Background:Myopia is a global public health concern, and its prevalence has been increasing year by year worldwide. Orthokeratology uses gas-permeable contact lenses to reshape the corneal contour and correct low-to-moderate myopia. Orthokeratology has also been shown to reduce myopia progression in children. For adults, ortho-K lenses remain a viable option for myopia correction; however, their usage rate is relatively low due to maintenance difficulties and safety concerns. To date, few studies have compared the efficacy, safety, and corneal dynamics of ortho-K use between teenagers and adults. Methods:Subjects with myopia of either sex aged between 12 and 65 years were enrolled in this prospective open-label study. The subjects were fitted with Progressive Boston Orthokeratology Shaping Lenses for overnight wear and were instructed to wear (before going to sleep) the lenses for > 7 h each night and remove them in the morning, for 9 months. Manifest refraction spherical equivalent (MRSE) and uncorrected visual acuity (UCVA) were assessed. Results:Overall, 68 subjects (134 eyes) completed the study, and of these, 15 (22.06%) subjects were teenagers (≤ 19 years) and 53 (77.94%) subjects were adults (> 19 years). In the teenager and adult groups, the mean MRSE changed from -2.84 D and -3.31 D at baseline to approximately 0.0 D in both groups at 9 months. UCVA improved significantly in both groups, reaching approximately Snellen 20/20 (logMAR 0) within the first few weeks of treatment and remaining stable throughout the study period. No clinically significant increases in intraocular pressure were observed during treatment, and endothelial cell density remained clinically stable. Mild corneal staining occurred in a small number of examinations and resolved with conservative management. After discontinuation, both MRSE and UCVA in both groups quickly returned to baseline by Week 4. Conclusion:These findings suggest that orthokeratology is an effective option for temporary correction of low-to-moderate myopia in both teenagers and adults. Within the limitations of the sample size, orthokeratology may be considered a safe and effective myopia correction option for adults.
Objective:To investigate associations between baseline structural and functional biomarkers and 6-month post-treatment best-corrected visual acuity (BCVA) among patients with diabetic macular edema (DME) receiving intravitreal anti-VEGF therapy. Methods:Data from patients treated at Hebei Eye Hospital between December 2022 and January 2024 were retrospectively analyzed. Baseline biomarkers, including the disruption of the external limiting membrane (ELM) and ellipsoid zone (EZ), disorganization of retinal inner layers (DRIL), and epiretinal membrane (ERM) on spectral domain optical coherence tomography (SD-OCT), as well as the amplitude and implicit time of N1 and P1 waves in multifocal electroretinography (mfERG), were collected. The associations between these biomarkers and BCVA after anti-VEGF treatment were then assessed. Linear regression analysis was applied to quantify the correlations between baseline SD-OCT morphological biomarkers and 6-month anti-VEGF visual therapeutic efficacy. Multivariate logistic regression analysis was conducted to assess the efficacy of anti-VEGF treatment and baseline mfERG biomarkers. Results:A total of 87 eligible DME patients completed three monthly anti-VEGF loading injections and 6-month follow-up, including 48 patients in the response group and 39 in the nonresponse group. Linear regression assessed whether baseline retinal layer disruption predicted 6-month visual response and revealed that extensive ELM (t = 2.914, p = 0.004) and EZ (t = 2.112, p = 0.036) disruption at baseline and extensive DRIL (t = 2.922, p = 0.004) were associated with nonresponse defined as < 3 lines of BCVA improvement at 6 months after the final anti-VEGF injection. A multivariate logistic regression analysis indicated that, for an N1 implicit time of R1, each 1-ms reduction in N1 implicit time for Ring 1 corresponded to an adjusted odds ratio of 1.252 for favorable visual response (95% CI [1.101, 1.422], p = 0.001) after anti-VEGF treatment. The results were the same for an N1 implicit time of R2 (1.111, 95% CI [1.028, 1.201], p = 0.008), a P1 implicit time of R1 (1.049, 95% CI [0.998, 1.102], p = 0.029), and a P1 implicit time of R2 (1.105, 95% CI [1.012, 1.206], p = 0.025). Conclusions:Baseline SD-OCT and mfERG biomarkers were significantly associated with anti-VEGF treatment outcomes in this DME cohort. Shorter N1 and P1 implicit times in the first and second mfERG rings were correlated with favorable treatment responses, while extensive disruption of ELM and EZ, severe DRIL, and the presence of tractional ERM were linked to poorer anti-VEGF responses. These structural and functional biomarkers may offer potential prognostic reference value for evaluating treatment prognosis. Further large-sample and prospective studies are still required to validate their clinical applicability and routine use in guiding therapeutic decision-making.
