Idiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure, predominantly seen in obese women. IIH presents with symptoms such as headache, vision loss, and papilledema, requiring early diagnosis and treatment. This study aimed to evaluate the diagnostic value of non-invasive methods, including transorbital ultrasonography (TOUS) and optical coherence tomography (OCT), by measuring parameters such as optic nerve sheath diameter (ONSD) and retinal nerve fiber layer thickness (RNFLT) in IIH diagnosis. The study included 31 patients diagnosed with IIH (29 women, 2 men) and 31 healthy controls.Query ONSD measurements were performed using TOUS before and after lumbar puncture (LP) in patients. Additionally, OCT was used to measure RNFLT, ganglion cell complex (GCC), and retinal thickness. Statistical analysis was conducted using the Mann–Whitney U test, ROC curve, and correlation analyses. The ONSD measurements in the patient group were significantly higher compared to the control group (p < 0.001). A marked decrease in ONSD was observed post-LP (p < 0.001). OCT measurements showed that RNFLT was significantly thicker in the patient group compared to controls (p < 0.001). In patients with papilledema, RNFLT was higher than in those without papilledema. A moderate positive correlation was found between ONSD and RNFLT (R = 0.59, p < 0.001). ONSD measured by TOUS and RNFLT assessed by OCT are reliable non-invasive methods for diagnosing IIH. These techniques can reduce the need for invasive procedures like LP, enhancing patient comfort. Our study contributes to the literature by providing cut-off values for ONSD and RNFLT and supports their effectiveness in early IIH diagnosis. Validation of these findings through future studies with larger patient groups is essential.
To compare visual and optical outcomes after selective corneal wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis (CW-FS-LASIK), aspheric aberration-free femtosecond laser-assisted in situ keratomileusis (AF-FS-LASIK), and small-incision lenticule extraction (SMILE) in patients with asymmetric corneal astigmatism. This retrospective comparative study included 269 patients (269 eyes) who underwent CW-FS-LASIK (67 eyes), AF-FS-LASIK (69 eyes), or SMILE (133 eyes) for myopia with asymmetric corneal astigmatism. Asymmetric corneal astigmatism was defined as an inferior–superior (I–S) dioptric difference of at least 1.00 D within the central 3 mm anterior corneal zone on the anterior sagittal curvature map. Visual and refractive outcomes, functional optical zone (FOZ), decentration, and corneal higher-order aberrations (HOAs) at analysis diameters of 4 and 6 mm were compared at 1 month postoperatively. Baseline characteristics were comparable among the three groups except for sex distribution. At 1 month, visual and refractive outcomes were comparable, and no significant difference in decentration was observed. FOZ was larger in the SMILE group than in the other groups (P < 0.001). At the 4 mm analysis diameter, postoperative total HOAs and total coma were lower in the CW-FS-LASIK group. At the 6 mm analysis diameter, induced total coma was lowest in the CW-FS-LASIK group, whereas induced spherical aberration was lowest in the SMILE group. All three procedures achieved similarly favorable early visual and refractive outcomes in eyes with asymmetric corneal astigmatism. CW-FS-LASIK showed lower corneal coma, but its clinical relevance remains uncertain and requires further validation with patient-reported outcomes.
