAC eyes underwent phacoemulsification cataract extraction, intraocular lens implantation and goniosynechialysis one day after the remission of episode. Moreover, the contralateral eyes were performed laser peripheral iridotomy (LPI). Patients were followed-up at 1 day after remission of APAC and 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. All participants underwent ophthalmic examinations after remission of the acute episode but before surgery, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), visual field (VF), and retinal nerve fiber layer (RNFL) thickness and circumpapillary vessel density (cpVD) obtained by swept-source optical coherence tomography(SS-OCT). Correlation analysis was performed to identify the cpVD as a predictor of glaucoma progression. RESULTS: The vascular network was visibly attenuated and focal capillary dropout was evident in APAC eyes. The cpVD 1 day after APAC episode and 1 week postsurgery in APAC eyes was 45.96% (45.96 ± 3.41), and 46.19% (46.19 ± 3.15) which were significantly (P=0.020 and P༝0.035) reduced compared to 48.35% in the unaffected eyes. However, it remained stable during the follow-up in the subsequent year. The retinal nerve fiber layer (RNFL) thickness initially showed thickening at 1 day (P༝0.05), and followed by a progressive thinning from 1 week (P༝0.04) to 6 months (P༝0.02), and eventually reached a stable state. At the last follow-up in APAC eyes, peripapillary retinal VD was positively correlated with RNFL thickness (P༝0.01) and negatively correlated with VF mean deviation (P༝0.04). CONCLUSION: In APAC eyes, the circumpapillary VD decreased significantly 1 day after the APAC episode was fully resolved, and remained stable during the follow-up. However, the RNFL thickness ultimately plateaued at a stable level at 6 months. Thus, cpVD may be the more sensitive predictor than the RNFL thickness for the glaucomatous progression of APAC patients. CLINICAL TRIAL REGISTRATION NUMBER IF REQUIRED: Not applicable.
Dual-decoder multi-task network with graph attention mechanism for OCT retinal layer and fluid segmentation.
Dong X, Okuwobi IP
BMC Ophthalmol · 2026 Jul · PMID 42401859 · Full text
BACKGROUND: Diabetic macular edema (DME) is a leading cause of visual impairment and blindness among the diabetic population, and leads to abnormal retinal morphology, distorted layer boundaries and blurred structures in...
BACKGROUND: Diabetic macular edema (DME) is a leading cause of visual impairment and blindness among the diabetic population, and leads to abnormal retinal morphology, distorted layer boundaries and blurred structures in optical coherence tomography (OCT) images. Accurate segmentation of retinal layers and pathological fluid regions is critical for clinical diagnosis, but remains challenging due to irregular fluid distribution and low boundary contrast. This study aims to develop an effective segmentation method to jointly extract retinal layers and fluid regions for assisting clinical screening. METHODS: A novel dual-decoder multi-task network with graph attention mechanism was proposed for joint segmentation. A primary decoder completed region segmentation, while an auxiliary decoder focused on boundary detection. A cross-decoder spatial attention module was designed for bidirectional feature interaction, and a global reasoning module was embedded to capture long-range anatomical dependencies. Experiments were conducted on the public Duke DME dataset with five-fold subject-independent cross-validation, and paired t-tests were adopted for statistical significance analysis. RESULTS: The proposed method outperformed comparative mainstream segmentation models in overall and category-wise evaluation. It achieved stable accuracy in normal retinal layer segmentation and obtained competitive performance in identifying fluid regions, effectively reducing the interference of pathological changes and improving boundary consistency of segmentation results. CONCLUSIONS: The proposed method enables accurate joint segmentation of retinal layers and fluid regions. It provides a reliable automated analysis tool for diabetic macular edema, and can serve as an effective auxiliary reference for routine clinical screening and quantitative evaluation.
Determinants of axial length growth in infantile persistent fetal vasculature following early lensectomy-vitrectomy: a retrospective cohort.
Deng G, Yuan M, Wang T … +5 more , Ma J, Li L, Liu J, Li S, Lu H
BMC Ophthalmol · 2026 Jul · PMID 42401843 · Full text
PURPOSE: To identify clinical determinants of axial length (AL) before and after early surgery in infantile persistent fetal vasculature (PFV). METHODS: Single-center retrospective cohort of 58 unilateral PFV eyes (2019-...