Purpose:To evaluate the guideline knowledge alignment of two large language models (LLMs), GPT-5.5 Instant and DeepSeek-V4, and to determine their preclinical reliability as reference tools in refractive surgery. Methods:Using the 38 evidence-based recommendations of the international keratorefractive lenticule extraction (KLEx) guidelines as the gold standard, both LLMs were evaluated in their default configurations. Two ophthalmologists independently assessed the clinical safety and medical accuracy of the model responses using a 5-point Likert scale (1-5 points). Agreement between each model's recommendation strength and the guideline was quantified by intraclass correlation coefficient (ICC), structural reliability by the DISCERN scale, and readability by the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) indices. Results:Likert ratings did not differ between GPT-5.5 Instant (4.96 ± 0.206) and DeepSeek-V4 (4.89 ± 0.385; p = 0.134). Across 114 independent generations, the ICC for agreement with the guideline was 0.884 (95% CI, 0.836-0.918) for GPT-5.5 Instant and 0.739 (0.640-0.813) for DeepSeek-V4 (both p < 0.001). DISCERN scores were 70.18 ± 5.16 and 68.05 ± 5.41 (p = 0.085); FRE, 9.93 ± 8.33 and 3.74 ± 5.24 (p < 0.001); and FKGL, 16.07 ± 2.21 and 18.95 ± 1.96 (p < 0.001). Conclusion:Both models aligned closely with the guidelines, with significant concordance in GRADE-based recommendation strength. They may serve as preclinical reference tools in refractive surgery but not as a substitute for specialist judgment.
Purpose:To characterize alterations in peripapillary structural and microvascular features in children and adolescents with myopia across different stages of severity using swept-source optical coherence tomography angiography (SS-OCTA). Methods:This cross-sectional study was conducted with the enrollment of 106 eyes from 54 children. Three groups of Group A (AL ≤ 24 mm, 34 eyes), Group B (24 < AL < 25 mm, 37 eyes), and Group C (AL ≥ 2 5 mm, 35 eyes) were established based on the axial length (AL) of the included participants. All participants completed a standardized ophthalmic examination protocol, including best-corrected visual acuity (BCVA), autorefraction, AL and SS-OCTA. The specific parameters were the peripapillary retinal thickness (pRT), peripapillary choroidal thickness (pCT), peripapillary superficial vascular complex density (pSVD), peripapillary deep vascular complex density (pDVD), peripapillary choroidal vessel volume (pCVV) and peripapillary choroidal vascular index (pCVI). Data were analyzed using one-way analysis of variance and Pearson correlation analysis. Results:There were significant differences in pRT within the NS, NI, IT, TS, and ST regions with increasing AL (p < 0.05). The value of pCT decreased in the IT, TI, TS, and ST regions, while pDVD declined in the NS, IT, TI, TS, and ST regions, and pCVV decreased in the NS, NI, IN, IT, TI, and TS regions. Conversely, pSVD increased in the NS, NI, IT, TI, TS, and ST regions (all p < 0.05). Furthermore, significant positive correlations were found between pRT and pSVD, pDVD and pCT, pCVV and pCT, pCVV and pDVD, as well as pCVI and pCVV (R = 0.346, 0.297, 0.946, 0.298, and 0.361, all p < 0.05, respectively). Meanwhile, significant negative correlations were observed between AL and pCT, AL and pDVD, AL and pCVV, pRT and pDVD, pRT and pCVI, pSVD and pDVD, as well as pSVD and pCVV (R = -0.304, -0.236, -0.288, -0.402, -0.195, -0.332, and -0.203, all p < 0.05, respectively). Conclusion:The pRT shows a significant thinning trend when AL exceeds 25 mm. AL has negative correlations with pCT and pDVD, but positive correlations with pSVD in the IT, TI, ST, and TS regions. These findings highlight the potential of peripapillary structural parameters for monitoring myopia progression.
