Early detection of diabetic macular edema (DME) is essential to prevent vision loss through timely treatment. Optical coherence tomography (OCT) is the diagnostic gold standard but is not suitable for home monitoring. The Amsler grid represents a simple and inexpensive potential screening tool. This study aimed to determine the sensitivity of the Amsler grid for detecting DME and to assess its association with the size of foveal edema. In this cross-sectional study, 1,444 eyes of 722 diabetic patients were examined using Spectralis OCT and the Amsler grid, and 90 eyes with DME were identified. A sensitivity analysis restricted to one eye per participant and excluding eyes with concomitant macular pathologies included 34 eyes with intrafoveal DME, in which the area of foveal edema was quantified. For very small DME (area ≤ 0.01 mm²), the sensitivity of the Amsler grid was 20.0
Tube occlusion after glaucoma drainage device (GDD) implantation is a recognized complication typically requiring surgical revision. The Aurolab Aqueous Drainage Implant (AADI) is a cost-effective device increasingly used in low- and middle-income countries, yet, to our knowledge, laser management of AADI tube blockage has not been reported. Two consecutive cases of postoperative AADI tube obstruction were managed with Nd: YAG laser. Case 1 was an 11-year-old one-eyed girl with primary congenital glaucoma and a failed trabeculotomy-trabeculectomy who developed iris obstruction of a sulcus-placed AADI tube 10 months after implantation. Nd: YAG laser iridotomy restored tube patency. A transient intraocular pressure (IOP) spike, mild hyphema, and moderate anterior chamber reaction occurred and resolved spontaneously within 3 days. At 7 months, IOP remained 12 mmHg without anti-glaucoma medication and no re-occlusion. Case 2 was a 38-year-old one-eyed aphakic man with extensive flame burn, prior bilateral penetrating keratoplasty, and open-sky vitrectomy who developed vitreous tube occlusion 4 weeks after AADI implantation. Nd: YAG vitreolysis reduced IOP from 32 to 28 mmHg within 2 h. However, on day 16 post-laser, conjunctival erosion with plate exposure, bullous keratopathy, and tube migration developed in the setting of limbal stem cell deficiency, necessitating implant explantation. Nd: YAG laser may serve as a practical first-line rescue for iris- or vitreous-related obstruction of sulcus-placed GDD tubes in selected high-risk eyes, potentially avoiding immediate surgical revision. This approach is cost-effective and relevant in resource-limited settings. However, long-term success depends on the underlying ocular surface and structural condition of the eye.
To evaluate the corneal endothelial layer characteristics in the meibomian gland dysfunction (MGD) cases and compare them to those of the healthy controls. Cross-sectional. 100 eyes from 50 MGD cases and 66 eyes from 33 healthy controls were evaluated in this study. The ocular surface disease index (OSDI), Schirmer’s test, tear break-up time (TBUT), tear meniscus height, and MGD staging were evaluated as the subjective and objective parameters of dry eye disease (DED) and MGD. The corneal endothelial cell density (ECD), coefficient of variation in endothelial cell size (CV), and hexagonal cells proportion (HA) were evaluated using the corneal specular microscopy. Linear mixed-effect models (LMMs) were used to compare endothelial parameters between groups. The mean age in the MGD group was 56.9 years, and in the controls, 44.3 years. Although the age difference was significant, it was treated as a covariate in the LMM to adjust for age differences across groups. The adjusted mean ECD was 183 cells/mm2 lower in the MGD cases than in the controls. However, the difference was marginally statistically insignificant (95
To evaluate the impact of combined Hydrus Microstent implantation and cataract surgery on the 24-hour intraocular pressure (IOP) range in patients with open-angle glaucoma. This retrospective, single-center study included 125 consecutive eyes of 125 patients who underwent combined Hydrus Microstent implantation and cataract surgery. Inpatient 24-hour IOP profiles (comprising daytime Goldmann applanation tonometry and nocturnal iCare rebound tonometry) from before and after surgery were analyzed. Surgical success was defined as a postoperative mean 24-hour IOP ≤ 21 mmHg with either a ≥ 20
Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and a major cause of visual impairment. Despite the high prevalence of T2DM in Iran, longitudinal evidence on DR is limited. This study aimed to investigate the incidence and predictors of DR among patients with T2DM in Yazd, Iran. This retrospective cohort study used routinely collected clinical data from 753 adults with T2DM who attended the Diabetes Center of Yazd, Iran, between 2012 and 2024. Participants were followed from their first clinic visit until the development of DR, loss to follow-up, death, or the end of the study period. Kaplan–Meier survival analysis and Cox proportional hazards regression models were used to estimate time to DR and identify associated risk factors. Among 753 subjects with T2DM, 208 (27.6
