AimTo evaluate structural and locational changes of the macula and their relationship with visual acuity (VA) in children with retinopathy of prematurity (ROP).MethodsPremature children aged 7-12 years, included in the study. Children were divided into 3 groups: those without ROP (Group 1), those with spontaneously regressed ROP (Group 2), and those with laser-treated ROP (Group 3). Age-matched healthy term children were included in the control group. All children underwent eye examination. Axial length (AL), central macular thickness (CMT) and central choroidal thickness (CCT) were measured on optical coherence tomography (OCT). Horizontal distance between the foveal center (FC) and the temporal edge of the optic disc (OD) (HD-FTOD); horizontal distance between the vertical line passing through the FC and the inferior edge of OD (HD-FIOD); the closest distance between the foveal-located ETDRS grid and the edge of OD (D-FGOD); vertical distance between horizontal lines passing through the FC and tangent to the inferior edge of OD (VD-FIOD) were calculated. The results were compared between groups.ResultsMedian VA was lower in group 3 compared to group 1 and control (p =0.014). CMT was higher in group 2 and 3 compared to group 1 and control (p <0.001). There was no difference in CCT between the groups (p =0.093). HD-FTOD and HD-FIOD were longer in premature groups compared to the control (p <0.001), but VD-FIOD was similar in all groups (p =0.412). Increased minus cylinder and HD-FTOD were associated with increased logMAR scores and poor VA; increased age, birth weight, gestational age, AL, and VD-FIOD were found to be associated with decreased logMAR scores and good VA.ConclusionROP is associated with an increase in macular thickness. Foveal hypoplasia (macular developmental arrest) is common in cases with ROP. Prematurity, ROP and especially the development of ROP requiring treatment cause a temporal displacement of the macula. This displacement negatively affects visual prognosis. ROP affects both anatomical and functional maturation of the macula.
ObjectiveThis study systematically evaluated the clinicopathological characteristics, treatment strategies, and prognostic factors of ocular adnexal lymphoma (OAL) in a Western Chinese cohort to provide evidence supporting the development of management guidelines for Asian populations.MethodsThis study retrospectively analyzed 348 patients with pathologically confirmed OAL who underwent ophthalmic surgery at West China Hospital, Sichuan University, between 2010 and 2023. Clinical characteristics, imaging findings, histopathological features, treatment modalities, and follow-up data were collected. Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards regression.ResultsA total of 348 patients were included (median age, 58 years; 59.2% male). The most common presenting symptoms were a periorbital mass (60.92%), eyelid edema (40.8%), and proptosis (31.61%). Mucosa-associated lymphoid tissue (MALT) lymphoma was the predominant pathological subtype (82.18%). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 87.8% and 70.8%, respectively. Multivariate analysis identified advanced Lugano stage and aggressive histological subtype as independent predictors of poorer PFS and OS. Among the 179 patients with limited-stage MALT lymphoma, those who received postoperative radiotherapy achieved a significantly higher 5-year PFS than those managed with observation alone (90.8% vs. 54.1%, p < 0.001). Intraocular invasion was identified in two patients.ConclusionOAL is generally associated with a favorable prognosis, although outcomes vary considerably according to disease stage and pathological subtype. Comprehensive ophthalmic evaluation, accurate histopathological classification, and thorough systemic staging are critical for optimal management. In patients with limited-stage MALT lymphoma, postoperative radiotherapy is associated with a significant improvement in progression-free survival.
PurposeTo assess the changing reasons and frequency of IOL explantation respectively replacement in a long-term settingSettingEye clinic, Potsdam, GermanyDesignMonocentric retrospective observational case seriesMethodsA retrospective analysis of all patients who underwent IOL explantation at our clinic between 1/2009 and 07/2025 was conducted. Opacified IOLs were examined using light microscopy, electron microscopy and energy-dispersive X-ray spectroscopy.ResultsA total of 244 IOLs were replaced in our clinic. At the time of explantation, patients were 72 years old on average (±15.41; min 2 years; max 96 years). The most common reason for explantation (60%) was dislocation or subluxation of the IOL, followed by IOL opacities (18%), corneal decompensation associated with anterior chamber lenses (9%), visual disturbance in the refractive IOL (4%), refractive error (4%), cataract development due to phakic IOL (4%) and Uveitis-Glaucoma-Hyphema Syndrome (1%). Over the years, there has been an increase in IOL explantations. For all reasons for explantation, the median interval between primary IOL implantation and IOL replacement was 54 month (IQR, 3.6-132 months). All opacified IOLs exhibited calcification. Secondarily implanted IOLs most commonly used iris fixation (57%), followed by sulcus fixation (22%), capsular bag fixation (17%) and scleral fixation (4%).ConclusionThe most common reason seen for explantation was IOL dislocation, and the most common refixation site was the iris.