Purpose:To evaluate the 1-year outcome of vitreous cortex remnants (VCRs) removal using a nitinol flex loop during pars plana vitrectomy (PPV) in the treatment of recurrent retinal detachment (rRD). Patients and Methods:A total of 95 eyes from 95 patients with rRD with the intraoperative evidence of VCRs were retrospectively analyzed at the First Affiliated Hospital of Nanjing Medical University. Vitreous visualization was enhanced with triamcinolone. The presence of VCRs was determined by gently scraping the retinal surface with a disposable nitinol loop. Patients were divided into two groups: conventional PPV with the aid of vitrectomy probe and intraocular forceps between January 2022 and December 2022 (Group A, 41 eyes), and PPV assisted by the FINESSE Flex loop for VCRs removal between January 2023 and December 2023 (Group B, 54 eyes). Outcomes were assessed during follow-ups at postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. Primary outcomes included vitrectomy duration, single-surgery anatomic success rate, intraoperative and postoperative complications, and best-corrected visual acuity (BCVA). Results:Group B had a significantly shorter vitrectomy duration compared to Group A (p < 0.001). The incidence of intraoperative iatrogenic retinal breaks was significantly lower in Group B (3.7%) than in Group A (22.0%) (p = 0.015). Other intraoperative complications, including focal retinal hemorrhage and inadvertent lens touch, were comparable between groups (all p > 0.05). No cases of iatrogenic rhegmatogenous RD or vitreous hemorrhage were observed in either group. The single-surgery anatomic success rate was higher in Group B (98.1%) than in Group A (85.4%) (p = 0.049). No significant differences were found in the total number of RD surgeries or final BCVA between groups (p = 0.076 and p = 0.109, respectively). During the follow-up, unattached retinas occurred in 6 eyes in Group A and 1 eye in Group B; ocular hypertension was noted in 2 eyes in Group A and 3 in Group B. Conclusion:Use of the FINESSE Flex loop during PPV for rRD allows a shorter surgical duration, a lower incidence of iatrogenic retinal breaks, and a higher single-surgery anatomic success rate, without increasing postoperative complications.
Purpose:To introduce and evaluate the seminuclear flip phacoemulsification (SNFP), a new soft nucleus cataract phacoemulsification surgical technique, in comparison with the conventional quick-chop phacoemulsification (QCP). Design:Prospective observational study. Methods:According to the Emery-Little Classification System for grading nuclear opacity, 176 cases with nuclear hardness of Grades 1 and 2 were divided into two groups; one group received SNFP, and the control group underwent QCP. The intraoperative ultrasound time, ultrasound energy, complications, postoperative best-corrected visual acuity, central corneal thickness, and central corneal endothelial cell density were evaluated to determine the advantages of the new technique over conventional surgery. Results:The ultrasound time was significantly shorter in the SNFP group than in the QCP group (p = 0.01). The difference in the ultrasound energy between the groups was not statistically significant. Two cases of posterior capsule rupture were observed in the QCP group, while no such case was observed in the SNFP group. There was no significant difference in visual acuity or central corneal thickness between the two groups before the operation or 1 day, 7 days, or 1 month after the operation. There was no significant difference in the density of central corneal endothelial cells between the two groups before and 1 month after the operation. Conclusions:SNFP can improve the efficiency of phacoemulsification and reduce the complication risk in soft nucleus cataract surgery. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2200063495.