The present study aimed to develop and optimize puerarin-loaded proniosomal gel for topical ocular delivery in dry eye disease (DED), overcoming poor corneal permeability, rapid precorneal elimination, and frequent dosing limitations of conventional ophthalmic formulations. Proniosomal gels were prepared using Span 60, cholesterol, Gelucire 44/14, lecithin and Carbopol 974P by coacervation-phase separation method. A three-factor Box-Behnken design (BBD) was employed to optimize three independent variables amount of Span 60 (X1), cholesterol (X2), and Gelucire 44/14 (X3) with entrapment efficiency (EE
To determine the impact of COVID-19 infection and vaccination on risk of corneal transplant rejection. All corneal transplants performed in Auckland, New Zealand (NZ), between January 2010 and December 2022 were included. Demographic, clinical, and surgical characteristics were recorded, along with COVID-19 vaccination and infection history. Time to corneal transplant rejection was analysed using Weibull survival regression with clustered standard errors at the graft level to account for repeated events and time-varying covariates. A total of 1183 corneal transplants were performed in 926 patients, with a median age of 52 years (IQR 32–70); 47.5
This study aimed to investigate the impact of obstructive sleep apnea syndrome (OSAS) severity on retinal microvascular alterations in hypertensive individuals and to determine whether the presence of asymptomatic organ damage (AOD) further modulates these ocular changes. A total of 102 hypertensive participants who underwent overnight polysomnography were classified into three groups based on the apnea–hypopnea index (AHI): non-OSAS (n=34), mild OSAS (n=36), and moderate–severe OSAS (n=32). All subjects underwent optical coherence tomography angiography (OCTA) to evaluate foveal superficial and deep capillary densities (FovSupMVD, FovDepMVD), foveal avascular zone (FAZ), and choroidal thickness. Among OSAS patients, AOD status was determined based on left ventricular mass index, carotid intima-media thickness, and microalbuminuria. Comparative and correlation analyses were performed to assess the influence of OSAS severity and AOD presence on retinal microcirculatory parameters. A significant reduction in both FovSupMVD and FovDepMVD was observed with increasing OSAS severity (p = 0.001 and p < 0.001, respectively), while FAZ size remained unchanged. Although overall retinal thickness parameters were largely similar among groups, RTn differed significantly between groups (p = 0.044). Interestingly, temporal and nasal choroidal thickness increased significantly in the moderate–severe OSAS group (p = 0.006 and p = 0.005). Although AOD was associated with higher systemic vascular markers (e.g., carotid thickness, LVMI, microalbuminuria), OCTA parameters did not differ significantly between AOD-positive and AOD-negative patients (all p > 0.05). No significant interaction was found between OSAS severity and AOD on OCTA measures. Retinal microvascular impairment in hypertensive OSAS patients was found to be strongly associated with OSAS severity, whereas the presence of AOD did not appear to contribute additional effects. These findings suggest that chronic intermittent hypoxia inherent to OSAS may play a primary role in retinal microvascular disruption. Retinal vessel density may have potential as a non-invasive biomarker of microvascular dysfunction in hypertensive patients with OSAS.
This study aimed to evaluate the impact of a compression dressing on postoperative pain, ocular surface changes, edema, ecchymosis, and aesthetic outcomes following upper eyelid blepharoplasty. This observer-blinded, randomized, controlled trial included 112 eyelids from 56 patients who underwent bilateral upper eyelid blepharoplasty between June and August 2025. After surgery, one eyelid received a compression dressing (CD), while the other eyelid received no dressing (ND). Edema and ecchymosis were graded by masked observers on postoperative days 1, 7, 30, and 90. Aesthetic outcomes were evaluated using the Global Aesthetic Improvement Score. Pain was evaluated using a visual analog scale, and patient comfort was assessed by side preference. On postoperative day 1, ecchymosis scores were significantly lower in the CD group than in the ND group (unadjusted p = 0.002; Holm-adjusted p = 0.012). Edema scores were also lower on the CD side (unadjusted p = 0.012) and aesthetic scores were higher (unadjusted p = 0.046); however, neither difference remained statistically significant after Holm–Bonferroni correction for multiple comparisons (adjusted p = 0.060 and p = 0.138, respectively). No significant differences were observed in any parameter on postoperative days 7, 30, or 90 (all adjusted p > 0.05). Corneal staining scores were comparable between groups at all follow-ups, and no corneal erosions were observed. Pain scores on day 1 were similar (p = 0.977). Compression dressing after upper eyelid blepharoplasty was associated with a significant reduction in early postoperative ecchymosis, an effect that persisted after correction for multiple comparisons. Reductions in edema and improvements in aesthetic scores were observed on postoperative day 1 but did not remain statistically significant after adjustment. Overall, the benefits of compression dressing were limited in magnitude and transient, and routine use may not be necessary; its application should be individualized according to patient needs. Trial Registration: ClinicalTrials.gov, NCT07701265 (retrospectively registered on July 8, 2026).
