Background/aims Standardised treatment guidelines for endogenous fungal endophthalmitis (EFE) are lacking. The purpose of this study is to describe treatment strategies and clinical outcomes of eyes with EFE. Methods Retrospective cohort study performed at eight academic institutions across the USA. Demographic, clinical and treatment data for patients with clinically or culture-proven EFE between 2010 and 2025 were included. Patients were stratified by route of systemic therapy for analysis. Results A total of 118 eyes of 87 patients were included. Most patients were treated initially with intravenous systemic antifungal therapy (64%). Patients with systemic symptoms and systemic culture positivity and eyes with negative intraocular fluid cultures were more likely to be treated initially with intravenous systemic therapy. Voriconazole (34%) and fluconazole (30%) were the most used initial systemic agents. Eyes treated with intravenous antifungals were less likely to undergo surgery (intravenous 21% vs oral 50%, p=0.001), but this trend did not maintain statistical significance when controlling for confounders (OR 0.33 (95% CI 0.1 to 1.06), p=0.067). Worse presenting vision (OR 1.78, p<0.001) and infection with mould (OR 4.26, p<0.001) were associated with worse final vision. Ocular examination findings did not significantly affect the initial treatment route, the requirement for surgery or final vision. Conclusions Patients with systemic disease were more likely to be treated initially with intravenous therapy, whereas ocular findings did not significantly influence initial systemic treatment strategy. Initial treatment with intravenous therapy may decrease the odds of requiring surgical intervention.
BACKGROUND/AIMS:This study aimed to evaluate how axial length influences false-positive rates in ganglion cell analysis (GCA) and retinal nerve fibre layer (RNFL) maps and to identify distinct false-positive patterns on optical coherence tomography (OCT) deviation maps across axial length subgroups. METHODS:A retrospective cross-sectional study of 194 healthy eyes included spectral-domain OCT imaging. False positives were defined as colour-coded areas on GCA/RNFL maps. Eyes were stratified into three axial length groups: group A (<23 mm), group B (23 mm≤axial length<25 mm) and group C (≥25 mm). Abnormal OCT deviation map patterns were analysed and compared across axial length groups. RESULTS:False-positive results were observed in 76.1% of cases for GCA and 62.2% for RNFL maps. Rates increased significantly with axial length: for GCA deviation maps, the rates were 45.2% in group A, 51.2% in group B and 87.5% in group C (p<0.001). The most frequent false-positive pattern in hyperopic eyes was the small doughnut type (67.9%), while diffuse thinning and inferior crescent patterns predominated in highly myopic eyes (both 38.1%). In logistic regression analysis, axial length was an independent predictor of false positives in all maps (OR 1.09-2.64, p<0.05). Older age also correlated with false positives (OR 1.04-1.06, p<0.05), except for minimum ganglion cell-inner plexiform layer thickness. CONCLUSION:Abnormal OCT diagnostic classification should be interpreted with caution, particularly in eyes with long axial length and in older patients. Distinctive patterns in the GCA deviation map are observable in patients with markedly short or long axial lengths, and recognising these false-positive patterns may prompt more cautious interpretation.