Retinal pigment epithelial and outer retinal atrophy (RORA) and complete RORA (cRORA) are major determinants of long-term vision in neovascular age-related macular degeneration (nAMD), but their development across subtypes is poorly defined, especially in Asian populations, in whom pachychoroid-driven disease is common. We compared long-term visual outcomes and atrophy burden between the conventional and novel nAMD classifications. One hundred twenty eyes of 120 treatment-naïve patients with nAMD followed at least six years were classified by conventional (typical nAMD [tAMD], polypoidal choroidal vasculopathy [PCV], retinal angiomatous proliferation [RAP]) and novel (drusen type, pachychoroid type, mixed type, other type) schemes. All eyes received three loading anti-VEGF injections followed by a pro re nata regimen. RORA within the central 1 mm was graded on optical coherence tomography; lesions ≥ 250 μm were defined as cRORA. Visual acuity (VA) retention, atrophy prevalence, and VA around atrophy onset were assessed. Mean age was 78.0 ± 9.2 years and overall VA retention was 71
Congenital orbital masses encompass a broad spectrum of etiologies, among which encephalomeningocele is exceedingly rare and particularly diagnostically challenging when atypical. We report a 2-hour-old female neonate who presented with a giant left orbital mass causing marked proptosis. Imaging revealed a mixed cystic-solid lesion with calcifications and septations, but no bony defect was identified preoperatively. A transcranial approach was performed, revealing a small orbital roof defect with herniation into the anterior cranial fossa. Histopathology confirmed encephalomeningocele. The surgery successfully preserved the globe, although mild lagophthalmos resulted in exposure keratopathy. Follow-up imaging showed a small residual lesion. This case highlights that congenital orbital encephalomeningocele can present with atypical features, including a giant lesion with a disproportionately small bone defect that was not detectable on imaging, particularly in neonates. Histopathology is essential for diagnosis, and encephalomeningocele should be considered in the differential diagnosis of congenital orbital masses even when classic imaging findings are lacking.
To evaluate anatomical and functional outcomes after idiopathic full-thickness macular hole (FTMH) surgery and identify factors associated with anatomical closure and six-month visual outcome. This retrospective study included 74 eyes of 74 patients who underwent primary pars plana vitrectomy (PPV) between June 2014 and November 2025. Surgery was performed with either conventional internal limiting membrane (ILM) peeling or temporal inverted ILM flap surgery. Baseline clinical data, optical coherence tomography (OCT) parameters, including minimum linear diameter (MLD) and macular hole index (MHI), tamponade type, anatomical outcomes, reoperation status, and best-corrected visual acuity (BCVA) were analyzed. Primary anatomical closure was defined as closure after the initial surgery, whereas final anatomical closure was defined as closure at final follow-up, including closure after reoperation. An exploratory adjusted linear regression model evaluated factors associated with six-month BCVA. Primary anatomical closure was achieved in 59 eyes (79.7
To investigate baseline and post-loading optical coherence tomography angiography (OCTA) characteristics associated with 1-year fibrosis in treatment-naïve neovascular age-related macular degeneration (nAMD), and to evaluate whether baseline clinical variables combined with OCTA-derived biomarkers could improve fibrosis prediction. This retrospective, single-center study included treatment-naïve nAMD eyes with type 1 or type 2 macular neovascularization (MNV) that completed a 3 + PRN anti-VEGF loading regimen and had at least 12 months of follow-up. High-quality OCTA images were required at baseline and at the post-loading visit, defined as within 1 week after completion of the three-injection anti-VEGF loading phase. OCTA quantitative parameters, including fractal dimension, branch points, endpoints, segments, and MNV vessel density, were measured within the manually delineated MNV region of interest. Baseline clinical and imaging characteristics were compared between fibrosis and non-fibrosis groups. Univariate and multivariable logistic regression analyses were performed to identify factors associated with 1-year fibrosis, and receiver operating characteristic (ROC) curves were used to assess predictive performance. A total of 72 patients (88 eyes) were included, of which 31 eyes developed fibrosis at 1 year and 57 did not. Compared with the