To investigate the association between hyperhomocysteinemia (HHcy) and retinal vein occlusion (RVO) in a high-altitude population, evaluate the relationship between different degrees of homocysteine (Hcy) elevation and RVO, and describe the distribution of branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). This hospital-based case-control study included 125 consecutive patients diagnosed with RVO and 125 healthy controls recruited from the same high-altitude region (≥ 2500 m) between July 2023 and March 2026. Demographic characteristics, cardiovascular risk factors, and laboratory parameters, including serum Hcy, folate, vitamin B12, lipid profile, hemoglobin, and hematocrit, were evaluated. HHcy was classified as mild (15–30 µmol/L), moderate (31–100 µmol/L), or severe (> 100 µmol/L). Patients with RVO were categorized as BRVO or CRVO. Multivariable logistic regression analysis was performed to identify factors independently associated with RVO. Patients with RVO had significantly higher serum Hcy concentrations than controls (18.26 ± 5.34 vs. 10.35 ± 3.12 µmol/L; P < 0.001), accompanied by significantly lower folate and vitamin B12 levels. HHcy was present in 68.0
Although often considered asymptomatic, optic disc drusen (ODD) may be associated with subtle changes in visual pathway function. In this study, the ability of dynamic pupillometry to reveal impairment in patients with visible ODD was examined. In this cross-sectional case‒control study, 67 eyes from 39 patients with visible ODD and 60 eyes from 30 controls comparable in age and sex were examined. All participants underwent fundus imaging, optical coherence tomography (OCT), and dynamic pupillometry. The parameters included the maximum and minimum pupil diameter (PD), mean constriction velocity (MCV), mean dilation velocity (MDV), constriction amplitude (CA), and mean mesopic and photopic PD. Fundus autofluorescence (FAF) intensity on the optic disc was graded 1 to 4 according to quadrant involvement. Group comparisons and FAF-grade associations were analyzed using generalized estimating equations (GEE) to account for inter-eye correlation. The MCV was significantly lower in ODD eyes compared with controls (1.50 ± 0.41 vs. 1.96 ± 0.74 mm/s; β = −0.41, 95
This study aimed to identify long non-coding RNAs (lncRNAs) differentially expressed in diabetic corneal neuropathy (DCN) and to explore candidate regulatory networks associated with DCN. A DCN mouse model was established, and RNA sequencing was performed on trigeminal ganglia (TG) from control and DCN mice. Differentially expressed lncRNAs and mRNAs were identified, followed by cis-target prediction, Gene Ontology (GO) enrichment analysis, correlation analysis, and construction of lncRNA-associated competing endogenous RNA (ceRNA) networks. The expression of selected lncRNAs was validated by qRT-PCR. RNA sequencing identified 85 upregulated and 127 downregulated lncRNAs, together with 246 upregulated and 223 downregulated mRNAs in DCN mice. Cis-target prediction identified 59 candidate lncRNA–mRNA pairs, and the corresponding protein-coding genes were primarily associated with biological processes including lipid metabolism and autophagy. Correlation analysis further supported coordinated expression within the candidate cis-associated lncRNA–mRNA pairs. CeRNA network analysis suggested that 88 lncRNAs may be associated with 19 mRNAs through interactions with 14 miRNAs. qRT-PCR confirmed the differential expression of E230016M11Rik, Snhg1, and Airn, supporting their potential as candidates for further mechanistic investigation in DCN. This study identifies differentially expressed lncRNAs (DElncRNAs) in DCN and provides candidate regulatory networks that may offer new insights into its molecular basis and guide future mechanistic studies.