AIMS:To evaluate long-term corneal endothelial changes in children following ocular trauma and the influence of trauma type and surgical history. METHODS:Prospective study that evaluated corneal endothelial parameters in a retrospectively identified cohort of 59 paediatric patients with unilateral trauma and bilateral specular microscopy ≥6 months after injury. Endothelial cell density (ECD), coefficient of variation (CV) and percentage of hexagonal cells (HEX) were compared between traumatised and fellow eyes. Subgroup analyses were performed according to trauma type (open vs closed globe) and surgical history. RESULTS:59 children (mean age 7.3±3.6 years) were included, comprising 37 open-globe (OGI) and 22 closed-globe injuries (CGI). At a mean follow-up of 48.6±31.8 months, traumatised eyes exhibited significantly lower ECD (2528±633 vs. 3202±356 cells/mm²; p<0.01), higher CV (p<0.01) and lower HEX (p<0.01). Both OGI and CGI demonstrated significant endothelial loss relative to controls. Eyes that underwent additional intraocular surgery exhibited a 33.3% reduction in ECD compared with fellow eyes in OGI (p<0.01) and a 15.7% reduction in CGI (p=0.043). Even without additional intraocular surgery, ECD loss persisted in both OGI (15.7%; p<0.01) and CGI (7.6%; p=0.015). CONCLUSIONS:Paediatric ocular trauma was associated with lower endothelial cell density and morphologic alterations. Although endothelial compromise was observed across both OGI and CGI, the magnitude of loss was greater in OGI and in eyes requiring additional intraocular surgery. These findings highlight the importance of careful surgical planning to help preserve endothelial reserve in eyes with prior trauma.
PURPOSE:To assess the role of education on myopia prevalence and refractive status in children enrolled in kindergarten and the early grades of primary school. METHODS:In this population-based, cross-sectional study, children from primary schools and kindergartens were recruited prior to the onset of the COVID-19 pandemic in January 2020. Cycloplegic autorefraction and axial length (AL) were measured in all children. Data on parental myopia, family income and children's lifestyle factors were collected via a standard questionnaire. Mediation analyses were used to explore the influence of education on myopia prevalence, spherical equivalent (SE) and AL. RESULTS:In 2525 kindergarten children (413 in grade 2 /(K2) and 2112 in grade 3 (K3)) and 9018 primary school children (4250 in grade 1 (P1) and 4768 in grade 2 (P2)), myopia prevalence increased with academic grade: 7.6% of K2, 8.7% K3, 17.3% P1 and 29.1% P2. AL was longer in K3 than in K2 children (p<0.001) although SE did not differ (p=0.18). Exploratory analyses suggested statistical mediation by education duration in the association between age and myopia-related outcomes. Among kindergarten children, parental myopia was the sole factor associated with myopia prevalence, SE and AL. For primary school children, schooling duration in P1, age, sex, family income and parental myopia were associated with myopia prevalence, SE and AL. CONCLUSION:The prevalence of myopia significantly increased from kindergarten to primary school with education duration being a possible mediator from primary school onward. Notably, significant changes in AL were observed among kindergarten children.
BACKGROUND/AIMS:Retinopathy of prematurity (ROP) zone classification guides disease severity assessment and Early Treatment for Retinopathy of Prematurity (ETROP)-based treatment decisions but remains subjective, particularly in the peripheral retina. We developed and validated an anatomically derived quantitative ROP zone reference map to standardise zone assessment in wide-field paediatric retinal images. METHODS:A reference map was constructed using optic disc-fovea distance and multimodal anatomical data, then applied to RetCam panoramic images generated with a robust deep learning registration pipeline. Four ophthalmologists evaluated 85 ROP examinations with and without the reference map in a crossover reader study. Reader-reference and interobserver agreement for zone classification and zone-dependent ETROP decisions were assessed using kappa statistics. RESULTS:The reference map improved reader-reference agreement for zone classification from 0.58 to 0.92 and interobserver agreement from 0.47 to 0.86. In a Zone III versus non-Zone III analysis, reader-reference agreement improved from 0.40 to 0.88. In 20 zone-dependent ETROP observations, agreement improved from 0.85 to complete concordance within this subset. CONCLUSION:The quantitative ROP zone reference map improved reliability of zone classification and supported more consistent ETROP guideline application in this retrospective reader study.