Background/Objectives:Inherited retinal diseases (IRDs) are a leading cause of blindness in working-age adults. Although artificial intelligence (AI) shows potential for disease classification, progress is limited by small datasets, reliance on labelled data and limited integration of multiple imaging modalities. RETFound, a foundation model pretrained on over 900,000 fundus photographs, may address these limitations. While RETFound is based on the transformer architecture, convolutional neural networks (CNNs), such as ResNet and EfficientNet_B0, have also demonstrated strong performance in classifying retinal diseases. This study adapted RETFound and CNNs for analysing fundus autofluorescence (FAF) and pseudocolour ultra-widefield (UWF) images, establishing a framework to classify IRDs. Subjects/Methods:Deidentified FAF and UWF images were obtained from controls and patients with Best disease, rod-cone dystrophy, Stargardt disease and choroideremia. Images underwent preprocessing and were used to fine-tune RETFound. Model performance was compared with classical machine learning algorithms (logistic regression, support vector machine, gradient boosting and random forest) and deep learning architectures (ResNet18, ResNet50, vision transformer, EfficientNet_B0 and ConvNeXt-Tiny) pretrained on ImageNet. Results:The fine-tuned RETFound model achieved an accuracy of 0.815, with the best performance for rod-cone dystrophy (F1 = 0.820). RETFound outperformed classical machine learning models and a vision transformer pretrained on ImageNet. ResNet18 achieved a weighted F1 of 0.839 and demonstrated the best classification performance for Stargardt disease and choroideremia (F1 0.821 and 0.728, respectively). ResNet50 achieved a weighted F1 of 0.825 and demonstrated the best classification performance for normal retinas and Best disease (F1 0.945 and 0.616, respectively). ResNet architectures achieved the best performance overall. Conclusions:ResNet architectures and fine-tuned RETFound both demonstrated strong accuracy in classifying IRD classes, demonstrating potential for clinical application and deployment in eye care settings as tools for IRD diagnosis, triage and management.
Purpose:To explore the clinical changes associated with intense pulsed light (IPL) combined with triamcinolone acetonide (TA) injections in patients with chalazion and to evaluate associated changes in Hospital Anxiety and Depression Scale (HADS) scores and meibomian gland lipid profiles. Methods:This study was designed as a retrospective single-arm pre-post case series involving 15 adult patients with chalazion who had not received alternative treatments for at least three months. No control group was included. The primary outcome was complete resolution of chalazion at the final follow-up (T2). Secondary outcomes included changes in ocular surface parameters (OSDI, TBUT, CFS, and SIT), psychological status assessed using the HADS, and alterations in meibomian gland lipid composition evaluated by lipidomic analysis. Results:All patients met the predefined criteria for complete chalazion resolution at the final follow-up (T2). Significant improvements were observed, with OSDI scores decreasing from 26.27 ± 5.11 to 16.6 ± 10.42, TBUT increasing from 3.23 ± 1.05 to 7.53 ± 2.75 s, and CFS reducing from 1 ± 1.13 to 0.27 ± 0.7. Depression (HADS-D) and anxiety (HADS-A) scores also decreased significantly. The SIT increased from 9.87 ± 5.05 to 11.27 ± 7.32, though not statistically significant. Lipidomics analysis identified 719 lipids, with significant reductions in sphingolipids (Cer and SM) and glycerophospholipids (LPC, LPE, PC, and PE) posttreatment (p < 0.05). A negative correlation was found between DG and TBUT, and a positive correlation between MGDG O and CFS. Conclusion:In this retrospective single-arm pre-post case series, IPL combined with TA treatment was associated with the resolution of chalazion and improvements in several clinical and lipidomic parameters. However, these findings should be considered exploratory and interpreted with caution, as spontaneous chalazion resolution and concurrent warm compress therapy may have contributed to the observed changes.