To report descriptive early visual and refractive outcomes of different simultaneous-vision intraocular lenses (IOLs) implanted during refractive lens exchange (RLE) or cataract surgery in eyes with prior hyperopic LASIK or FemtoLASIK, without comparing individual IOL platforms or functional categories. Acibadem Maslak Hospital and Dunyagoz Etiler Hospital, Istanbul, Turkiye. Retrospective descriptive observational cohort study. Consecutive patients with documented prior hyperopic LASIK/FemtoLASIK who underwent bilateral RLE or cataract surgery with simultaneous-vision IOL implantation were included. IOLs were selected based on preoperative clinical profiles and categorized within the contemporary functional IOL framework as partial depth-of-field (partial-DOFi) enhanced, partial-DOFi extended, and full-DOFi continuous. This taxonomy was used as a descriptive framework only; the study was not powered to compare individual IOL models or functional categories. Primary outcomes included refractive predictability based on postoperative manifest refraction available for the full cohort, cumulative monocular uncorrected distance/intermediate/near visual acuity (UDVA/UIVA/UNVA; logMAR) at postoperative month 3 (POM3), and safety (loss of corrected distance visual acuity [CDVA] ≥ 2 lines). A right-eye-only patient-level sensitivity analysis was performed to assess the potential influence of inter-eye correlation. Sixty-four eyes of 32 patients were analyzed. At POM3, mean UDVA was 0.05 ± 0.05 logMAR; 90.6
To compare the efficacy and safety of five femtosecond laser platforms (FLPs) in femtosecond laser-assisted cataract surgery (FLACS) and guide clinical selection. Systematic searches (PubMed, Cochrane Library, Web of Science, Embase, ClinicalTrials.gov, Chinese databases) identified randomized controlled trials and cohort studies (from January 2009 to May 2024) on FLACS for age-related cataracts. Outcomes included cumulative dissipated energy (CDE), effective phacoemulsification time (EPT), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal endothelial density (CED), central corneal thickness (CCT), overall complications (OCs), capsular complications (CapCs), corneal complications (CorCs), and conjunctival complications (ConCs). Continuous outcomes were expressed as weighted mean differences (WMDs) with 95
Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease that affects almost all body organs. Although ocular manifestations such as lacrimal gland inflammation, orbital myositis, scleritis, and uveitis have been reported, there are currently no reports of ocular vascular involvement. Herein, we report a rare case of clinically suspected IgG4-RD presenting with acute occlusion of retinal choroidal microvessels. A 39-year-old male complaining of blurred vision in his right eye had a large area of white retinal lesions with unclear boundaries surrounding retinal blood vessels. Spectral-domain optical coherence tomography revealed typical paracentral acute middle maculopathy (PAMM) features. Fundus fluorescein angiography and indocyanine green angiography revealed two clearly defined high fluorescence areas. His platelets, erythrocyte sedimentation rate, C-reactive protein, serum IgG4 and D-dimer levels were significantly elevated. An enhanced computed tomography scan of the entire abdomen revealed inflammatory lesions in the pancreas and kidneys. A multidisciplinary team of ophthalmologists, rheumatologists, radiologists, neurologists, and general surgeons was convened. According to the 2019 American College of Rheumatology and the European League Against Rheumatism (ACR/EULAR) IgG4-RD classification criteria, our patient had a cumulative score of 27 as shown: serum IgG4 levels 4.045 g/L + 6, renal cortex thickening + 10. enhancement and weakening of pancreas, blurred tail edge of pancreas, dilation of pancreatic duct + 11. The patient was diagnosed with possible IgG4 RD with retinal and choroidal microvasculature involvement. The inflammation in the eyes, pancreas, and kidneys of the patient improved significantly after systemic immunosuppressive therapy with prednisolone and azathioprine. To our knowledge, this is the first reported case of clinically suspected IgG4-RD with retinal choroidal microvessels involvement in the absence of histopathological confirmation, broadening the known spectrum of ocular manifestations of IgG4‑related disease. A comprehensive multidisciplinary evaluation is recommended for joint diagnosis and treatment in patients with atypical manifestations of IgG4-RD. Ophthalmologists and internists should consider IgG4-RD in the differential diagnosis of unexplained retinal vascular occlusions, particularly in patients with systemic inflammatory markers or organ involvement.