PURPOSE:The purpose of this study is to develop a fully automated system for determining the optimal time to begin anti-vascular endothelial growth factor (anti-VEGF) treatment, based on retinal changes observed in optical coherence tomography (OCT) images and visual acuity (VA) scores. METHODS:This retrospective study included two cohorts: patients with intermediate dry age-related macular degeneration (AMD) who did not progress to neovascular AMD (NVAMD) and those who progressed and received anti-VEGF treatment. Subjects had ≥3 consecutive visits. Two tasks were defined: (1) develop a deep learning (DL) model to identify the need for anti-VEGF treatment and (2) estimate outer retina thickness (ORT) from Bruch's membrane to the outer plexiform layer as an imaging biomarker. A convolutional neural network extracted OCT features related to ORT, and two long short-term memory models were trained on separate datasets to address Task I and II treatments. RESULTS:A total of 122 patients (207 eyes) were included: 49 in dataset 1 (69 eyes; mean (SD) age 84 (8); 25 (51%) female) and 100 in dataset 2 (138 eyes; 82 (7); 54 (54%) female). Task I performance was evaluated by the model's alignment with clinical decisions on anti-VEGF initiation, and demonstrated area under the receiver operating curve of 0.73 (95% CI 0.59 to 0.87), area under the precision-recall curve of 0.51 (95% CI 0.35 to 0.66), an accuracy of 0.87 (95% CI 0.76 to 0.97), a precision of 0.73 (95% CI 0.59 to 0.87), a sensitivity of 0.69 (95% CI 0.54 to 0.83) and a specificity of 0.92 (95% CI 0.84 to 1.00). Task II achieved NMAE 0.12 (95% CI 0.04 to 0.20). CONCLUSIONS:This DL framework provides a fully automated approach for determining optimal treatment timing, supporting earlier intervention to preserve VA in NVAMD patients. TRANSITIONAL RELEVANCE:An accurate DL framework that can help with identifying the best time to initiate therapy for NVAMD.
AIMS:To evaluate survival, globe salvage and visual outcomes of globe-preserving treatment approaches in unilateral cT2 and cT3 retinoblastoma, with a focus on cT3 disease. METHODS:This multicentre, retrospective cohort study enrolled 1566 treatment-naïve unilateral retinoblastoma eyes (870 clinical (c)T2, 696 cT3 by eighth American Joint Committee on Cancer clinical tumour, node, metastases staging) from 11 Chinese tertiary centres. Patients underwent intra-arterial chemotherapy, intravenous chemotherapy or primary enucleation. Outcomes were globe salvage, overall survival, metastasis-free survival, high-risk histopathological feature prevalence and vision-preserving rate (≥light perception (LP)). RESULTS:In this multicentre cohort of 1566 eyes, the globe-salvage rate across cT2 and cT3 retinoblastoma was higher with intra-arterial chemotherapy than with intravenous chemotherapy. When stratified by cT3 subcategories, intra-arterial chemotherapy achieved significantly higher globe-salvage rates than intravenous chemotherapy in cT3b eyes (HR 3.65; 95% CI 1.91 to 6.98) and cT3c eyes (HR 4.02; 95% CI 2.79 to 5.80). In contrast, globe salvage did not differ between intra-arterial chemotherapy and intravenous chemotherapy in cT3d eyes. Overall survival and metastasis-free survival did not differ between intra-arterial chemotherapy and primary enucleation. Among eyes with cT3b or cT3c disease, 79.4% of eyes salvaged with intra-arterial chemotherapy and 65.0% of eyes salvaged with intravenous chemotherapy retained at least LP. Detected high-risk pathological features were not significantly different between eyes treated with intra-arterial chemotherapy and those undergoing primary enucleation in cT3b or cT3c disease. Among secondary enucleated eyes with cT3d disease, intra-arterial chemotherapy was associated with lower rates of choroidal invasion. CONCLUSION:Intra-arterial chemotherapy may enable globe salvage in cT3b/c retinoblastoma, whereas cT3d eyes continue to warrant prompt enucleation.