Gene therapy is an increasingly useful treatment option, especially in children, where most inherited diseases manifest. This review provides a literature synthesis of current gene therapy treatments in pediatric ophthalmology. Our search encompassed the ClinicalTrials.gov database. Sixteen clinical trials with published results reporting gene therapy for genetic ocular diseases in children (under 18 years) were included. Diseases under investigation for gene therapy in children included Leber's Congenital Amaurosis (CEP290, RPE65 genes), Leber's Hereditary Optic Neuropathy (ND4), Retinitis Pigmentosa (MERTK), Usher Syndrome Type 2 (USH2A), X-linked Retinitis Pigmentosa (RPGR), Achromatopsia (CNGA3, CNGB3), and X-linked Retinoschisis (RS1). Most clinical trials in our search were in Phases 1 or 2, with five studies having progressed to Phase 3. In certain cases, treatment demonstrated encouraging results, providing the patients with an improvement in BCVA, retinal sensitivity, and quality of life. However, the outcome measures regarding the efficacy and tolerability of gene therapy varied and some studies noted adverse events. Clinical trials that have yet to publish their results were also recorded. While the field of pediatric ophthalmology shows promise for gene therapy options, future strategies should include stratified enrollment based on age, separate cohorts for pediatric and adult patients, or adaptive trial designs.
BackgroundIdiopathic Canalicular Inflammatory Disease (ICID) lacks evidence-based management. We compared the long-term efficacy of four treatment modalities using anterior segment optical coherence tomography (AS-OCT) as an objective biomarker.Materials and methodsProspective randomized study included 52 patients (87 eyes) with ICID allocated to topical corticosteroids, cyclosporine A (Cs A), monocanalicular intubation, and combined therapy (intubation + Cs A). Evaluations included the Munk scale, punctal size, and AS-OCT morphometry at baseline, post-treatment, and at 6-12 months of follow-up.ResultsCs A monotherapy demonstrated the most stable functional outcome; the median Munk score decreased significantly and remained sustained at 6-12 months (72.7% success; median recurrence 473 days). Intubation yielded superior short-term anatomical results, but showed functional regression after extubation. Combined therapy demonstrated poor efficacy (0% success at 6-12 months; median recurrence 93 days), likely due to the stent-induced limitation of Cs A exposure. AS-OCT identified canalicular lumen diameter and punctal epithelial thickness as independent predictors of success. Conventional clinical scales have shown insufficient sensitivity compared to AS-OCT.Conclusion.Prolonged Cs A monotherapy provides superior long-term outcomes compared with mechanical interventions, supporting an anti-inflammatory approach. AS-OCT morphometry is a sensitive tool for predicting the treatment success. Combined therapy with simultaneous stent placement and Cs A should be reconsidered because of counterproductive mechanical barrier effects.
Pterygium is increasingly recognised as a localized manifestation of limbal stem cell deficiency (LSCD), rather than a purely degenerative lesion. This review synthesizes recent findings on the pathophysiological mechanisms underlying pterygium - particularly its links to UV-induced damage, epithelial-mesenchymal transition, and chronic inflammation - through the lens of limbal niche disruption. Histopathological and immunological evidence is complemented by advanced imaging modalities such as optical coherence tomography and in vivo confocal microscopy, which offer unprecedented insights into limbal architecture. Finally, the review under discussion here highlights emerging surgical paradigms, with a particular emphasis on limbal-conjunctival autografting as a means of reducing recurrence and restoring epithelial homeostasis. A more profound comprehension of limbal dynamics in pterygium has the potential to inform future diagnostic and regenerative interventions in ocular surface disease.