non-fibrosis group, eyes that developed fibrosis had worse baseline best-corrected visual acuity (BCVA), greater baseline central macular thickness (CMT), and a higher prevalence of subretinal hyperreflective material (SHRM), retinal hemorrhage, type 2/mixed MNV, high pigment epithelial detachment, and intraretinal fluid. At baseline, the fibrosis group showed significantly higher MNV vessel density, whereas MNV fractal dimension showed a borderline difference. At the post-loading visit, MNV fractal dimension, MNV branch points, MNV endpoints, MNV segments, and MNV vessel density were all significantly higher in the fibrosis group. However, within-group comparisons between baseline and the post-loading visit revealed no significant changes in OCTA parameters in either group. In multivariable analysis, baseline BCVA (OR 1.162, 95
Dry eye is the most prevalent ocular complaint among patients with primary Sjögren’s syndrome, manifesting as pronounced eye discomfort and frequently complicated by mental disorders including anxiety and depression. Prior research has demonstrated that the chronic care model improves both clinical indicators and psychological status. This study compared changes in clinical parameters and psychological status in patients with primary Sjögren’s syndrome following a 24-week chronic disease management intervention. This single-group pre-post study was conducted at a tertiary hospital in China between April 2022 and October 2023. A total of 34 patients diagnosed with primary Sjögren’s syndrome were recruited into this study. Questionnaires including the Ocular Surface Disease Index questionnaire, treatment compliance, the Knowledge-Attitude-Practice questionnaire, and the Depression Anxiety Stress Scales-21, were administered to patients at different follow-up time points. Patients also received objective ocular examinations consisting of Schirmer’s test values, Tear Break-Up Time, corneal staining assessed with the NEI scale, and conjunctival staining assessed with the Sicca OSS scale. Data were analyzed using SPSS version 27.0, with descriptive statistics, paired t-tests, repeated-measures analysis of variance (with Bonferroni correction), Spearman’s rank correlation analysis, and McNemar tests. Statistical significance was set at p < 0.05. A total of 34 patients were enrolled (mean age 56.62 ± 12.16 years; 94.12 https://www.chrictr.org.cn/ ) on March 26, 2025, ChiCTR2500099615.
To determine whether the Defocus Incorporated Multiple Segments (DIMS) spectacle lens is non-inferior to Orthokeratology lenses (OKL) in slowing the progression of myopia in children. A parallel-group, non-inferiority randomised clinical trial at the University Hospital of Southern Denmark compared the myopia control treatment efficacy of DIMS spectacle lenses with OKL in myopic children aged 6–12 years. Our primary outcome was axial length growth after 18 months of therapy, adjusted for change in central corneal thickness in the OKL group. The participants were allocated to the treatments using centralised computer-generated randomisation. The interpreters were blinded. Non-inferiority was concluded if the upper bound of the 95
The presence of ocular abnormalities in patients with sensorineural hearing loss (SNHL) may affect children’s developmental milestones due to impairment of primary sensory inputs. This study aimed to evaluate the prevalence of different ophthalmologic abnormalities in pediatric patients with bilateral SNHL who were candidates for cochlear implantation (CI). We performed a retrospective medical chart review of 261 pediatric patients under 13 years of age with bilateral SNHL who were candidates for CI and were evaluated at a tertiary cochlear implantation referral center in northwestern Iran between March 21, 2017, and June 20, 2025. Ophthalmologic findings were assessed as the main outcome measures. The overall prevalence of ocular findings was 19.5
Abstract Purpose Retinal vessel oximetry requires fundus images at two wavelengths with different hemoglobin absorption characteristics. Simultaneous acquisition using one-chip color cameras may be affected by incomplete spectral separation of detector channels, whereas multi-chip systems such as 3-chip CCD cameras can achieve improved spectral separation. We present a serial dual-wavelength illumination approach integrated into a conventional fundus camera and compare oxygen saturation measurements with those obtained from a commercial retinal oximeter. Methods A custom LED illumination unit was fiber-coupled into a fundus camera to provide serial illumination at 548 nm (isosbestic hemoglobin wavelength) and 605 nm (oxygen-sensitive wavelength with differential absorption between oxy- and deoxyhemoglobin), each for 250 ms. Corneal irradiance was 33 mW/cm² at 548 nm and 7 mW/cm² at 605 nm. Sequentially acquired images were registered and analyzed using established retinal oximetry algorithms. Mean