PURPOSE:To investigate how corneal radius (CR) affects the optimal axial length-to-corneal radius (AL/CR) ratio cut-off for myopia detection and to construct a multivariable model for estimating myopia probability in children and adolescents. METHODS:A total of 6782 children and adolescents aged 3-18 years from Shanghai, China, were included. Myopia was defined as a cycloplegic spherical equivalent (SE) less than or equal to -0.50 dioptres. Participants were stratified into six CR groups (0.25 mm intervals). Receiver operating characteristic curve analysis was used to determine optimal AL/CR cut-off values for each CR group. Linear regression was performed to model the relationship between CR and optimal cut-offs. A multivariable logistic regression model incorporating CR, AL/CR ratio, age and sex was fitted, and model-based estimates were summarised using contour plots and lookup tables. RESULTS:Mean age was 9.36±3.59 years, and myopia prevalence was 33.8%. Optimal AL/CR cut-offs decreased with increasing CR, from 3.10 (7.08≤CR≤7.33 mm) to 2.93 (8.33<CR≤8.60 mm), with areas under the curve (AUCs) of 0.94-0.97 across groups. The optimal AL/CR cut-off was linearly associated with CR (optimal cut-off=4.073-0.135×CR; R2=0.948; p=0.001). The multivariable model showed high discrimination (AUC=0.97) in this dataset. Age- and sex-specific lookup tables and probability contour plots were generated to summarise model-based estimates. CONCLUSIONS:The optimal AL/CR ratio cut-off for myopia detection varies systematically with CR. These findings indicate that CR contributes to variation in AL/CR-based myopia classification. The fitted equation, probability contour plots and lookup tables provide CR-informed reference estimates for interpreting AL/CR in children and adolescents.
BACKGROUND/AIMS:To investigate temporal trends in refractive and corneal astigmatism (CA) in adults and examine their association with the COVID-19 pandemic. METHODS:This population-based cross-sectional study included adults (≥18 years) recruited from parents participating in the Hong Kong Children's Eye Study who underwent comprehensive ocular examinations at two academic centres (2015-2024). Refractive error of the worse eye and corresponding CA were measured using an autorefractor and optical biometry without cycloplegia. Age-standardised prevalence was calculated annually. Logistic regression assessed associations between the pandemic period and astigmatism, adjusting for age, sex, axial length and spherical equivalent. RESULTS:A total of 29 583 adults (mean age 40.6±5.6 years; 35.3% men) were included. Age-standardised prevalence of refractive astigmatism (RA) increased from 41.7% in 2015 to 46.2% in 2024 (p=0.002) and CA from 45.0% to 52.9% (p=0.002). Compared with 2015, the adjusted odds of RA in 2024 increased by 52% (OR 1.52, 95% CI 1.30 to 1.76; p=9.34×10-8), and CA by 47% (OR 1.47, 95% CI 1.27 to 1.71; p=2.38×10-7). Mean refractive and CA increased by 0.11 D and 0.14 D, respectively. A shift towards moderate and severe astigmatism was observed. CA correlated strongly with K2 (β=0.891, p<0.001). CONCLUSIONS:The prevalence and severity of astigmatism in adults increased following the COVID-19 pandemic, independent of axial length and spherical equivalent. Findings suggest corneal changes, especially along the steep meridian, may underlie this trend and warrant further investigation into environmental and lifestyle factors.