BackgroundCorneal deformations caused by keratoconus induce high optical aberrations (HOAs), which affect the quality of life even with an appropriate optical correction. Quality of life is mainly assessed using questionnaires, but their use in clinical practice is limited by the time required and their subjectivity. The aim of this study was to test the correlation between quality of vision assessed by aberrometry and quality of life questionnaire.MethodsVision-related quality of life was assessed using the NEI-VFQ 25 (National Eye Institute Visual Function Questionnaire). Quality of vision was evaluated using an aberrometer (OQAS®, HD analyzer, Visiometrics, Terrassa, Spain) based on two indices: the Objective Scattering Index (OSI) and the Tear Film Analysis (TFA).ResultsModerate negative correlations were observed between NEI-VFQ-25 total scores and OSI (r = -0.41; p = 0.0061) as well as TFA (r = -0.44; p = 0.0038) in keratoconus patients.ConclusionThese findings suggest an association between objective optical quality and vision-related quality of life in keratoconus. Aberrometry may be a rapid and clinically accessible complementary tool for assessing visual quality in routine practice. It could be used alongside patient-reported outcome measures. Further studies are needed to better define its role in clinical evaluation.
This systematic review evaluates the efficacy and safety of intraoperative intravitreal dexamethasone implant (DEXi) during cataract surgery in patients with diabetic macular edema (DME). Following PRISMA guidelines, PubMed and Scopus were searched up to March 2026, identifying 17 eligible studies. Intraoperative DEXi was associated with early improvements in best-corrected visual acuity (mean change from baseline ranging from approximately 0.15 to 0.60 logMAR across studies) and with reductions in central macular thickness (mean change from baseline ranging from an increase of approximately 7 µm to a reduction of approximately 195 µm), the magnitude of the anatomical response depending markedly on the timing of measurement and on baseline edema severity. Follow-up ranged from 3 to 24 months. Comparative evidence suggests simultaneous administration may accelerate visual recovery and anatomical stabilization compared with delayed treatment, potentially reducing postoperative interventions. Intraocular pressure elevation was the most frequently reported adverse event; it was generally mild and transient and manageable with topical therapy, with no major safety concerns, although long-term data remain limited. Despite study heterogeneity, the available findings are compatible with the feasibility and possible clinical benefit of combining cataract surgery with intraoperative DEXi in DME, although they do not allow firm conclusions to be drawn. However, the body of evidence consists predominantly of Level 3 and Level 4 studies, with only two small, randomized trials, and Low to Very Low certainty according to GRADE. Intraoperative DEXi may contribute to improving functional and anatomical outcomes but, given the Low to Very Low certainty of the current evidence, large-scale randomized trials are required before this approach can be routinely recommended, and to optimize patient selection and protocols.
BackgroundEarly detection of diabetic retinopathy (DR) is crucial for preventing blindness. Optical coherence tomography angiography (OCTA) offers a non-invasive method for visualizing retinal microvasculature and may facilitate earlier detection of DR. This systematic review evaluates the current evidence regarding OCTA-derived biomarkers for the identification of early DR.MethodsA systematic review of the literature was performed. Due to substantial heterogeneity in study designs, OCTA protocols, and outcome measures, a meta-analysis was not feasible.ResultsTwenty-one studies were included. OCTA scan sizes ranged from 3 × 3 mm to 6 × 6 mm and evaluated both the superficial and deep capillary plexuses. Vessel density (VD) was the most consistently reported biomarker, with reduced VD observed in early DR in 13 of 15 studies. Enlargement of the foveal avascular zone (FAZ) was reported in 9 of 17 studies. Microaneurysms were more frequently identified in diabetic eyes in 3 of 5 studies, while increased vessel tortuosity was reported in 2 of 5 studies.DiscussionCurrent evidence suggests that OCTA can detect retinal microvascular abnormalities associated with early DR before advanced clinical manifestations become evident. Reduced VD emerged as the most consistent indicator of early disease, while an increased microaneurysm burden may serve as a complementary marker. In contrast, the diagnostic value of FAZ alterations remains uncertain.ConclusionBy identifying the OCTA parameters most strongly associated with early DR, this review suggests the potential role of OCTA in earlier diagnosis, risk stratification, and monitoring of diabetic patients.