Rhegmatogenous retinal detachment with choroidal detachment (RRD-CD) poses persistent surgical challenges, and the role of perioperative steroids remains controversial. This study developed a geometric model quantifying the mechanical impact of choroidal thickening on vitreous cavity dimensions, and to provide a mechanistic rationale for silicone oil (SO) underfill and retinal re-detachment in RRD-CD. A spherical geometric model quantified the effects of choroidal thickness changes (Δr) on vitreous cavity volume (ΔV) and the surface area of the inner choroidal boundary (RPE–Bruch’s membrane complex) (ΔS). We retrospectively reviewed clinical data from 23 patients with RRD-CD and selected three representative cases to illustrate the model’s predictions as proof-of-concept. The model predicts that a 1-mm uniform increase in choroidal thickness—assuming global, uniform thickening as a theoretical upper-bound scenario—reduces vitreous cavity volume by approximately 1.65 mL (23
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
To elucidate the pathogenesis of lacrimal drainage pathway disease-associated keratopathy (LDAK), we investigated the cytokine profile in tear fluid and the ocular surface microbiome in patients with lacrimal duct disorders. This multi-center prospective study enrolled patients with dacryocystitis or lacrimal duct obstruction treated between January 2020 and March 2023. Tear fluid cytokines from 25 samples from affected and contralateral eyes each were analyzed using a multiplex bead assay. Affected eyes were classified into severe (n = 17) and non-severe (n = 8) groups. In 12 eyes, samples were re-collected 3 months after lacrimal tube insertion. The conjunctival sac microbiota from 27 samples from affected eyes were analyzed using 16S rRNA gene sequencing. Alpha and beta diversity were evaluated using the Kruskal–Wallis test and PERMANOVA, respectively. Inflammatory cytokines, including IL-1β, IL-6, IL-8, TNF-α, MIP-1β, and MCAF, were significantly elevated in affected eyes compared with contralateral eyes (all P < 0.01). These levels were significantly higher in severe cases than in non-severe cases (all P < 0.05) and decreased significantly following lacrimal duct tube insertion (all P < 0.05). Microbiome analysis revealed that both alpha and beta diversity were significantly increased in affected eyes (Faith’s PD P < 0.001 and PERMANOVA P < 0.001, respectively); however, these alterations resolved and returned to a normal state following surgical treatment. Lacrimal duct disorders were associated with increased cytokine expression and altered microbiome composition on the ocular surface, which may be associated with the development of LDAK. The normalization of both the immune environment and microbiota following surgical intervention suggests that interactions between the immune system and the microbiome play a critical role in the clinical course of LDAK.
EFEMP1-associated maculopathy is a rare autosomal dominant retinal disorder that can resemble age-related macular degeneration. Genetically confirmed cases with detailed multimodal imaging and functional phenotyping remain uncommon. We describe the only molecularly confirmed case identified through the Irish national inherited retinal disease registry at the time of review. A 43-year-old man of Bengali ancestry, assessed in Ireland, presented with a 3-year history of progressive visual loss that had accelerated in the left eye during the preceding 3 months. Multimodal imaging demonstrated bilateral, nearly confluent posterior-pole and peripapillary drusenoid deposits, central hypoautofluorescence, outer-retinal disruption and sub-retinal pigment epithelium material, without haemorrhage, angiographic leakage or intra- or subretinal fluid. Formal perimetry demonstrated dense bilateral central field defects. Full-field electroretinography showed bilateral pan-retinal rod-predominant dysfunction, suggesting possible functional involvement beyond the macula, although this finding requires confirmation. A 28-gene macular-dystrophy panel identified the heterozygous pathogenic EFEMP1 variant NM_001039348.3:c.1033 C > T, p.(Arg345Trp). Accelerated unilateral visual decline prompted an empirical trial comprising three intravitreal bevacizumab injections administered at monthly intervals to the left eye because occult choroidal neovascularisation could not be definitively excluded. Visual acuity and optical coherence tomography findings remained unchanged and treatment was discontinued. Anatomical and visual findings remained stable at the 6-month follow-up. EFEMP1-associated maculopathy should be considered in adults younger than the typical age of onset of age-related macular degeneration who exhibit extensive radial or peripapillary drusen. Genetic testing can establish the diagnosis, inform counselling and help prevent unnecessary treatment. The rod-predominant pan-retinal dysfunction observed in this patient suggests a potentially broader functional phenotype, although confirmation in additional cases is required.
Longer axial length has been associated with lower odds of diabetic retinopathy (DR), but population-based evidence using directly measured axial length remains limited. We evaluated this association among Korean adults with diabetes using Korea National Health and Nutrition Examination Survey (KNHANES) 2017–2021 data. This cross-sectional study restructured right- and left-eye data into an eye-level dataset matching axial length with eye-specific DR status. The primary analysis used rescaled examination-weighted generalized estimating equations (GEE) accounting for inter-eye correlation and adjusted for age, sex, hypertension, body mass index, HbA1c, diabetes duration, and serum creatinine. Secondary analyses included unweighted GEE, axial length quartiles, ocular covariate adjustment, participant-level survey logistic regression incorporating KNHANES strata, primary sampling units, and examination weights, restricted cubic spline analyses, and an exploratory analysis of moderate-or-worse DR. Diabetic macular edema (DME) was summarized descriptively because of sparse events. Among 2,773 eyes from 1,450 participants, each 1-mm longer axial length was associated with lower odds of prevalent DR in the primary examination-weighted GEE model (OR, 0.881; 95
Vernal keratoconjunctivitis (VKC) is a chronic allergic ocular surface disease, and it remains unclear whether dry eye findings persist once the disease becomes inactive. We aimed to evaluate ocular surface parameters in patients with inactive VKC compared with healthy controls, and to explore whether the limbal and palpebral subtypes differ. In this cross-sectional study, 21 patients with inactive VKC (11 limbal, 10 palpebral) and 21 age- and sex-matched healthy controls were included. Tear breakup time (TBUT), Schirmer test, tear osmolarity, and central corneal sensitivity were assessed by a single examiner in a fixed test sequence, from the least to the most invasive, in one randomly selected eye per participant. Comparisons were performed between the VKC and control groups and between VKC subtypes. TBUT was lower in the VKC group compared with controls (median 7.5 s, IQR 5.0 to 9.0 vs. 10.0 s, IQR 8.0 to 14.0, p = 0.003). Schirmer test values were also lower in the VKC group, although the difference was not statistically significant (p = 0.066). Tear osmolarity and corneal sensitivity were similar between the groups. In the subgroup analysis, TBUT differed significantly among the groups (p = 0.011). Both limbal and palpebral VKC subtypes had lower TBUT values than controls (Bonferroni-adjusted p = 0.037 and p = 0.049), and no difference was detected between the two VKC subtypes. In this cohort, clinically inactive VKC was associated with reduced tear film stability. Tear osmolarity, Schirmer test results, and corneal sensitivity did not differ significantly from controls, although the small sample size limited the ability to detect differences.