PURPOSE: To identify clinical determinants of axial length (AL) before and after early surgery in infantile persistent fetal vasculature (PFV). METHODS: Single-center retrospective cohort of 58 unilateral PFV eyes (2019-2022). All infants underwent lensectomy, posterior capsulectomy, vitrectomy, and targeted cauterization under general anesthesia before 12 months. Baseline AL, phenotype, and structural findings (enlarged ciliary processes, retrolental membrane, posterior capsular defect, corneal opacity, posterior synechiae, retinal detachment, Morning Glory disc anomaly) were recorded. Mean follow-up was 21.9 ± 11.4 months (12-48). PRIMARY ENDPOINT: poor growth, defined a priori as an absolute postoperative inter-eye AL difference ≥ 2.0 mm at last visit. SECONDARY OUTCOMES: preoperative inter-eye asymmetry and postoperative AL change (ΔAL). Multivariable models evaluated predictors. RESULTS: All surgeries occurred < 12 months. Preoperatively, anterior PFV, corneal opacity, posterior synechiae, retinal detachment, and Morning Glory anomaly were associated with shorter AL versus the fellow eye (all P < 0.05), whereas posterior capsular defect correlated with longer AL (P < 0.05). Postoperatively, greater ΔAL occurred when enlarged ciliary processes, retrolental membrane, and posterior capsular defect were absent (all P < 0.05). Poor growth occurred in 12.1%; presentation ≤ 6 months independently predicted poor growth (OR 11.62; 95% CI 1.20-112.46; P = 0.034). CONCLUSIONS: In infantile PFV, age at onset, phenotype, and specific structural abnormalities determine AL trajectories. Early standardized surgery may favorably modify growth, whereas complicated cataract in early infancy signals risk for subnormal postoperative elongation and warrants closer surveillance.
A case of severe macular displacement secondary to aggressive proliferative vitreoretinopathy.
Gallo B, Mikhail MA
BMC Ophthalmol · 2026 Jul · PMID 42399857 · Full text
BACKGROUND: We report a case of severe macular displacement occurring after multiple vitrectomy surgeries for recurrent rhegmatogenous retinal detachment (RRD) associated with severe proliferative vitreoretinopathy (PVR)...
BACKGROUND: We report a case of severe macular displacement occurring after multiple vitrectomy surgeries for recurrent rhegmatogenous retinal detachment (RRD) associated with severe proliferative vitreoretinopathy (PVR). CASE PRESENTATION: A 32-year-old African male underwent multiple vitrectomy surgeries for RRD with PVR. Sequential fundus photographs and Optical Coherence Tomography (OCT) documented the significant foveal displacement and macular dragging. After multiple vitrectomies the retina was successfully reattached, but a severe inferior displacement of the macula with foveal ectopia occurred, caused by the development of proliferative membranes along the chorioretinectomy edge. CONCLUSIONS: This report highlights a case of severe macular displacement and foveal ectopia, a rare and devastating complication of PVR that prevents favourable visual outcomes in these complex RRD scenarios. Our case contributes to the limited literature on PVR outcomes in Black Africans, suggesting a potential role of ethnic variations in the fibrotic healing responses that warrants further investigation.
Flanged scleral fixation: thermoplastic properties of suture materials and implications for flange geometry.
Parlak M, Werner JU, Cinar M … +1 more , Wolf A
BMC Ophthalmol · 2026 Jul · PMID 42399825 · Full text
BACKGROUND: Flanged scleral fixation techniques are increasingly used in the management of intraocular lens dislocation and aphakia. However, complications such as conjunctival erosion and scleral migration remain a conc...
BACKGROUND: Flanged scleral fixation techniques are increasingly used in the management of intraocular lens dislocation and aphakia. However, complications such as conjunctival erosion and scleral migration remain a concern. Flange geometry may play a critical role in anchoring stability. This study investigates the thermoplastic properties of various suture materials to identify optimal conditions for flange formation. METHODS: A disposable electrocautery device with a power supply and tip temperature of 392 °C was used for standardised application. Seven suture materials were used: polypropylene (6/0), polyamide 6 (6/0), polyamide 6.6 (6/0), vinylidene fluoride-co-hexafluoropropylene (PVDF) (6/0), polyester (5/0), and polytetrafluoroethylene (PTFE) (5/0 and 6/0). All sutures were heated 0.5, 1, 2, 3, 4, and 5 mm from the distal end and examined in 4 repeat measurements. The prepared flanges were photographed and measured using a digital microscope. The flange dimensions and geometry were assessed. Ratios of flange width to flange length and flange width to suture diameter were calculated. RESULTS: All suture materials except polyamide 6.6 (6/0) and PTFE (5/0) formed a flange shape due to the increase in temperature as demonstrated by repeated measurements with a high degree of reproducibility. While polypropylene and PVDF took on a mushroom/rhomboid shape, the flange shape of polyamide 6 and polyester was spherical. The flange geometry of PTFE was funnel-shaped with sharp edges. With increasing duration of heat exposure, the flange length of polypropylene and PVDF increased more significantly than the flange width. CONCLUSION: Polypropylene and PVDF demonstrate favorable thermoplastic properties for flanged scleral fixation, enabling reproducible flange formation with short heating times. A heating length of approximately 1 mm appears optimal for controlled flange geometry. Further biomechanical and in vivo studies are required to validate clinical performance.