To quantitatively evaluate iris and limbal vascular density using anterior segment optical coherence tomography angiography (AS-OCTA) in pediatric and adult participants across different body mass index (BMI) categories and to investigate the potential effects of obesity on anterior segment microcirculation. This prospective cross-sectional study included 300 participants: 200 adults (≥ 19 years) and 100 children (4–17 years). Adult participants were classified according to the World Health Organization BMI criteria, whereas pediatric participants were categorized using age- and sex-specific BMI-for-age percentiles. Iris and limbal vascular density were measured using AS-OCTA in the superotemporal, superonasal, inferonasal, and inferotemporal quadrants. Adult and pediatric groups were analyzed separately. No significant differences in iris or limbal vascular density were observed among BMI categories in adults (all P > 0.05). Likewise, iris vascular density did not differ significantly among BMI-for-age categories in children. However, limbal vascular density differed significantly in the superotemporal (P = 0.014) and inferotemporal (P = 0.040) quadrants in the pediatric group. Post hoc analysis demonstrated a significant difference only between the normal-weight and obese groups in the superotemporal quadrant, whereas no significant pairwise differences were identified in the inferotemporal quadrant. Obesity was not associated with widespread alterations in anterior segment vascular density in adults, whereas localized limbal vascular differences were observed in children. These findings suggest that obesity-related anterior segment microvascular changes may be region-specific and age-dependent. Larger longitudinal studies are needed to clarify the clinical significance of these findings and to determine the potential role of AS-OCTA in the assessment of obesity-related ocular microvascular alterations.
To estimate the prevalence of common retinal diseases in Türkiye during 2017–2023 and to characterize age and gender-specific differences. This retrospective, single-center, hospital-based study included 475,865 adults presenting to an ophthalmology outpatient clinic. The study period was divided into pre-pandemic (January 2017–March 2020), acute pandemic (March–June 2020), and post-pandemic (June 2020–July 2023) phases. Patient age, gender, diagnoses, and major complications were recorded. The primary outcomes were defined as changes in the prevalence of common retinal diseases and their complications before and after the pandemic. Among 475,865 adults, 10,131 (2.13
To compare postoperative limbal epithelial thickness (LET) measured by anterior segment optical coherence tomography (AS-OCT) following conjunctival limbal autograft (CLAU) and conjunctival flap (CF) surgery in patients with primary grade 3 pterygium. This retrospective comparative study included 42 patients with primary grade 3 pterygium who underwent either CLAU (n = 21) or CF (n = 21). At 12 months postoperatively, AS-OCT was used to measure LET together with peripheral and central corneal epithelial and stromal thicknesses. Corresponding healthy fellow eyes served as controls. Secondary outcomes included best-corrected visual acuity (BCVA), operative duration, and recurrence. Between-group and within-group comparisons were performed using appropriate statistical tests. Mean postoperative LET was 61.33 ± 2.41 µm in the CLAU group and 62.81 ± 5.86 µm in the CF group, with no significant difference between groups (p = 0.141). LET did not differ significantly between operated and fellow eyes in either group. Likewise, peripheral and central corneal epithelial and stromal thicknesses were comparable between operated and fellow eyes and showed no significant differences between surgical techniques. BCVA and recurrence rates were similar in both groups, whereas operative duration was significantly shorter in the CF group (23.90 ± 1.67 vs. 40.29 ± 2.98 min, p < 0.001). No intraoperative or postoperative complications or recurrences were observed during the 12-month follow-up. At the 12-month postoperative evaluation, CLAU and CF demonstrated similar AS-OCT–based limbal epithelial thickness and corneal structural measurements. Although CF required a significantly shorter operative time, these findings should not be interpreted as evidence of equivalence between the two techniques. Larger prospective studies with serial postoperative AS-OCT assessments are warranted.