BACKGROUND/AIMS:Retinitis pigmentosa (RP) is characterised by progressive photoreceptor degeneration accompanied by vascular abnormalities. We have previously demonstrated that minocycline exhibits therapeutic potential in RP. This trial aimed to evaluate its neurovascular protective effects. METHODS:Patients with RP were enrolled and administered 100 mg of minocycline once daily for 12 months. A total of 32 eyes from 16 participants were included. The primary outcomes were changes in retinal and choroidal vasculature, including vessel density, lacunarity, foveal avascular zone (FAZ) area, fluorescein angiography (FA) score and subfoveal choroidal thickness (SFCT). The secondary outcomes included changes in photoreceptor structure and function, including ellipsoid zone width, best-corrected visual acuity (BCVA), mean macular sensitivity, mean deviation (MD) and error score. Adverse events were recorded. Additionally, Rd1 mice were used to further investigate the vascular effects of minocycline. RESULTS:After 12-month minocycline treatment, RP patients exhibited increased vessel density in both the retinal superficial capillary plexus (SCP) and retinal deep capillary plexus (DCP), accompanied by reduced FAZ area and decreased lacunarity in the SCP and DCP. FA score and SFCT remained stable, as did all secondary outcomes. A total of 24 adverse events were reported in 8 patients, and all resolved spontaneously without additional intervention. Additional experiments in Rd1 mice demonstrated improved retinal vascular abnormalities and preserved blood-retinal barrier integrity, accompanied by upregulated expression of tight junction proteins. CONCLUSIONS:Oral 100 mg minocycline once daily for 12 months was beneficial to protect vascular integrity and stabilise photoreceptor structure and function with good tolerability.
BACKGROUND/AIMS:Aggressive retinopathy of prematurity (A-ROP) is a severe subtype of ROP that can require repeated treatment yet risk factors for retreatment remain incompletely defined. This study aims to identify risk factors for anti-vascular endothelial growth factor (VEGF) re-injection in A-ROP across US-born and non-US-born infants. METHODS:Data from premature infants with ROP were collected across 23 sites (16 USA, 7 non-USA) from 2007 to 2021. A-ROP re-injection risk was evaluated using generalised estimating equations, adjusted for birth weight (BW), gestational age (GA) at birth, ROP zone at injection, hospital site and initial anti-VEGF agent. RESULTS:Of 1677 examined eyes, 1600 had ROP; 283 had A-ROP (mean BW 712 g, mean GA 24.8 weeks) and 1317 had non-A-ROP (mean BW 812 g, mean GA 25.9 weeks). Infants with A-ROP had lower mean BW and GA (p<0.001). Across A-ROP cases, each 100 g increase in BW decreased re-injection risk by 26% (p=0.041). Compared with bevacizumab, ranibizumab was associated with a higher risk of re-injection in A-ROP eyes (risk ratio=4.82, p=0.009). ROP zone II was associated with a 2.48-fold higher risk of re-injection than zone I (p=0.014), which was attenuated after correction for bilaterality. CONCLUSIONS AND RELEVANCE:A-ROP is associated with lower BW, lower GA at birth and more posterior ROP zone than non-A-ROP. Lower BW and initial ranibizumab treatment are related to greater risk of repeat anti-VEGF injection. There was more retreatment in zone II A-ROP eyes compared with those in zone I, which did not persist after correction for bilaterality.
BACKGROUND:Glaucoma and cataract are among the leading causes of visual impairment worldwide. Both are prevalent in older adults, but it remains unclear whether their association is independent of age and shared risk factors. AIM:To assess whether glaucoma and its treatments are independently associated with cataract odds using a population-based sample. METHODS:Cross-sectional analysis of UK Biobank participants recruited between 2006 and 2010. (Analysis completed in April 2026). Glaucoma and cataract were defined using self-report and International Classification of Diseases-codes from hospital and primary care records. Participants were grouped as no glaucoma, glaucoma with no recorded treatment, topical medications, laser procedures or glaucoma surgery. Multivariable logistic regression estimated cataract odds ratios (OR, 95% CI). Models adjusted for demographic variables, clinical comorbidities and ocular parameters. RESULTS:Among 497 109 adults, glaucoma was associated with higher odds of cataract (OR 3.09, 95% CI 2.73 to 3.49, p<0.01) in fully adjusted models. Odds were higher among those using topical glaucoma treatments (OR 3.14, 95% CI 2.54 to 3.89, p<0.01). Participants who had undergone glaucoma surgery had the highest odds of cataract (OR 12, 95% CI 8.99 to 16.2, p<0.01). Findings were consistent in sensitivity analyses using alternative case definitions. CONCLUSION:Glaucoma and its management were associated with increased odds of cataract, although the adjusted analysis for the first-line laser subgroup was limited by sample size and cannot be reliably estimated. Longitudinal studies are needed; if confirmed, the results may inform cataract surveillance and timing of operation, relevant in ageing populations.