Background/AimsWe aim to report the risk factors, clinicopathological characteristics, treatment modalities, and outcomes of ocular surface squamous neoplasia (OSSN) and squamous papilloma (SQP) in a Chinese population.MethodsA retrospective cohort study was performed on subjects with histologically proven OSSN and SQP between April 2012 and August 2022 at two hospitals in Hong Kong.ResultsFifty eyes of 48 subjects were analysed, of which 24 were OSSN. The overall ten-year annual incidence rate was 0.34 per 100,000 persons. Men were more commonly affected. Moderate-to-severe dysplastic lesions were more frequently associated with pterygia or pinguecula (p = 0.034), diffuse growth (p = 0.0027), and involvement of the cornea and limbus (p = 0.0037) than benign lesions. Malignant lesions more frequently involved the fornix (p = 0.0086) and involved the inferior quadrant, although the latter did not reach statistical significance. There was no shift in surgical treatment patterns between the periods 2012-2016 and 2017-2022. Recurrence-free survival probabilities were 90% at 6 months and 87.0% at 1, 2 and 3 years, with a median follow-up duration of 24 months (IQR 2-48 months). No tumour-related mortality was recorded.ConclusionThe incidence of OSSN and SQP has remained stable over the last decade in our locality, where the prevalence of the Human Immunodeficiency Virus infection has been low. Male sex and a history of pterygia and/or pinguecula were associated with OSSN in our population. The majority achieved complete resolution following excision with or without adjuvant therapy.
BackgroundPlatelet-rich fibrin (PRF) is an autologous biomaterial rich in growth factors that can support tissue regeneration. Its effects on corneal wound healing, particularly in terms of shape and thickness, remain unclear.AimThis study aimed to evaluate the healing efficacy of PRF in experimentally created corneal wounds in rats using morphological, histological, and immunological assessments.MethodsFifty-four male Wistar albino rats were divided into three groups after corneal defects: 2 mm PRF + tarsorrhaphy, 5 mm PRF + tarsorrhaphy and sham (tarsorrhaphy only). PRF was applied in free form. Wound closure was measured at 24, 48, and 72 h using fluorescent staining. Histopathology and cytokines (EGF, TNF-α, IL-6, IL-10) were evaluated.ResultsWound areas decreased in all groups, and there was no significant difference between PRF and control corneas (p > 0.05). EGF increased at 24 h in the 2 mm group and remained high up to 72 h. TNF-α and IL-6 were higher in the 5 mm group at 48-72 h, while IL-10 increased with PRF thickness but did not suppress inflammation. Histopathological examination showed that epithelial regeneration was almost complete in the control corneas, while stromal edema, inflammatory infiltration, and neovascularization were observed in the PRF-treated corneas, especially in the 5 mm group.ConclusionFree-form PRF did not increase epithelial closure in rat corneal wounds and triggered a thickness-dependent inflammatory response; this indicates that PRF thickness must be carefully evaluated in ocular applications.
PurposeTo compare the anatomical and functional outcomes of DME treatment with anti-VEGF between patients with and without macular ischemia and investigate the association between OCT biomarkers and macular ischemia.MethodsRetrospective, multicenter, real-world analysis. Based on FFA before treatment, patients were divided into two groups: those with macular ischemia and those without macular ischemia. BCVA, CMT at 0, 6, and 12 months and treatment burden were recorded. Cyst patterns, EZ and/or ELM status, DRIL, hyperreflective foci, and presence of subretinal fluid were evaluated at every visit in OCT.ResultsA total of 1004 eyes from 770 patients were included. Macular ischemia was detected in 238 eyes (23.7%). Baseline BCVA was significantly lower in the ischemic group (0.81 ± 0.53 logMAR vs. 0.55 ± 0.39 logMAR, p = 0.0001). After adjustment for baseline covariates, ischemic eyes demonstrated longitudinal BCVA improvement at months 6 and 12 despite persistently lower overall vision levels. CMT significantly decreased over time in both groups without significant differences in anatomical response. Treatment burden was comparable between groups. Disorganization of retinal inner layers, hyperreflective foci, and vitreomacular interface abnormalities were significantly associated with macular ischemia.ConclusionIn real-world settings, eyes with macular ischemia showed meaningful functional and anatomical improvement after anti-VEGF therapy in DME, despite worse visual acuity throughout follow-up. Macular ischemia was associated with poorer final visual outcomes but did not preclude treatment response.