Artificial intelligence (AI) has achieved substantial progress in retinal image classification and disease screening, butits clinical value will ultimately depend on whether it can support meaningful decisions across the patient journey. This Opening Editorial introduces the Special Collection “Multimodal AI in Retinal Disease: Imaging, Clinical Data, and Real-World Endpoints” and outlines priorities for the clinical translation of multimodal retinal AI. Multimodal AI offers an opportunity to integrate fundus photography, optical coherence tomography, OCTangiography, ultra-widefield imaging, and other retinal modalities with clinical characteristics, treatment history, and longitudinal change. Such integration may improve risk stratification, disease monitoring, treatment-response prediction, and individualized follow-up. However, adding modalities or increasing model scale does not in itself establish clinical utility. Future studies should demonstrate incremental value over strong unimodal and clinical baselines, address missing data and distribution shifts, and validate performance across institutions, devices, and diverse patient populations. Evaluation should extend beyond retrospective discrimination metrics to outcomes relevant to patients and health systems, including visual function, referral appropriateness, time to treatment, treatment burden, safety, access, and patient experience. Transparent reference standards, independent external validation, uncertainty assessment, and rigorous reporting are also essential. The next phase of retinal AI research should move beyond technical performance toward clinically meaningful, externally validated, and patient-centered evaluation. Multimodal AI will have greatest impact when it demonstrates reliable incremental value and supports trustworthy, equitable, and scalable decision-making in real-world retinal care.
While many large language models (LLMs) have been extensively investigated for their clinical decision-making capabilities, few studies have characterized their abilities to reason through complex, open-ended ethics cases. This study compared GPT-5.1 and expert human ethicist responses to real-world ethical scenarios specific to ophthalmology. Ten ethical scenarios from the American Academy of Ophthalmology’s Ask the Ethicist website were randomly selected and presented to GPT-5.1 using ChatGPT. AI-generated responses were subsequently compared to those of the expert human ethicist using conventional readability metrics. A panel of 10 physicians independently rated all responses via 6-point and 5-point Likert scales for both outcomes of likelihood-of-use in their own careers and perceived patient impact, respectively. GPT-5.1 versus human ethicist responses differed significantly on Flesch Reading Ease (10.9 ± 9.6 vs. 25.4 ± 10.9, p = 0.002) and Gunning Fog Index (21.3 ± 1.9 vs. 19.5 ± 2.9, p = 0.037). For likelihood-of-use, median ratings were 4.1 [3.8–4.3] for human ethicist versus 5.0 [4.7–5.2] for GPT-5.1 responses (p = 0.013). Median ratings for perceived patient impact of human ethicist versus GPT-5.1 responses were 3.6 [3.3–3.7] versus 3.9 [3.8–4.4], p = 0.008. Inter-rater reliability was moderate for both outcomes and response sources (ICC [2, 10]: 0.56–0.69). Compared to human ethicist responses, GPT-5.1 responses demonstrated lower readability; however, GPT-5.1 responses received significantly higher ratings for both outcomes of likelihood-of-use and perceived patient impact, respectively. These results advocate for further explorations of GPT-5.1 and other LLMs as potentially useful tools for evaluating common bioethical challenges in ophthalmology.