Construction of a prediction model for the early efficacy of 577-nm-SML in treating CSC based on Bayesian network.
Fang L, Zuo H, Huang M
BMC Ophthalmol · 2026 Jul · PMID 42399812 · Full text
BACKGROUND: Central Serous Chorioretinopathy(CSC) is a chorioretinal disorder, predominantly affects young to middle-aged adults, resulting serious vision disorder. This study aimed to develop a Bayesian network model to...
BACKGROUND: Central Serous Chorioretinopathy(CSC) is a chorioretinal disorder, predominantly affects young to middle-aged adults, resulting serious vision disorder. This study aimed to develop a Bayesian network model to predict the key factors influencing the early therapeutic efficacy of 577 nm-SML in patients with CSC. METHODS: A total of 159 patients (159 eyes) diagnosed with CSC and treated with 577 nm-SML at the First Affiliated Hospital of Guangxi Medical University from January 2019 to November 2023 were retrospectively analyzed. Baseline data including age, sex, eye side, disease course, and past medical history were collected. Ophthalmic imaging detects central macular thickness (CMT), macular foveal volume (MFV within 1mm, 3mm, 6mm diameter), height and area of subretinal fluid (SRF), structural changes in the outer retinal layers (ORL), type and area of leakage lesions, etc. Influential variables significantly associated with 577nm-SML efficacy were screened using LASSO regression, then construct a Bayesian network model to predict factors that significantly affect the therapeutic effect. RESULTS: LASSO regression identified 19 significant variables related to treatment outcomes from the 40 possible risk factors included, including disease duration, sex, eye Side, smoking, hormone, macular foveal volumes (3 mm and 6 mm diameters), and the height and area of SRF, ORL integrity, typical PED, location of PED, location of RPE bulging, heterogeneity of NPL, HF of ORL, HF of choroid, leakage type, leakage location, leakage correlate with OCT. The Bayesian network presents complex interactions among these factors, shows that patients with smaller macular foveal volumes (within 3 mm diameter), shorter disease duration, and focal leakage exhibited superior responses to 577nm-SML treatment. CONCLUSION: The therapeutic response to 577nm-SML in CSC is influenced by multifactorial dynamics. Bayesian network can well present the complex network relationship between the therapeutic effect of 577nm-SML and related influencing factors, and identify potential risk factors that affect early efficacy.
Clinical risk factors for recurrence in adult-onset myelin oligodendrocyte glycoprotein antibody-associated optic neuritis.
Cao S, Wu T, Pan C … +3 more , Wei S, Zhou H, Liu Y
BMC Ophthalmol · 2026 Jul · PMID 42399801 · Full text
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) is a subtype of demyelinating optic neuritis (ON) characterized by a considerable risk of relapse; however, the demographic and...
BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) is a subtype of demyelinating optic neuritis (ON) characterized by a considerable risk of relapse; however, the demographic and clinical factors associated with recurrence remain poorly defined, posing ongoing challenges for patient management. METHODS: A retrospective analysis was conducted on adult-onset MOG-ON patients diagnosed in the Ophthalmology Department of the Chinese People's Liberation Army General Hospital (PLAGH) from January 2019 to January 2024. Patients were divided into two groups based on their experience of a relapse course: the relapsing group and the monophasic group. Multivariate analysis was performed to examine the effects of various clinical factors on the risk of recurrence. RESULTS: Among 126 screened participants, 56 were excluded. A total of 70 patients (median [IQR] age at onset, 35.50 [30.00, 48.75] years; 46 females [65.71%]) were included. During a median follow-up of 31.50 (IQR 21.25-52.75) months, disease relapse occurred in 54.29% (38/70) of patients. Multivariate analysis revealed that being female significantly elevated recurrence risk (hazard ratio [HR] 3.92, 95% CI 1.63-9.42, p = 0.002), while administration of immunosuppressive maintenance therapy after the first episode was associated with a lower likelihood of recurrence (HR 0.30, 95% CI 0.10-0.87, p = 0.026). At the final follow-up, the relapsing group had significantly worse visual outcomes compared with the monophasic group (median [IQR] VA, 0.40 [0.16-0.82] logMAR vs. 0.22 [0.10-0.40] logMAR; p = 0.012). CONCLUSION: In adult-onset MOG-ON, female sex is associated with an increased risk of recurrence, whereas early maintenance immunosuppressive therapy is associated with a lower recurrence risk. Furthermore, patients with a relapsing disease course exhibit poorer visual outcomes at follow-up compared with those with a monophasic course.
Quadrant-specific assessment of anterior chamber angles in primary angle-closure suspects using anterior segment-OCT: a cross-sectional observational study.