Purpose:To predict prognosis and aid in the treatment of residual strabismus/ocular misalignment by analyzing the pattern of ocular motility disturbances caused by orbital tumors, and investigating factors associated with the severity of misalignment or motility limitation. Methods:The medical records of 63 patients diagnosed with orbital tumors were retrospectively reviewed. The location, type, and size of the tumor were noted. The limitation of extraocular muscle (EOM) movement was quantitatively scored for upgaze, downgaze, abduction, and adduction by the severity of limitation on a grading scale of 0 to -4. The maximum range of abduction, adduction, supraduction, and infraduction was measured by image analysis based on 9 gaze photographs using the 3D Strabismus Photo Analyzer. Results:Twenty patients (29%) experienced ocular motility limitations in the affected eye. Twelve patients had orbital tumors situated in the extraconal space (60%), while the other 8 patients (40%) had lesions in the intraconal space. The mean size of extraconal tumors was significantly larger than intraconal tumors (p = 0.010), and there were no significant differences in tumor size between every four groups. In 75% of patients with extraconal tumors, ocular motility was limited toward the action of the adjacent EOM. Conversely, in cases with intraconal tumors, ocular motility was limited toward the opposite direction of the nearest EOM action in 75% cases. Compared with the normal fellow eye, significant limitations of ocular motility were observed in adduction (p = 0.043) and supraduction (p = 0.002). The size of intraconal tumors was the only significant factor related to ocular motility limitation (p = 0.010). Conclusion:Ocular motility limitations were more common with large extraconal tumors, mostly in the direction of the adjacent EOM. In contrast, ocular motility was limited toward the opposite direction of the nearest EOM with intraconal tumors. Tumor size in the intraconal space was the only significant factor associated with ocular motility impairment.
Purpose:Glaucoma is a leading cause of irreversible blindness, and Medicare payments influence access to and utilization of glaucoma procedures. This study examines the relationship between Medicare payments and service volumes for glaucoma procedures. Methods:This retrospective longitudinal study used Medicare Part B National Summary Data Files from the Centers for Medicare and Medicaid Services (CMS). Data for glaucoma procedures from 2013 to 2021 with at least five years of available data were analyzed. The dataset included service volumes, average payments, total practicing ophthalmologists, and Medicare Part B beneficiary trends across the United States. The relationship between Medicare payments and service volumes was quantified using payment-volume elasticities, calculated as the percentage change in procedural volume per 1% change in Medicare reimbursement. Results:Twenty procedures were evaluated. Minimally invasive glaucoma surgeries (MIGS) exhibited the greatest sensitivity, with a payment-volume elasticity of 4.67% (p < 0.001): for every 1% increase in payment, MIGS volume increased by 4.67%. Traditional Glaucoma Surgeries (TGS) had a payment-volume elasticity of 1.96% (p = 0.002), with a 1% decrease in payment resulting in a 1.96% decrease in TGS volume. Specific procedures like goniotomy (CPT: 65820) and aqueous drainage device (CPT: 66183) also showed significant elasticities of 4.27% and 4.13%, respectively. Conclusions:A significant relationship between Medicare payment adjustments and the utilization of glaucoma procedures was observed, with potential implications for access and care delivery. MIGS demonstrated the highest sensitivity to payment changes, suggesting that reimbursement policies could influence the adoption and availability of these surgeries beyond clinical decision-making.
Objective:To investigate the impact of chalazion history on meibomian gland loss and dry eye disease (DED). Methods:This study was a retrospective case-control study. Sixty patients with a history of chalazion admitted to a certain hospital from June 2021 to June 2024, who were selected as the previous chalazion group, and another 90 patients with no previous history of chalazion who visited the outpatient clinic consecutively during the same period were selected as the nonchalazion group. Comprehensive ocular surface parameters were compared between groups to evaluate long-term meibomian gland loss and DED. The chalazion group was further divided into MG loss (n = 42) and non-MG loss (n = 18) subgroups based on glandular loss status. Logistic regression analyzed factors influencing meibomian gland loss. The MG loss subgroup was stratified by severity into mild-moderate (< 1/3 or 1/3-2/3 loss) and severe (> 2/3 loss) groups for comparison of parameters of DED (Schirmer's test, tear break-up time [BUT], and fluorescein staining [FL]). Pearson's correlation assessed the relationship between meibomian gland loss severity and DED manifestations. Results:Significant differences were observed between the chalazion and nonchalazion groups in tear meniscus height, BUT, conjunctival redness index, and lipid layer thickness (p < 0.05). The MG loss subgroup indicated statistically significant differences from the non-MG loss subgroup in chalazion recurrence frequency, surgical history, tear meniscus height, BUT, conjunctival redness index, and lipid layer thickness (p < 0.05). All differential indicators demonstrated no collinearity (VIF ≤ 10, tolerance ≥ 0.1). Logistic regression identified chalazion recurrence frequency and surgical history as independent risk factors for meibomian gland loss. Pearson's analysis revealed negative correlations between meibomian gland loss severity and both Schirmer's test results (r1 = -0.761) and BUT (r2 = -0.543), and a positive correlation with FL scores (r3 = 0.752) (all p < 0.05). Conclusion:Retrospective analysis revealed that a proportion of patients with meibomian gland loss had prior chalazion history, demonstrating distinct ocular surface characteristics compared to nonchalazion patients. Recurrent chalazion episodes and surgical history were identified as significant contributors to meibomian gland loss, with glandular loss severity showing strong correlations with DED clinical parameters. These findings highlight the substantial impact of recurrent chalazion and surgical interventions on meibomian gland dysfunction and DED development, emphasizing the need for early clinical recognition and proactive management.
