Age-related macular degeneration (AMD) has considerable global burden, being a major cause of vision loss. Subsequently, genetic predisposition holds a role in this case by contributing to disease susceptibility. Polymorphisms in genes such as Complement Factor H (CFH) and Age-Related Maculopathy Susceptibility 2 (ARMS2) play a key role as risk factors for AMD. This systematic review and meta-analysis synthesizes existing evidence to investigate and quantify the association between these polymorphisms and the actual risk of AMD. Additionally, the paper sets to unravel the prevalence of high- and low-risk genotypes among AMD patients. In accordance with PRISMA guidelines, we conducted a systematic search of PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library databases to identify relevant studies. We included primary studies that involved patients diagnosed with AMD and assessed genetic polymorphisms of CFH (Y402H, rs1061170), ARMS2 (A69S, rs10490924), and we included studies evaluating CFH Y402H and ARMS2 A69S in relation to AMD susceptibility and extracted any available data on anti VEGF treatment response for narrative synthesis. The analytical series considered random effects models to perform the associated meta-analyses. Study heterogeneity was assessed using the I² statistic measure as a standard assessment within the studies. The odds ratio (OR) with 95
INTRODUCTION:Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss in older adults. Intravitreal anti-vascular endothelial growth factor (VEGF) agents-including Aflibercept, Ranibizumab, Bevacizumab, Brolucizumab, and Faricimab-are the mainstay of therapy. However, their comparative efficacy and safety remain uncertain. This study aimed to compare the visual and systemic outcomes of these agents to inform clinical decision-making. METHODS:A systematic search of PubMed, Embase, Scopus, and Web of Science from inception to September 2025 identified randomized controlled trials (RCTs) and observational studies comparing at least two anti-VEGF agents in nAMD. Eligible studies reported outcomes of best-corrected visual acuity (BCVA) change, visual gain ≥ 15 letters, mortality, or arteriothrombotic events. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. A frequentist network meta-analysis estimated mean differences (MD) and odds ratios (OR) with 95 % confidence interval (CI). The protocol was registered in PROSPERO (CRD42025631298). RESULTS:Sixteen studies involving 6758 participants (follow-up 3-24 months) met the inclusion criteria. For BCVA improvement, Aflibercept had the highest surface under the cumulative ranking curve (SUCRA) ranking (0.80), although all agents showed similar mean differences that were not statistically significant: aflibercept (MD 0.80; 95 % CI -1.20-2.80), Ranibizumab (0.64; -1.87-3.15), Bevacizumab (0.60; -2.02-3.22), Faricimab (2.20; -0.69-5.09), and Brolucizumab (4.20; -5.97-14.36). The larger point estimate for Brolucizumab reflects imprecision rather than superior visual efficacy. Mortality was lowest with Aflibercept (risk ratio (RR) 0.76; 95% CI 0.41-1.55). For arteriothrombotic events, no statistically significant differences were observed between anti-VEGF agents. Comparisons between Aflibercept and Bevacizumab (RR 1.11; 95% CI 0.60-2.07), aflibercept and Ranibizumab (RR 0.77; 95% CI 0.49-1.21), and Bevacizumab and Ranibizumab (RR 0.88; 95% CI 0.60-1.30) showed wide confidence intervals, reflecting substantial imprecision. Certainty of evidence (GRADE) ranged from moderate to low. CONCLUSION:All anti-VEGF agents stabilize or improve vision in nAMD. Aflibercept may provide the most favorable efficacy-safety balance, Faricimab offers promising durability, and Brolucizumab demonstrates large visual gains with potential safety concerns. Further head-to-head and long-term real-world studies are needed to optimize individualized treatment strategies.