The aim of this study was to evaluate the association between serum IgG4 levels and the presence, activity, and severity of thyroid eye disease (TED) within a single cohort of patients with Graves’ disease, and to assess the potential role of IgG4 as a complementary biomarker across the clinical spectrum of the disease. This cross-sectional study included 46 patients diagnosed with Graves’ disease, comprising 23 patients with TED and 23 without TED. All participants underwent a comprehensive ophthalmological and biochemical evaluation, including thyroid function testing, autoantibody profiling, and measurement of serum total IgG, IgG4, and the IgG4/IgG ratio. Disease activity was assessed using the Clinical Activity Score (CAS ≥ 3), and disease severity was classified according to the European Group on Graves’ Orbitopathy (EUGOGO) criteria. Serum IgG4 levels were significantly higher in TED patients than in those without TED (97.7 ± 92.6 vs. 52.9 ± 42.9 mg/dL; p = 0.041). The IgG4/IgG ratio was also increased (8.05 ± 6.75
Post-operative communication plays an important role in identifying complications after glaucoma surgery, yet communication patterns following glaucoma drainage device implantation remain poorly characterized. This study aimed to characterize post-operative telephone communication following glaucoma tube shunt surgery and evaluate associations between patient telephone encounters, urgent visits, and post-operative complications. Electronic medical records from a single tertiary academic eye center were reviewed for 449 patients who underwent primary glaucoma drainage device implantation (Ahmed, n = 215; Baerveldt, n = 234) between January 1, 2015 and December 31, 2019. Demographic data and details of telephone encounters within 3 months post-operatively were collected. Telephone calls were categorized into five reasons: post-operative symptoms, medication refills/renewals, medication-related concerns, questions regarding post-operative instructions, or follow-up scheduling. Frequency, timing, and reasons for calls were analyzed, as well as rates of post-operative urgent visits and complications. Statistical analyses included Wilcoxon rank sum and Fisher’s exact tests. 46.1
This study compared central visual quality in myopic children wearing spectacles with highly aspherical lenslets (HAL) versus traditional single-vision spectacle lenses (SV) and examined the association between contrast sensitivity and myopia control efficacy. Myopic children aged 8 to 15 years were enrolled. All participants had worn either HAL or SV spectacles for at least six months and were classified into HAL and SV groups. Central visual quality was assessed using the quick contrast sensitivity function (qCSF) with both HAL and SV test lenses in randomized order. Axial length was measured at the qCSF visit and again after six months. Seventy participants completed all examinations, with 31 in the SV group and 39 in the HAL group. A significant main effect of test lenses was found, with HAL test lenses yielding lower contrast sensitivity than SV test lenses (p = 0.002). A significant main effect of group was also observed (p = 0.01), with the HAL group showing lower contrast sensitivity than the SV group (mean difference: 0.10). This difference in central visual quality was consistent regardless of the test lens used (interaction effect p = 0.67). Contrast sensitivity was positively associated with axial elongation in the HAL group (p < 0.05) but not in the SV group. Satisfactory myopia control was defined as axial length progression of less than 0.055 mm over 6 months. A model with contrast sensitivity alone showed modest discriminative ability for myopia control (AUC = 0.63, p < 0.05). Adding covariates increased the AUC, but the improvement was not statistically significant (p = 0.08). In this exploratory subgroup analysis, lower post-wear contrast sensitivity was associated with slower axial elongation among HAL wearers, but prospective baseline validation is needed before clinical prediction can be established.