Purpose:Describe visual outcomes, rotational stability, and patient experience with a new, trifocal, toric intraocular lens (IOL), CNWTTx (Alcon, Fort Worth, TX.). Patients and methods:Prospective, cohort study in a private practice in Salt Lake City, UT. Patients 45 years and older with visually significant cataracts, bilateral regular corneal astigmatism requiring a T3-T6 IOL power lens, no other significant eye disease undergoing sequential cataract surgery with Clareon PanOptix Toric IOL (CNWTTx) followed for 3 months postoperatively. Primary endpoints: monocular corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA). Secondary endpoints: rotational position of the IOL and a patient satisfaction survey. Results:Twenty-five patients were recruited into the study and 22 received bilateral Clareon PanOptix Toric IOLs. At 3-month postoperative visit, visions were monocular mean CDVA of LogMAR (LM) 0.004, mean DCIVA of LM 0.110, and mean DCNVA of LM 0.056. 89% of patients had 0.5 diopters or less of residual astigmatism. Mean lens rotation was 1.67° at 1 month, and no lenses had rotated more than 5°. The majority of patients "never" used glasses at near (88%), at arm's length (100%) and at a distance (92%). In spite of 25% of patients noting photopic phenomena either "most of the time" or "always," a majority (88%) of patients were either "satisfied" or "very satisfied" with their vision, and 92% would have the same lens implanted again. Conclusion:The CNWTTx lens results in excellent visual acuities at distance, intermediate, and near, leading to high rates of spectacle independence. The lens is rotationally stable, and patients are subjectively satisfied with their visual outcomes.
Aims:To compare peripapillary retinal nerve fiber layer (pRNFL), choroidal microvascular dropout (CMvD) and vessel density (pVD), as well as macular ganglion cell complex (GCC) and vessel density (mVD) in eyes with glaucoma and optic neuritis (ON) due to multiple sclerosis (MS-ON) or neuromyelitis optica spectrum disorder (NMOSD-ON) using OCT and OCT angiography (OCTA), and to assess its correlations with visual acuity and visual field (VF) parameters. Methods:Thirty-one eyes (16 patients) with glaucomatous optic neuropathy (GON), 26 eyes (16 patients) with MS-ON, 19 eyes (12 patients) with NMOSD-ON, and 53 healthy eyes (27 subjects) underwent 24-2 VF, OCT, and OCTA. The pRNFL thickness, pVD, and CMvD, as well as macular GCC thickness and mVD, were analyzed and compared using generalized estimating equations. Area under the receiver operating characteristic curves was calculated. Results:All disease groups showed significantly reduced structural parameters compared to controls. MS-ON and NMOSD-ON did not differ and demonstrated greater GCC thinning than GON despite similar pRNFL thickness (except nasally). mVD did not significantly differ among disease groups. In contrast, superficial and deep pVD distinguished the disease groups from controls and were significantly lower in nasal and temporal sectors in MS-ON and particularly in NMOSD-ON compared to GON. Although CMvD occurred in all groups, it was significantly more frequent and extensive in GON. Significant correlations were found between OCTA and OCT and visual function parameters in MS-ON and NMOSD-ON but not in GON eyes. Conclusions:OCT and OCTA parameters seem to differentiate GON, MS-ON, and NMOSD-ON from controls, but substantial overlap exists among the diseases. The presence of CMvD, particularly when extensive, was more commonly observed in GON, although its presence in other groups limits its diagnostic specificity. Trial Registration: Brazilian Clinical Trials Registry: 76722517.2.0000.0068.