Purpose To characterise regional and topographic choroidal thickness (CT) profiles using ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) and to compare topographic CT between normal eyes and eyes with pachychoroid disease. Methods All participants underwent UWF SS-OCT using an approximately 26 mm × 21 mm field of view with fixation centred on the fovea. CT was quantified within concentric rings centred on the optic nerve head and stratified by sector. Linear mixed-effects models were performed separately for each sector, adjusting for age, sex and spherical equivalent (SE). Main outcome measures were regional CT differences between normal and pachychoroid eyes. Results 60 subjects were included in the study. 37 participants (61.7%) were males and 23 (38.3%) were females. 24 participants (40%) were classified as pachychoroid and 36 (60.0%) as normal. Across all sectors and eccentricities, pachychoroid eyes demonstrated significantly greater CT compared with normal eyes (p<0.001). The largest differences were observed in the temporal sector. In mixed-effects models, pachychoroid status remained a significant independent predictor of increased CT in all sectors (p<0.05) after adjusting for age, SE and sex. SE was independently associated with CT in the inferior, superior and temporal sectors, whereas age and sex were not consistently associated. Conclusions UWF SS-OCT shows that pachychoroid disease is associated with diffuse, sectorally heterogeneous choroidal thickening extending beyond the fovea. These findings support the concept of pachychoroid disorders as conditions of global choroidal remodelling and highlight the value of regional, distance-based choroidal assessment as a potential imaging biomarker.
This report presents the clinical, electrophysiological and multimodal imaging findings of an individual with bilateral vitelliform maculopathy. Adaptive optics imaging enables in vivo visualisation of retinal microstructure at cellular resolution, providing a detailed baseline for longitudinal assessment and a potential outcome measure for future cellular-targeted therapies.
PURPOSE:To assess the cut-off value for an axial length-related increase in the prevalence of glaucomatous/glaucoma-like (GON/GLON) and non-glaucomatous (NGON) optic neuropathy. METHODS:The project included the population-based Beijing Eye Study (n=3088; age: 40+ years), Ural Eye and Medical Study (n=5199 participants; age: 40+ years), Ural Very Old Study (n=428; age: 85+ years), Ural Children Eye Study (n=4185; school grade: 1+) and Central India Eye and Medical Study (CIEMS; n=4199; age: 30+ years). Using fundus photographs (all studies) and optical coherent tomographic images (all studies except for CIEMS), we assessed the prevalence of GON/GLON and NGON, defined by optic nerve head appearance and absence of neurological perimetric defects. RESULTS:The total study population included 34 864 eyes (17 099 individuals; age: 46.1±23.0 years; range: 6 to 100 years) (axial length: 23.19±1.05 mm; range: 18.22-34.20 mm). Prevalence of GON/GLON and NGON were 438/17 099 (2.6%; 95% CI 2.0 to 3.0) and NGON 57/17 099 (0.3%; 95% CI 0.0 to 0.4) respectively. Higher GON/GLON prevalence was correlated with longer axial length (OR: 1.45; 95% CI 1.35 to 1.56; p<0.001) after adjusting for age and intraocular pressure. The increase in GON/GLON prevalence started at an axial length of 27.0 mm and 26.5 mm for a younger subgroup aged ≤52 years and an older subgroup aged >52 years respectively. Higher NGON prevalence was associated with longer axial length (OR: 4.35; 95% CI 3.58 to 5.29; p<0.001) after adjusting for age. The increase in NGON prevalence started to rise at an axial length of 27.0 mm and 26.5 mm for the younger subgroup and older subgroup, respectively. CONCLUSIONS:Prevalence of GON/GLON and NGON started to increase at an axial length of 27.0 mm and 26.5 mm for individuals aged ≤52 years or >52 years, respectively. These cut-off values may be helpful for the differentiation of moderate myopia versus high myopia.
