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
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
Exudative retinal detachment is characterized by subretinal fluid accumulation; however, the cellular composition of subretinal fluid remains largely unknown owing to the rarity of surgically obtained samples. We report the first single‑cell transcriptomic analysis of subretinal fluid from a patient with systemic lupus erythematosus on long‑term oral glucocorticoids who developed rapidly progressive bullous exudative retinal detachment, aiming to elucidate the immune cell landscape and provide molecular evidence to guide individualized treatment decisions. A 48‑year‑old female with a 20‑year history of systemic lupus erythematosus presented with exudative retinal detachment in the left eye during long‑term glucocorticoid therapy. Best‑corrected visual acuity was hand motion in the right eye and 0.15 (20/133 Snellen) in the left. Fundus photography and optical coherence tomography revealed shallow retinal detachment, and fluorescein angiography showed progressive leakage. After two weeks of observation with worsening detachment, she underwent pars plana vitrectomy with silicone oil tamponade. Subretinal fluid collected intraoperatively was analyzed by single‑cell RNA sequencing. Compared with subretinal fluid from a rhegmatogenous retinal detachment, the exudative sample contained substantially more immune cells, predominantly macrophages. These macrophages exhibited an inflammation‑suppressing signature, characterized by downregulation of MHC class II genes and upregulation of TTR, RNASE1, and CCL18. Pseudotime analysis suggested differentiation toward a reparative, tissue‑resident phenotype. Based on these findings, glucocorticoids were tapered and discontinued postoperatively. At nine‑month follow‑up, the retina remained attached, and the patient was clinically stable. This study provides the first single‑cell transcriptomic profile of subretinal fluid in glucocorticoid‑associated exudative retinal detachment, revealing that macrophages in this patient’s subretinal fluid exhibited an immunosuppressive, reparative phenotype. Single‑cell sequencing can provide clinically actionable insights to guide individualized treatment strategies in patients with complex autoimmune conditions.
Pentacam-derived lens density provides an objective measure of lens opacity in cataract. However, the roles of ocular dominance and lifestyle-related factors in lens density variation remain unclear. This study investigated the association of ocular dominance and lifestyle factors with lens density in patients with age-related cataract. This cross-sectional study included 52 patients with age-related cataract recruited from Peking University People’s Hospital between May 15 and June 30, 2026. Ocular dominance, Pentacam-derived lens density, pupil parameters, visual acuity, and lifestyle factors were assessed. Paired tests, Spearman correlation, and linear regression analyses were used for statistical analysis. The mean age of participants was 66.5 ± 7.8 years. Dominant eyes exhibited significantly higher Pentacam lens density than non-dominant eyes (P = 0.024). Dominant eyes also showed smaller pupil area (P = 0.024) and smaller pupil diameter (P = 0.019) than non-dominant eyes. Best-corrected visual acuity (BCVA) was significantly lower in dominant eyes than in non-dominant eyes (P = 0.007). Dynamic pupil variability did not differ significantly between eyes (P = 0.104). Greater interocular differences in lens density were significantly associated with greater interocular differences in BCVA (r = − 0.403, P = 0.003). In multivariable regression analysis, dominant-eye BCVA was associated with dominant-eye pupil area after adjustment (β = −7.314, P = 0.017). In multivariable linear regression models adjusted for age, sex, and available lifestyle variables, smoking (β = 15.304, P = 0.025), alcohol drinking (β = 12.955, P = 0.012), and reading or using a phone with lights off (β = 18.869, P < 0.001) were associated with higher dominant-eye lens density. Ocular dominance was associated with lens density asymmetry in patients with age-related cataract. Higher dominant-eye lens density was related to worse dominant-eye visual acuity relative to the non-dominant eye. Smoking, alcohol drinking, and reading or using a phone with lights off were associated with higher dominant-eye lens density after adjustment for available covariates. These findings suggest that both ocular dominance and lifestyle-related factors may be relevant to lens opacity variation, although prospective studies are needed for confirmation.
To describe clinical characteristics, surgical management, and visual outcomes of work-related intraocular foreign body (IOFB) injuries and factors associated with visual acuity (VA) at the last recorded follow-up visit. This retrospective study included 59 patients with work-related IOFBs treated at a tertiary referral center (2017–2025). Clinical and surgical data were recorded, including IOFB location/size, retinal detachment, endophthalmitis, and surgical approach; the Ocular Trauma Score (OTS) was calculated where assessable. VA was converted to logMAR and analyzed continuously. Associations with follow-up VA were assessed with univariable tests and multivariable linear regression (initial VA, retinal detachment, posterior IOFB location, endophthalmitis, and their interaction), plus a follow-up-duration sensitivity analysis. Mean age was 43.5 ± 12.6 years and 98.3
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
To describe a novel, minimally invasive surgical technique, termed “posterior interception and elevation” for correcting Intraocular Lens (IOL) tilt following the Yamane double-needle intrascleral fixation technique. Eleven eyes with postoperative IOL tilt following Yamane fixation underwent the posterior interception and elevation procedure. Two 10 − 0 polypropylene sutures were placed posterior to the tilted IOL optic to intercept and elevate it into the correct anatomical position without manipulating the original haptics. Proper IOL centration and alignment were confirmed intraoperatively, and the sutures were secured within the scleral wall. All cases achieved successful IOL repositioning with no intraoperative complications. Postoperative imaging (AS-OCT) confirmed centered IOLs with resolved tilt. Patients reported excellent comfort, with no awareness of the intraocular sutures. No recurrence of IOL tilt or haptic dislocation was observed during the follow-up period. The posterior interception and elevation technique is a simple, rapid, and effective method for correcting IOL tilt after Yamane fixation. By avoiding manipulation of the original haptics, this minimally invasive approach reduces surgical trauma while providing stable anatomical and functional outcomes, representing a promising alternative to conventional haptic repositioning or IOL exchange.