To evaluate inflammation-related histopathological changes in the lacrimal sac, nasal bone, and nasal mucosa in patients with primary acquired nasolacrimal duct obstruction (PANDO). This prospective case series included 31 eyes of 31 patients who underwent external dacryocystorhinostomy due to PANDO. Lacrimal sac, nasal bone, and nasal mucosa specimens were obtained during surgery. The specimens were evaluated for the presence of chronic inflammation-related histopathological changes, specifically chronic inflammatory cell infiltration, fibrosis, and capillary proliferation. The severity of these histopathological changes was also graded. The male-to-female ratio was 10/21, and the mean age of the patients was 52.16 ± 9.12 years (range: 43–67). There were several inflammation-related histopathological changes in the lacrimal sac, including moderate inflammatory cell infiltration (38.71
To investigate Pentacam HR-derived topographic, topometric, tomographic, and corneal densitometric characteristics in asymptomatic offspring of patients with keratoconus and to determine the prevalence of keratoconus detected during screening in this high-risk population. In this cross-sectional study, 56 offspring of patients with keratoconus and 60 age- and sex-matched healthy controls without a family history of keratoconus underwent comprehensive ophthalmic examination and Pentacam HR imaging. Participants diagnosed with keratoconus during screening were excluded from comparative analyses. Topographic, topometric, tomographic, and corneal densitometric parameters were compared between groups. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the examined parameters. Keratoconus was identified in 8 of 56 offspring (14.3
To assess choroidal thickness (CT) and choroidal vascularity index (CVI) in a subclinical keratoconus (SK) population. A prospective, cross-sectional analysis was performed on 42 participants of unilateral keratoconus (KC), defined by clinical keratoconus (CK) in one eye and SK in the contralateral eye along with 42 age- and sex-matched healthy control participants. CT measurements were obtained at the subfoveal, nasal 750 µm (N750), and temporal 750 µm (T750) locations. Measurements of CVI, luminal area (LA), stromal area (SA), and total choroidal area (TCA) were calculated from enhanced depth imaging optical coherence tomography (EDI-OCT) images. Generalized estimating equations were used to account for the inter-eye correlation between CK and SK eyes. CT values at all three measured points differed significantly among the study groups (all p < 0.001). Both the CK and SK groups exhibited significantly greater CT than the control group at all measured locations. CK eyes also demonstrated significantly greater subfoveal CT than SK eyes (adjusted p = 0.003), whereas nasal and temporal CT did not differ significantly between the CK and SK groups. The CK group exhibited a significantly larger TCA than both the SK (adjusted p = 0.019) and control groups (adjusted p = 0.005). No significant differences were observed in LA (p = 0.173) or CVI (p = 0.104) among the groups, while SA demonstrated a significant overall group difference (p = 0.011), which was attributable only to the comparison between the CK and control groups (adjusted p = 0.016). The findings demonstrate increased CT in both CK and SK, whereas most quantitative choroidal vascularity parameters remained unchanged. These observations suggest that choroidal thickening may represent an early structural alteration in the keratoconus spectrum. However, these findings represent associations only, and the underlying biological mechanisms and their prognostic significance cannot be determined from this cross-sectional design.
This experimental study aims to assess the protective impact of combined treatment with ketamine (KTM), lamotrigine (LMT), and ketoprofen (KTP), agents that have demonstrated neuroprotective properties in other experimental contexts, on rabbit retinas in an experimental model of pars plana vitrectomy (PPV) and silicone oil injection (SOI). Thirty-six rabbits were divided into six treatment groups: saline, KTP, KTM+LMT, KTM+KTP, LMT+KTP, and KTM+LMT+KTP. All rabbits underwent PPV and SOI in the right eye. The left eyes served as negative controls. Histological assessments were conducted to evaluate cell densities and structural changes in the ganglion cell layer (GCL), the inner nuclear layer (INL), and the outer nuclear layer (ONL). Apoptosis was evaluated using the TUNEL method. The KTP group exhibited reduced apoptosis and partial protection in all retinal layers. The KTM+LMT combination significantly protected the GCL. The KTM+KTP group showed notable protection in the INL. The LMT+KTP combination was effective for both the INL and GCL. The KTM+LMT+KTP combination provided the most comprehensive protection across the ONL and INL. The cell densities in the ONL, INL, and GCL were significantly greater in the treatment groups than in the positive control group. The combination of KTM, LMT, and KTP exhibited significant neuroprotective effects on rabbit retinas following PPV and SOI. These findings suggest the potential of this combination treatment as a therapeutic strategy for retinal pathologies.