BACKGROUND/AIMS:To investigate glaucoma prevalence and diagnostic discrepancies-undiagnosed glaucoma, missed diagnostic opportunities and false-positive diagnoses-in South Korea and to identify factors contributing to these errors. METHODS:This nationwide cross-sectional study used data from the Korea National Health and Nutrition Examination Survey 2019-2021. Participants aged ≥20 years who had gradable ophthalmic examinations were included. Glaucoma was adjudicated by specialists using International Society of Geographical and Epidemiological Ophthalmology criteria. Survey-weighted logistic regression analyses were performed to identify factors associated with undiagnosed glaucoma and missed diagnostic opportunities. RESULTS:The final analytical cohort comprised 18 710 participants. The weighted prevalence of glaucoma was 3.9% (95% CI 3.6% to 4.2%). The awareness rate was only 17.1%, leaving 82.9% (95% CI 80.4% to 85.4%) of cases undiagnosed. Notably, 44.7% (95% CI 41.0% to 48.3%) of undiagnosed cases represented a missed diagnostic opportunity. Multivariable analysis identified high myopia as the strongest predictor of a missed diagnostic opportunity (OR 23.53, 95% CI 5.65 to 98.09, p<0.001), alongside younger age (OR 0.98, p=0.039), rural residence (OR 1.97, p=0.047) and thicker retinal nerve fibre layer (OR 1.09, p<0.001). The lowest household income quartile was associated with undiagnosed glaucoma (OR 1.87, p=0.019). CONCLUSION:Diagnostic discrepancies present a dual burden: profound underdiagnosis coexists with frequent false-positive diagnosis. High myopia, milder disease phenotype and rural residence are central drivers of missed diagnostic opportunities. Reducing discrepancies will therefore require efforts at both the clinical-professional and health system levels.
PURPOSE:Cataract surgery in patients with chronic anterior uveitis may be associated with increased risk for complications and poor outcomes. This study analyses visual outcome, uveitis course and complications after cataract surgery with intraocular lens (IOL) implantation in adolescents and adults with juvenile idiopathic arthritis (JIA)-associated or antinuclear antibodies (ANA)-positive uveitis. METHODS:Data before and at 6 weeks, 1 and 2 years after surgery were retrospectively analysed according to Standardization of Uveitis Nomenclature (SUN) standards. Surgery was performed with small incisions, phacoemulsification and IOL implantation. Surgical technique was adapted to pre-existing uveitis-related morphological abnormalities. Predictors of visual outcome and vision-threatening complications at 2-year follow-up (FU) were analysed. RESULTS:93 surgeries of 83 patients (84% female; mean age 24.8±16.2 years) with JIA-associated (84%) or ANA-positive (16%) anterior uveitis were analysed. Preoperative treatment included topical steroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs; 72.0%) or biological (b) DMARDs (65.6%). Besides cataract, uveitis-related complications (eg, fibrotic lens membrane, posterior synechiae and pupil contraction) were present in 95.7% before surgery. Best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) improved from 1.57±1.32 preoperatively to 0.42±0.83 at 2 years (p<0.001). Postoperative complications included posterior synechiae formation (30%), giant-cell deposits (35.7%), posterior capsule opacification (51.9%) and macular oedema (12.7%). Significant preoperative predictors of poor visual outcome included poor BCVA and high laser flare (LF) values, and those of postoperative ocular complications also included poor BCVA and a lack of systemic anti-inflammatory drug use (each, p<0.05). CONCLUSIONS:Beneficial outcomes can be achieved following cataract surgery with IOL implantation in adolescents and adults with JIA-associated or ANA-positive anterior uveitis. Important prerequisites include preoperative inactivity, appropriate surgical technique and sustained long-term uveitis inactivity with the use of DMARDs.