arterial and venous oxygen saturation values were compared with measurements from a commercial retinal oximeter in nine participants undergoing routine ophthalmic examination. Linear regression analysis was performed to assess the association between methods, and agreement was additionally evaluated using Bland–Altman analysis. Results Mean arterial oxygen saturation was 99.4 ± 5.7% with serial illumination and 100.4 ± 3.0% with standard oximetry. Mean venous oxygen saturation was 71.5 ± 7.0% and 69.5 ± 11.6%, respectively. The mean absolute differences between both techniques were 3.6 ± 2.7% for arteries and 8.4 ± 9.3% for veins. Bland–Altman analysis showed a small arterial bias of 0.94% with limits of agreement from − 7.9% to + 9.8%. For venous measurements, bias was − 1.98% with wider limits of agreement (− 26.9% to + 22.9%). Arterial measurements showed borderline non-significant correlation ( R = 0.606, p = 0.084). Venous measurements showed no correlation. Conclusions Serial illumination is feasible for retinal vessel oximetry and mitigates detector-level spectral crosstalk associated with simultaneous dual-wavelength imaging using one-chip color cameras. Arterial measurements showed only a small systematic bias compared with the commercial retinal oximeter, whereas venous measurements demonstrated greater variability, indicating the need for further optimization and validation.
Portable visual-field testing devices have emerged as accessible approaches for detecting and monitoring manifest glaucomatous visual-field loss, particularly where standard automated perimetry is difficult to access. Their diagnostic accuracy and clinical reliability, however, remain uncertain due to heterogeneous study designs, variable thresholds, and inconsistent performance metrics. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy, test duration, and correlation of all portable VF devices compared with SAP, across multiple device categories and glaucoma severities. A comprehensive search of PubMed, Scopus, Web of Science, Cochrane Central, ClinicalTrials.gov, WHO ICTRP, and Google Scholar was conducted from inception through December 2025, without language restrictions. Eligible studies included diagnostic-accuracy or cohort designs comparing portable VF devices, including virtual-reality, tablet-based, web-based, or paper-based against SAP as the reference standard. Two reviewers independently extracted data and assessed quality using QUADAS-2. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated using bivariate random-effects models, with heterogeneity and publication bias evaluated via I², τ², and Deeks’ funnel asymmetry tests. Secondary outcomes included test duration and correlation coefficients for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). From 639 screened records, 21 studies involving 2,254 participants (1,362 glaucoma, 892 controls) were included. Pooled sensitivity was 86
Valsalva retinopathy is a well-recognized cause of sudden, painless visual loss resulting from preretinal hemorrhage following an abrupt increase in intrathoracic or intra-abdominal pressure. It is most commonly associated with activities such as coughing, vomiting, and physical exertion. We report the case of a 23-year-old previously healthy male who presented with acute, painless visual loss in the left eye following khat chewing and brief hanging from a window. Ophthalmic examination revealed a dense premacular hemorrhage associated with marked visual impairment. Optical coherence tomography (OCT) confirmed a subhyaloid hemorrhage, demonstrating a dome-shaped premacular hemorrhagic cavity beneath the posterior hyaloid face. A diagnosis of Valsalva retinopathy was established based on the clinical and imaging findings. The patient underwent Nd laser hyaloidotomy using a Q-switched Nd laser, resulting in successful drainage of the hemorrhage into the vitreous cavity. At one-month follow-up, complete visual recovery (6/6) was achieved, with complete resolution of the hemorrhage and no procedure-related complications. This case highlights an uncommon presentation of Valsalva retinopathy following brief hanging from a window. The hanging episode was considered the most likely precipitating event because of its potential to generate substantial Valsalva stress and a sudden increase in retinal venous pressure. Although khat use has not been established as a direct cause of Valsalva retinopathy, its sympathomimetic cardiovascular effects may have contributed to vascular susceptibility. This report expands the spectrum of atypical triggers associated with Valsalva retinopathy. Valsalva retinopathy should be considered in young patients presenting with sudden visual loss, even when the precipitating event is unconventional. Early treatment with Nd laser hyaloidotomy can result in excellent anatomical and visual outcomes in selected patients with dense premacular hemorrhage.