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 characterize binocular visual function in pediatric NOVL and evaluate its response to short-term accommodative suppression. In this retrospective case-control study, 22 children diagnosed with NOVL were enrolled and compared with age- and refractive error-matched healthy controls. Participants underwent optical coherence tomography (OCT), electroretinography (ERG), visual evoked potentials (VEP), microperimetry, and comprehensive binocular visual function testing. NOVL patients received topical tropicamide for 7 consecutive days and were reassessed on day 8 and at the final follow-up visit. Baseline LogMAR best-corrected visual acuity (BCVA) was 0.40 (0.28–0.52) in the NOVL group and 0.00 (0.00–0.00) in the control group. Structural and sensory pathway evaluations showed no significant differences between groups. Compared with controls, the NOVL group demonstrated reduced accommodative amplitude (P = 0.003), increased AC/A ratio (P = 0.002), and greater near exophoria (P = 0.004). On day 8 after intervention, BCVA improved to 0.00 (0.00–0.10) (P < 0.001), while spherical equivalent remained unchanged (P = 0.685). Visual acuity remained stable during follow-up. These findings suggest that visual impairment in a subset of children with NOVL may arise from dysregulation within accommodative-convergence control networks rather than sensory pathway deficits.
The effective optical zone (EOZ) after corneal refractive surgery is a critical determinant of postoperative visual quality, yet its magnitude and determinants remain variably reported. This study aimed to systematically compare the EOZ after small-incision lenticule extraction (SMILE) and flap-based femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia or myopic astigmatism, and to identify factors associated with EOZ. We conducted a PRISMA-compliant, PROSPERO-registered systematic review and meta-analysis (CRD420251075330). MEDLINE, CENTRAL, EMBASE, ClinicalTrials.gov, and WHO ICTRP were searched (January 2003–June 2025). Eligible randomized, nonrandomized, or cohort studies enrolled adults undergoing SMILE or FS-LASIK with reported EOZ. The primary outcome was the ratio of the EOZ area to the programmed optical zone (POZ) area (EOZ/POZ ratio). Two reviewers independently extracted data and assessed risk of bias. Random-effects models generated pooled estimates. Prespecified subgroup analyses examined surgical technique, myopia and astigmatism levels, change in spherical equivalent (ΔSE), POZ, and EOZ estimation method. Small-study effects were evaluated with funnel plots and Egger tests. Nineteen studies (39 arms; 2,300 eyes) met inclusion criteria. The pooled EOZ/POZ ratio was 0.65 (95
Performing intraocular surgeries such as glaucoma and cataract surgery in patients with severe hemophilia poses a significant challenge due to the high risk of vision-threatening hemorrhagic complications. There are few reports on the safe implementation of ophthalmic surgeries in patients with severe coagulation disorders complicated with multiple ocular diseases. A 49-year-old male patient with severe Hemophilia A and a 12-year history of Posner-Schlossman syndrome (PSS) was treated for secondary glaucoma in his right eye with trabeculectomy in October 2023. In October 2025, he received phacoemulsification and intraocular lens implantation for complicated cataracts caused by PSS in the same eye. With perioperative replacement therapy using coagulation factor concentrates and standardized and individualized surgical management measures, both surgeries were successfully completed and no serious postoperative bleeding-related complications occurred in the patient. This case demonstrates the feasibility of safe sequential glaucoma and cataract procedures in patients with severe coagulation disorders like hemophilia, when supported by perioperative coagulation factor replacement and individualized surgical protocols. In future ophthalmic surgeries, it is necessary to take into account both the recommended dosage in the guidelines and the patient’s psychological expectations, while also incorporating individualized pharmacokinetic testing, to ensure the safe and successful performance of the surgery.
Macular edema (ME) is a vision-threatening condition characterized by the accumulation of extracellular fluid in the macula due to disruption of the blood-retinal barrier. Although ME is commonly associated with underlying diseases such as diabetic retinopathy and age-related macular degeneration, pharmacologic agents may independently contribute to its development. The purpose of this study was to identify drugs associated with ME using a large global pharmacovigilance database and to evaluate differences in risk among drug classes. Data were obtained from VigiBase, the World Health Organization’s global database of individual case safety reports. All reports registered up to October 2, 2023 were screened, and cases in which ME was reported as an adverse event were extracted. Disproportionality analyses were performed to evaluate drug-event associations using the information component (IC), proportional reporting ratio (PRR), and odds ratio (OR). A positive lower bound of the 95