IntroductionUnderstanding the modifiable risk factors for Graves' orbitopathy (GO) is crucial for its prevention.MethodsWe searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Studies reporting the presence of GO compared to patients with Graves' disease (GD) without orbitopathy or healthy controls were included. Statistical analysis was performed using Review Manager 5.4.1.ResultsTwenty-two studies met the inclusion criteria. Smoking increased the risk of GO, with odds ratios (ORs) of 2.00 (95% CI [1.47, 2.72]; p < 0.0001) for current smokers and 1.77 (95% CI [1.33, 2.37]; p = 0.0001) for former smokers, compared with GD patients without orbitopathy. Thyroidectomy was associated with a higher OR of Graves' disease without orbitopathy, supporting a protective effect against orbitopathy (OR 2.53; 95% CI [1.03, 6.22]; p = 0.04). However, radioiodine therapy did not show a significant association (OR 0.89; 95% CI [0.42, 1.91];p = 0.77). Biomarkers, including vitamin D (p = 0.63), FT3 (p = 0.89), FT4 (p = 0.59), and TSH (p = 0.40), showed no significant differences. In comparison to healthy controls, smoking remained a major risk factor for GO (OR 4.81; 95% CI [1.39, 16.70]; p = 0.01), while elevated FT4 (MD 8.87; 95% CI [1.64, 16.10]; p = 0.02) and decreased TSH (MD -1.23; 95% CI [-2.25, -0.20]; p = 0.02) levels were found in the GO groups.ConclusionOur analysis provides a comprehensive understanding of clinical and biomarker-based risk factors to guide targeted prevention strategies.
BackgroundPatients affected by neovascular age-related macular degeneration (nAMD) require long-term anti-vascular endothelial growth factor (VEGF) therapy to maintain visual function. This study assessed 10-year functional outcomes as well as the cumulative incidence and progression of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in a real-world cohort.MethodsTreatment-naïve eyes of nAMD patients receiving intravitreal anti-VEGF therapy under a pro re nata regimen over 10 years were retrospectively analyzed. Demographics, visual acuity (VA) (LogMAR), number of injections, macular neovascularization (MNV) subtype, and treatment agents were collected. cRORA incidence was assessed according to the Classification of Atrophy Meeting (CAM) group, and the progression rate was quantified. Factors associated with final VA and cRORA progression rate were further investigated.Results35 eyes from 30 patients (63.3% female; mean age 74.9 ± 6.6 years) were analyzed. The median number of injections over 10 years was 69. VA declined by +0.016 logMAR/year, with a significant change compared to baseline only at the 10-year visit (p < 0.05). Baseline and 5-year VA correlated strongly with final VA (p < 0.001). cRORA developed in 48.6% of eyes, with a mean progression rate of 0.26 ± 0.11 mm/year.ConclusionOver 10 years, nAMD-affected eyes receiving anti-VEGF therapy demonstrated only a modest decline in visual function. While cRORA developed in nearly half of the eyes, no association with treatment intensity or MNV type was observed in this cohort. Early VA was significantly associated with long-term functional outcomes.
Purpose To evaluate the frequency and patterns of intravitreal therapy (IVT) switching in retinal diseases and describe associated visual acuity outcomes in real-world clinical practice. Materials and Methods This retrospective, monocentric study evaluated consecutive IVT-treated cases at a tertiary retina unit. Demographic data, diagnoses, initial agent, injection number, and treatment switches were recorded. Best-corrected visual acuity (BCVA, LogMAR) was assessed at baseline and final follow-up. Switching was defined as a change to another anti-VEGF agent or intravitreal dexamethasone (DEX) implant for inadequate functional and/or anatomical response. BCVA changes were compared using appropriate tests, stratified by indication (diabetic macular edema [DME], neovascular age-related macular degeneration [nAMD], retinal vein occlusion [RVO]). Results A total of 3,038 IVT-treated cases (11,345 injections) were analyzed. The main indications were DME (55.5%), nAMD (36.4%), and RVO (6.0%). Overall, 22.9% of treated cases underwent treatment switching, most frequently in DME (24.8%) and nAMD (20.8%). Within-group analyses showed significant BCVA improvement after switching in DME (p = 0.001), RVO (p = 0.032), and nAMD (p = 0.009), while non-switched groups showed no significant change. Aflibercept was the most commonly selected second-line agent (81.7%), and the aflibercept subgroup showed significant within-group BCVA improvement ( p < 0.001). Because treatment choice was not randomized, this finding should not be interpreted as evidence of superiority over other second-line agents. Conclusions In this retrospective real-world cohort, treatment switching was common in routine retinal practice, and switched cases showed within-group BCVA improvement in some diagnostic subgroups. These findings should be interpreted as descriptive associations rather than evidence of a causal treatment effect.