Glaucoma is a leading cause of irreversible blindness worldwide. Trabeculectomy remains a standard filtration procedure for substantial intraocular pressure (IOP) lowering but is associated with clinically relevant postoperative morbidity. Micro-invasive glaucoma procedures (MIGPs), encompassing minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb-forming glaucoma surgery (MIBS), have been increasingly adopted to potentially improve safety while maintaining acceptable efficacy. To compare the efficacy and safety of trabeculectomy versus MIGPs in glaucoma management. PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science were searched from inception to 14 November 2025. Randomized controlled trials and observational comparative studies evaluating trabeculectomy versus MIGPs were eligible. The primary outcome was IOP reduction. Secondary outcomes included complete and qualified surgical success, postoperative medication burden, and adverse events including conjunctival hemorrhage and best-corrected visual acuity (BCVA) loss. Fixed- or random-effects models were applied according to heterogeneity. Risk of bias was assessed using RoB2 and ROBINS-I. Eighteen studies (2,476 patients/eyes) were included. Compared with MIGPs, trabeculectomy achieved greater IOP reduction (mean difference −2.036 mmHg; p < 0.0001). In contrast, MIGPs were associated with a lower postoperative medication burden (mean difference 0.188, expressed as trabeculectomy minus MIGPs; p < 0.0001), indicating fewer medications postoperatively in the MIGPs group. MIGPs demonstrated higher odds of complete success (odds ratio 1.306, p = 0.016) but lower odds of qualified success (odds ratio 0.734, p = 0.031) relative to trabeculectomy. Safety outcomes favored MIGPs, with lower odds of conjunctival hemorrhage (logOR −0.79; approximately 55
BACKGROUND:Fungal keratitis remains a leading cause of corneal blindness in tropical and subtropical regions. The limited corneal penetration of topical antifungals has prompted investigation into intracameral amphotericin B (ICAMB), which delivers higher intraocular concentrations beyond the corneal epithelium and stroma, although the corneal endothelium remains a pharmacologic barrier. OBJECTIVE:To systematically evaluate the efficacy and safety of ICAMB in fungal keratitis and synthesize current evidence from randomized and observational comparative studies, together with descriptive case-based evidence. METHODS:This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline using PubMed, Scopus, Cochrane Library, and Google Scholar through May 2025. Eligible studies assessed ICAMB, alone or in combination with topical therapy, in confirmed or clinically suspected fungal keratitis. Outcomes included ulcer healing rate, mean healing time, visual acuity, hypopyon resolution, need for keratoplasty, and adverse events. Fixed- or random-effects models were applied according to statistical heterogeneity, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess evidence certainty. RESULTS:Seventeen studies (n = 491 eyes) were included. ICAMB significantly improved ulcer healing rate (odds ratios 1.8, 95% confidence intervals [CI]: 1.6-1.9, P < 0.001), shortened mean healing time by 4.27 days (95% CI: -5.8 to -2.8, P < 0.001), and reduced hypopyon duration by 14.6 days (95% CI: -17.4 to -11.8, P < 0.001). The requirement for therapeutic keratoplasty decreased significantly (logit event rate -0.71, P < 0.001). Improvement in visual acuity was modest but significant (standardized mean difference 0.49, P < 0.001). Heterogeneity across pooled analyses was negligible (I² = 0% in the reported pooled endpoints), and GRADE indicated moderate-to-high certainty for efficacy. Regarding safety, no definite ICAMB-attributable ocular toxicities (e.g., corneal endothelial decompensation, lens toxicity, retinal toxicity, or sustained intraocular pressure elevation temporally and causally linked to ICAMB) or systemic toxicities were reported at commonly used doses (typically ≤10 µg/0.1 mL); however, inflammatory and structural complications of fungal keratitis (e.g., uveitis, hypopyon, progressive thinning, perforation) were variably reported during follow-up and should not be interpreted as drug toxicities without explicit causal attribution. CONCLUSIONS:ICAMB was associated with improved healing and reduced surgical intervention in fungal keratitis without reported definite ICAMB-attributable ocular or systemic toxicity at commonly used doses. Although the evidence is primarily observational, the consistency of effect across cohort and case-series data supports its potential role as an adjunctive therapy in severe or refractory fungal keratitis. Conventional treatment in this context refers to standard topical antifungal therapy (e.g. natamycin, voriconazole). Available data on species-specific amphotericin susceptibility and ocular surface disease parameters in Candida-associated cases were limited, heterogeneous, and not suitable for pooled analysis. Future trials should include standardized outcome definitions and controlled comparisons to validate these findings.
PURPOSE:To evaluate the association between retinal vein occlusion and leukemia. METHODS:A comprehensive literature search was conducted across PubMed, Google Scholar, ScienceDirect, Scopus, and Cochrane Library from inception to October 20, 2025, following PRISMA guidelines and a registered PROSPERO protocol (CRD420251134924). Observational studies reporting ocular findings in leukemia were included. Data extraction and risk of bias assessment were performed independently using the JBI and ROBINS-I tools. Pooled effect sizes were calculated using Comprehensive Meta-Analysis (CMA v4.0), expressed as logit event rates with 95% confidence intervals. Case reports were narratively summarized but excluded from quantitative synthesis. RESULTS:Eight studies encompassing 1,016 participants were included in the meta-analysis. The pooled logit event rate for overall ocular manifestations was -0.3307 (95% CI: -0.456 to -0.206; P < 0.0001), corresponding to a prevalence of 42%. Retinal hemorrhage was the most frequent finding (logit = -1.90; 13%-15%), followed by retinal infiltration (logit = -3.55; 3%) and retinal vein occlusion (logit = -4.41; 1.2%). Heterogeneity was low for infiltration (I 2 = 10.2%) and retinal vein occlusion (I 2 = 0%). CONCLUSION:Ocular involvement occurs in nearly half of patients with leukemia, with retinal hemorrhages and microvascular compromise as dominant manifestations. Although retinal vein occlusion is rare, it signifies advanced hematologic derangement. These findings highlight the importance of routine ophthalmic screening including fundus examination, OCT, and OCTA-as integral components of leukemia management for early detection, systemic correlation, and vision preservation.