The influence of ocular prosthesis material and patient-related factors on clinical outcomes following enucleation with orbital implantation remains insufficiently characterized. This study evaluated clinical outcomes in relation to external ocular prosthesis material, age, and gender. This cross-sectional study included 58 patients who underwent enucleation with orbital implantation. Acrylic prostheses were used in 19 patients (32,6
To investigate short- and long-term effects of silicone hydrogel contact lens (SHCL) wear on the ocular surface and anterior segment, with a particular focus on corneal subbasal nerve morphology and corneal sensitivity using in vivo confocal microscopy (IVCM). Thirty eyes of 30 male participants without previous CL use were prospectively evaluated. Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), Schirmer’s test, corneal sensitivity, and tear meniscus area (TMA) were measured at baseline, 1 month, and 1 year. Corneal subbasal nerve parameters and dendritic cell density were assessed by IVCM. OSDI scores increased significantly after 1 month of SHCL wear (9.8 ± 2.34 vs. 16.6 ± 3.34; p < 0.001), accompanied by a significant rise in dendritic cell density (14.65 vs. 29.75 cells/mm2; p < 0.001). Both parameters returned to baseline after 1 year (p > 0.05). Corneal sensitivity remained stable at 1 month but declined significantly after 1 year (3.32 ± 1.06 vs. 2.03 ± 1.26 cm; p < 0.001). Subbasal nerve density, morphology, tortuosity, and reflectivity showed no significant alterations at either time point (p > 0.05). Short-term SHCL wear was associated with transient ocular surface inflammation and discomfort, whereas long-term wear was associated with reduced corneal sensitivity. No structural alterations were detected under the conditions of the present study.
To compare visual, anatomic, and graft-related outcomes after Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized versus non-vitrectomized eyes, and to identify factors associated with adverse outcomes in these eyes. This retrospective study analyzed DMEK performed between January 2018 and January 2025. Fifty-four vitrectomized eyes with pseudophakic bullous keratopathy (PBK) were compared with 50 non-vitrectomized PBK controls without major ocular comorbidity. Outcomes included best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD) and ECD loss, graft-related reinterventions, and cystoid macular edema (CME). 104 eyes were analyzed. BCVA and CCT improved significantly in both groups (p < 0.001). At 12 months, vitrectomized eyes had lower ECD (1458 ± 545 vs 1759 ± 436 cells/mm2; p = 0.030) and greater ECD loss (50.8 ± 18.6
To evaluate whether a cornea-specialized large language model (LLM) enhanced with retrieval-augmented generation (RAG) improves clinicians’ diagnostic and management accuracy in complex corneal cases compared to a general-purpose GPT-4o model and unaided clinician performance. This prospective, randomized, masked evaluation study involved three cornea trainees who each independently reviewed 39 real-world corneal cases under three experimental conditions: unaided, GPT-4o-assisted, and assisted by a cornea-specialized GPT-4o model. The cornea-specialized model was constructed by embedding over 200 publicly available Wikipedia articles into GPT-4o’s RAG framework. Participants provided open-ended diagnoses and selected the next-step management options (multiple choice). They were allowed up to three GPT-4o queries per case, and the AI-assisted arms were randomized to minimize bias. Accuracy for both tasks was compared against expert reference standards using McNemar’s test. Diagnostic accuracy was 48.7
To systematically compare the safety and efficacy of ciliary sulcus versus capsular bag fixation in pediatric intraocular lens implantation. We searched observational studies and RCTs in databases from inception until March 2025. Statistical analysis was performed using RevMan 5.4. Eight studies (843 patients) were included. No significant differences were found in postoperative BCVA, spherical equivalent, visual axis opacity, or inflammation incidence (p > 0.05). Ciliary sulcus fixation showed a significantly higher risk of secondary glaucoma (RR = 0.43, 95