The historical evolution of globe-preserving management provides important context for interpreting contemporary outcomes in lacrimal gland carcinoma. Since the early 1990s, evidence has challenged the assumption that orbit-sacrificing surgery, including cranio-orbital resection and orbital exenteration, confers a survival advantage. This was subsequently reinforced by more contemporary long-term comparative outcome data demonstrating no significant survival benefit over globe-preserving surgery with radiotherapy. Recent findings in lacrimal gland adenoid cystic carcinoma are broadly consistent with this established evidence base, although comparisons with exenteration remain susceptible to treatment-selection bias.
AIMS:To characterise the clinical and multimodal imaging (MMI) features of vitreoretinal lymphoma (VRL) with white spot lesions (WSLs) and differentiate it from multiple evanescent white dot syndrome (MEWDS). METHODS:This retrospective observational case-control study consecutively enrolled patients with biopsy-proven VRL between 2018 and 2024 at Fudan University Eye and ENT Hospital. Included patients with VRL with baseline WSLs on fundus photography comprised the WSLs VRL group compared with 34 eyes from 34 patients diagnosed with primary MEWDS in 2024. RESULTS:Totally 35 (35/158, 22%) eyes of 25 (25/89, 28%) patients (53.8 (SD 10.4) years; 80% female) presenting with WSLs were included in the WSLs VRL group. Eyes with WSLs presented with significantly shorter symptom duration and better visual acuity at initial examination than those without WSLs (both p<0.001). Compared with the MEWDS cohort, the WSLs in VRL demonstrated a distinct eccentric, peripheral and limited distribution, involving <50% retina in significantly more eyes than in MEWDS (p<0.001). Involvement of the posterior pole and macula was significantly less frequent in VRL (both p<0.001). The coexistence of multiple fundus autofluorescence patterns was more common in VRL (p<0.001), and a distinctive pattern of hypoautofluorescent spots with hyperautofluorescent rings was observed in 23 of 35 VRL eyes but was absent in MEWDS. Optical coherence tomography revealed more frequent retinal pigment epithelium abnormalities in VRL (p<0.001). CONCLUSIONS:WSLs emerged as a potential early sign of VRL, demonstrating distinct MMI features. Recognising these features aids early diagnosis and differentiation from mimickers like MEWDS.
BACKGROUND/AIMS:Retained intraocular foreign bodies (IOFBs) are important causes of vision-threatening ocular trauma and preventable visual impairment. This systematic review and meta-analysis evaluated the clinical manifestations, diagnostic approaches, surgical management and visual outcomes associated with IOFBs. METHODS:A systematic search of PubMed, Embase, Scopus and Web of Science identified studies published between 1 January 2000 and 30 November 2025. Eligible studies reporting clinical presentation, imaging findings, management strategies or outcomes of retained IOFBs were included. Data were synthesised using a random-effects meta-analysis model. RESULTS:A total of 59 studies involving 4289 patients were included of which 42 were eligible for quantitative meta-analysis. Reduced visual acuity (78%), ocular pain (42%) and intraocular inflammation (36%) were the most common clinical manifestations. Endophthalmitis occurred in 12.4% and retinal detachment in 9.8% of cases. Favourable visual outcomes (Best Corrected Visual Acuity-BCVA≥20/40) were achieved in 65.7% of patients. CT demonstrated the highest diagnostic accuracy (91.2%), while ultrasonography showed 83.6% sensitivity particularly in media opacity. Pars plana vitrectomy was the predominant surgical approach, with an overall surgical success rate of 96.5%. Early IOFB removal (≤24 hours) was associated with improved visual recovery and reduced complications. CONCLUSIONS:Early diagnosis and timely surgical intervention are critical for optimising outcomes in retained IOFBs. CT and pars plana vitrectomy remain central to management, while delayed intervention increases the risk of severe complications. Standardised protocols and prospective multicentre studies are needed to strengthen evidence and improve patient care.