Abstract Background The study’s objective was to investigate the development of the peripapillary retinal nerve fiber layer (pRNFL) thickness after Deep Sclerectomy (DS), XEN microstent implantation and Preserflo (PF) microshunt implantation compared to Trabeculectomy (TE). Methods This retrospective monocentric study analyzed eyes with primary open-angle glaucoma (POAG) after TE, DS, XEN- or PF-implantation over 2 years. Intraocular pressure (IOP), number of IOP-lowering medications, best-corrected visual acuity (BCVA), and success rates were analyzed. pRNFL was measured by spectral domain optical coherence tomography (SD-OCT). Results 462 eyes were analyzed. 108 underwent TE, 183 DS, 90 XEN- and 81 PF-implantation. Mean IOP and mean number of IOP-lowering medications decreased, while BCVA remained stable in all groups. Mean pRNFL significantly decreased in all groups, changing from 64.6 ± 2.0 to 57.8 ± 1.9 μm (-6.8 μm, p < 0.001), 63.6 ± 1.8 to 58.3 ± 2.5 μm (-5.3 μm, p = 0.005), 63.2 ± 2.2 to 60.0 ± 2.1 μm (-3.2 μm, p = 0.008) and 62.1 ± 1.8 to 59.9 ± 1.8 μm (-2.2 μm, p = 0.008) in the TE, DS, XEN and PF groups. Between 1 and 2 years postoperatively, no further statistically significant decline was observed in any group (TE: p = 0.131; DS: p = 0.374; XEN: p = 0.129; PF: p = 0.471). Conclusions Despite success in reducing IOP and IOP-lowering medications, the pRNFL declines during the first postoperative year, with no further statistically significant decline observed during the second year.
This study aimed to evaluate structural and microvascular changes in amblyopic eyes using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and to compare these findings with those of fellow eyes and healthy individuals. This is a cross-sectional controlled study. Retinal and choroidal structures were examined using the Spectralis OCT device (Spectralis, Heidelberg Engineering, Heidelberg, Germany), and vascular analyses were performed with the Topcon Triton SS-OCT (Topcon Triton, Tokyo, Japan). Structural parameters such as macular thickness, ganglion cell layer (GCL), inner plexiform layer (IPL), peripapillary retinal nerve fiber layer (PpRNFL), and choroidal thickness were measured. Additionally, luminal area (LA), total choroidal area (TCA), and choroidal vascular index (CVI) were calculated. Group comparisons were performed using linear mixed-effects models to account for the non-independence of amblyopic and fellow eyes. A total of 130 individuals were included in the study: 65 patients and 65 control subjects. The study included 65 amblyopic eyes (Group 1), 65 clinically healthy fellow eyes from the same patients (Group 2), and 65 healthy control eyes (Group 3). Amblyopic eyes were further divided into two groups: those with amblyopia due to anisometropia (Group 1 A) and those with amblyopia due to strabismus (Group 1B). Choroidal thickness was higher in Groups 1 and 2 compared to Group 3. OCTA values were not significantly different between the groups. Macular thickness, except for foveal macular thickness, was thicker in Groups 1 and 2 compared to Group 3. Foveal macular thickness was not significantly different between the groups. Several significant sectoral differences in GCL measurements were observed among the groups. The inner and outer sectors of the inner plexiform layer were significantly thicker in Groups 1 and 2 compared to Group 3, whereas foveal IPL thickness did not differ significantly among the main groups. In PpRNFL measurements, the temporal superior quadrant was thinner in both the amblyopic and fellow eye groups compared to the control group, whereas the nasal inferior quadrant was thicker in the amblyopic eye group than in the fellow eye and control groups. There were no differences between the groups in PpRNFL in the other quadrants. In CVI measurements, the control group had higher CVI values compared to both the amblyopic and healthy eyes. Amblyopia was associated with structural retinal and choroidal differences, whereas OCTA parameters did not differ significantly among the groups. Future larger-scale and longitudinal studies may better elucidate the contribution of retinal microvascular changes to the pathophysiology of amblyopia.