Pan X, Zhang Y, Zhang Q … +14 more , Feng H, Xiang F, Li C, Zhang M, Ji Q, Li Z, Jiang N, Yang Y, Hu Z, Cao K, Ruan MZC, Fan N, Han Y, Li S
BMC Ophthalmol · 2026 Jul · PMID 42399728 · Full text
BACKGROUND: Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness in Asian populations. However, the topographic distribution of angle narrowing across different quadrants remains incompletel...
BACKGROUND: Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness in Asian populations. However, the topographic distribution of angle narrowing across different quadrants remains incompletely characterized in primary angle-closure suspects (PACS), and routine clinical assessments often rely solely on horizontal scans. The study aims to identify the narrowest anterior chamber angle quadrant in PACS using Anterior Segment Optical Coherence Tomography (AS-OCT). METHODS: In this community-based cross-sectional study, 218 right eyes of 218 PACS subjects were recruited. All participants underwent standardized questionnaire surveys and ophthalmic examinations. AS-OCT parameters including angle opening distance (AOD), trabecular iris space area (TISA) and trabecular iris angle (TIA) were measured at 500 μm from the sclera spur (SS) in the superior, inferior, nasal and temporal quadrants. As iridotrabecular contact (ITC) in more than one quadrant precluded identification of the narrowest quadrant, only narrow-angle eyes (ITC in < 2 quadrants) were included in the analysis. Quadrant-wise comparisons and multivariate linear regression analyses were performed. RESULTS: Significant differences in angle width were observed across all four quadrants (P<0.001 for AOD500, TISA500, and TIA500). The superior quadrant exhibited the narrowest angle, followed by the inferior, nasal, and temporal quadrants in narrow-angle eyes. Multivariate linear regression analysis revealed that superior anterior chamber volume (ACV- superior)was positively associated (P<0.001), while superior iris thickness at 750 μm (IT750-superior) was negatively associated (P = 0.049) to superior AOD500. CONCLUSION: The superior quadrant is consistently the narrowest in PACS eyes, highlighting the necessity of including vertical cross-sectional scans in routine AS-OCT examination protocols for this population. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry on September 4th, 2020 (Registration Number: ChiCTR2000037944).
Retinal changes and treatment in ocular alkali burn: a systematic review of animal models and case reports summary.
Pothikamjorn TL, Jitworawisut A, Meevassana J
BMC Ophthalmol · 2026 Jul · PMID 42387427 · Full text
PURPOSE: This systematic review aimed to characterize pathological retinal changes following ocular alkali burns (OAB), evaluate potential therapeutic interventions to preserve retinal structure and function, and summari...
PURPOSE: This systematic review aimed to characterize pathological retinal changes following ocular alkali burns (OAB), evaluate potential therapeutic interventions to preserve retinal structure and function, and summarize reported human cases with retinal involvement. METHODS: A systematic search of PubMed, Embase, SCOPUS, and Web of Science, supplemented by manual reference screening, was independently performed by two reviewers in accordance with PRISMA 2020. Eligible studies, human or animal, investigated retinal damage directly attributable to OAB and/or interventions targeting retinal pathology. Screening and selection were performed, with disagreements resolved by consensus. Quality assessment used SYRCLE's Risk of Bias tool for animal studies and a modified NHLBI tool for case reports. The protocol was registered with PROSPERO (CRD42024598186). RESULTS: A total of 14 studies were included: 12 animal studies and 2 human case reports. Across animal models, seven therapeutic interventions were studied: anti-TNFα, mesenchymal stem cells (MSCs), N-acetylcysteine, tamoxifen, endoplasmic reticulum (ER) stress inhibitors, Solcoseryl gel, and anti-VEGF agents. Infliximab consistently improved retinal ganglion cell (RGC) survival and reduced apoptosis. MSCs, NAC, and TUDCA demonstrated strong anti-inflammatory effects, suppressing cellular infiltration and cytokine expression. ER stress inhibitors and tamoxifen preserved retinal architecture, while Solcoseryl gel offered structural protection but limited anti-inflammatory benefit. Anti-TNFα and anti-VEGF, either alone or in combination, reduced retinal inflammation and RGC loss, whereas anti-VEGF alone showed limited evidence. Among three human case reports, no posterior segment-directed therapies were administered, and visual outcomes ranged from full recovery to persistent vision loss. CONCLUSIONS: Retinal injury is a significant but under-recognized consequence of severe OAB. Preclinical studies demonstrate that treatments which offer neuroprotective and anti-inflammatory properties mitigate retinal damage in OAB models. However, clinical evidence remains limited. These findings underscore the importance of early retinal evaluation in OAB and highlight the need for future clinical studies to validate and implement effective treatment strategies.
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.
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.
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.
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