Herpes zoster ophthalmicus (HZO) may lead to ocular and periocular complications through involvement of the ophthalmic branch of the trigeminal nerve. Upper eyelid cicatricial ectropion is an uncommon sequela that may cause lagophthalmos, ocular surface exposure, irritation, and aesthetic deformity. This report describes surgical management of post-HZO upper eyelid cicatricial ectropion using a preauricular full-thickness skin graft. A 65-year-old woman presented with inability to fully close her left upper eyelid, accompanied by ocular redness, dryness, and burning sensation. She had been diagnosed with HZO two months earlier. Visual acuity was preserved, and no corneal epithelial defect was observed. Despite antiviral therapy and conservative ocular surface lubrication, progressive upper eyelid retraction, eyelash loss, lagophthalmos, and scleral exposure developed. After the active inflammatory phase had resolved and cicatricial retraction persisted, scar release was performed under local anaesthesia. The resulting 1,8 × 0,8 cm anterior lamellar defect was reconstructed with a preauricular full-thickness skin graft. At 8 months, eyelid closure was restored, visible ocular surface exposure was absent, dryness and burning had resolved, and acceptable tissue contour and color match were maintained without wound-site complication. Full-thickness skin grafting may be a practical reconstructive option for selected cases of post-HZO upper eyelid cicatricial ectropion when surgery is timed after resolution of active inflammation and donor-site selection accounts for eyelid color, thickness, and pliability. Broader treatment recommendations require additional cases with objective functional measurements and longer follow-up.
To evaluate and compare the long-term clinical outcomes of combined viscocanalostomy and repeat trabeculotomy (VCO+retbo) versus repeat trabeculotomy alone (retbo) in eyes with primary congenital glaucoma (PCG) that failed initial angle surgery. This prospective comparative study evaluated 164 eyes with PCG that exhibited an insufficient response to primary trabeculotomy, divided into VCO+retbo (n = 82) and retbo (n = 82) groups. Treatment success was defined as an intraocular pressure (IOP) between 6 and 21 mmHg with a ≥ 20 https://ethics.research.ac.ir/IR.TUMS.FARABIH.REC.1402.009 Trial registration: This study was not registered in a clinical trial registry. Per our institution’s standard practice, prospective registration is reserved for randomized controlled trials; as both surgical techniques compared here are routine, established procedures rather than novel or experimental interventions, the study proceeded under institutional ethics approval alone. Not applicable.
We aimed to compare serum complement C3, C3a, and C4 levels between cataract patients with and without pseudoexfoliation syndrome, and to compare these groups with the control group. There were three different groups in the study. The total of 150 patients, 50 in each group, were included. Group 1 consisted of cataract patients with pseudoexfoliation, Group 2 consisted of cataract patients without pseudoexfoliation, and Group 3 consisted of healthy individuals. After centrifugation of the blood samples, the serum portion was stored at − 80 °C until the analysis. Complement C3, C3a, and C4 levels were evaluated in these three groups using commercially available sandwich ELISA kits. There was a statistically significant difference just between Group 1 and Group 2 regarding C4 values. However, after the age correction, this significance was disappeared. No statistically significant difference in serum complement C3, C3a, and C4 levels was found between cataract patients with and without pseudoexfoliation syndrome after correcting for age. As only serum was evaluated, this finding does not exclude local complement pathway activation within the eye, and should not be read as evidence against a role for complement in pseudoexfoliation.