Background:Obstructive sleep apnea syndrome (OSAS) is characterized by intermittent partial or complete interruption of airflow due to upper airway collapse during sleep. Increased eyelid elasticity and the presence of a lax tarsus are features that define floppy eyelid syndrome (FES). The prevalence of FES may reach up to 64.5% among patients with OSAS. Despite its strong association with cardiovascular events, OSAS remains largely underdiagnosed. The objective of this study was to evaluate the degree of epidemiological association between FES and OSAS. Methods:Systematic reviews were evaluated to investigate the association between OSAS and FES in adults. This umbrella review was registered in PROSPERO and followed the PICO framework to define the research question. From August 2023 to January 2025, multiple databases were searched using relevant terms. The methodological quality of the included reviews was assessed using the AMSTAR 2 tool. Certainty of evidence was evaluated using a GRADE framework adapted for umbrella reviews, and an overlap analysis was performed. Results:Seven systematic reviews were included. According to AMSTAR 2, most were classified as having low methodological confidence. The final GRADE certainty ranged from low to moderate. Overlap analysis indicated moderate overlap. Nevertheless, the included studies consistently reported an association between FES and OSAS. Conclusion:Consistent with previous literature, this review supports an association between FES and OSAS. Identification of FES or EL during clinical examination may increase suspicion of OSAS. Despite its clinical relevance, this association remains underrecognized, and further studies using standardized diagnostic criteria are needed to strengthen the available evidence.
Purpose:The aim of the study is to investigate the role and possible mechanism of MicroRNA 200c (MiR-200c) in epithelial-mesenchymal transition (EMT) of Posterior Capsule Opacification (PCO). Methods:Human lens epithelial cells (LECs) were treated with TGFβ2 to induce EMT as a model for PCO. The mRNA levels of miR-200c and EMT markers were examined by real-time quantitative polymerase chain reaction (qPCR). Protein expression levels and mRNA levels of EMT-associated protein/transcriptional coactivators and Yes-associated protein (YAP) were also compared between miR-200c transfected and control cells by western blot analysis and qPCR. The scratch test was applied to detect the migration abilities of cells. Results:The expression level of miR-200c was upregulated in TGFβ2-induced EMT of LECs. Enhanced expression of miR-200c via agomir transfection accelerated both cell migration and the transition to a mesenchymal phenotype. Conversely, miR-200c inhibition using an antagomir effectively suppressed TGFβ2-mediated EMT. Bioinformatics analysis revealed that YAP signaling could be positively regulated by miR-200c, as evidenced by increased levels of YAP observed both in TGFβ2-treated groups and transfected with miR-200c agomir. Inhibition of Yap through the use of YAP-TEAD Inhibitor 1 (Peptide 17) effectively prevented the upregulation of key EMT markers such as FN, vimentin, and transcription factor SNAIL during TGFβ2-induced EMT. Conclusions:MiR-200c promotes EMT and migration in LECs by activating the YAP signaling pathway. MiR-200c may be used as a biomarker for the diagnosis or treatment in PCO.
Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) because of its immunomodulatory and anti-inflammatory benefits. However, long-term exposure can cause HCQ-induced retinopathy, a potentially irreversible adverse effect in which early detection is critical. This review summarizes the literature on the reported prevalence of HCQ-related retinal toxicity in SLE, highlights consistently supported risk modifiers (including higher daily dose relative to real body weight, longer duration/cumulative exposure, and renal impairment), and synthesizes current screening strategies centered on multimodal structural and functional testing. Spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), standard automated perimetry, and multifocal electroretinography (mfERG) are frequently emphasized as complementary tools for earlier detection, while emerging approaches such as OCT angiography-derived metrics and pharmacokinetic measures remain exploratory. Real-world screening adherence is often suboptimal, underscoring the need for implementation strategies that align dosing, risk stratification, and ophthalmic monitoring. Future work should standardize diagnostic definitions, clarify optimal screening intervals across risk strata, and prospectively validate promising biomarkers and automated screening workflows.
PurposeMechanical ocular injury involving the uvea poses significant surgical challenges and risks of irreversible visual impairment. Currently, there is no standardized classification to guide the management and prognosis of uveal injuries. This study aims to establish such a classification system.MethodsA methodological proposal for a novel classification was developed based on the most posterior location of uveal laceration/rupture and the extent of quadrant involvement. The classification was informed by clinical data with uveal injury. The system is designed to be determinable during clinical examination, emergency repair, or vitrectomy.ResultsThis study proposes a novel, standardized classification system for uveal injury based on the most posterior location of uveal laceration or rupture: Zone I (iris), Zone II (ciliary body), Zone III (choroid anterior to the equator), and Zone IV (choroid posterior to the equator), each subdivided (a-d) by extent of quadrant involvement. The system defines reproducible surgical approaches per zone.ConclusionThis novel classification is presented as a proposal to standardize the assessment of uveal injury, addressing a critical gap in existing ocular trauma systems. It provides a structured framework to guide surgical decision-making and anatomical restoration and to facilitate future research in the management of severe ocular trauma.
Purpose:To assess and compare visual quality and subjective outcomes of the toric and nontoric versions of a trifocal intraocular lens (IOL) combining a diffractive extended depth of focus (EDoF) profile with a diffractive multifocal pattern. Methods:This prospective cohort study included patients bilaterally implanted with the TECNIS Synergy or TECNIS Synergy Toric II IOL. At 3 months postoperatively, monocular and binocular uncorrected distance visual acuity (UDVA), corrected visual acuity (VA) at 100%, 50%, and 10% contrast, and binocular defocus curves were evaluated. A five-point Likert scale questionnaire assessed satisfaction at different distances, perception of halos, and willingness to choose the same lens again. Results:A total of 114 eyes (52 nontoric and 62 toric) were analyzed. Monocular UDVA was 0.02 ± 0.07 logMAR (nontoric) and 0.08 ± 0.11 logMAR (toric) (p = 0.02), while binocular UDVA was -0.05 ± 0.06 logMAR and -0.02 ± 0.10 logMAR, respectively (p = 0.13). Defocus curves showed VA better than 0.1 logMAR from +1.0 to -2.5 D in both groups. No significant differences in contrast sensitivity were observed between groups at any level (p > 0.05). Over 80% of patients in each group reported being satisfied or very satisfied at all distances. Halos were described as not or only slightly bothersome by 42% of patients. A small percentage expressed a low likelihood of choosing the same lens again (4% nontoric, 9% toric). Conclusion:Both IOL models provided similar and effective visual restoration from distance to near. Despite some reported visual disturbances, patient satisfaction and visual quality were high and comparable between the toric and nontoric lenses when appropriately aligned.
Background/Objectives:Postoperative endophthalmitis remains a vision-threatening complication despite advances in treatment. Current prognostic markers (Gram stain and initial visual acuity) have limited predictive values for real-time retinal neuronal function assessment and visual recovery. The purpose of this pilot study was to explore whether photopic electroretinograms might be used to forecast the endophthalmitis prognosis following intravitreal injection or phacoemulsification intraocular lens implantation. Subjects/Methods:This prospective observational study included 11 consecutive patients with acute postoperative endophthalmitis following phacoemulsification with IOL implantation (3 eyes) or intravitreal injections (8 eyes). ERGs were recorded using a portable RETeval™ system under nonmydriatic conditions. R Core Team (2019) was used to assess the preoperative electroretinogram outcomes, duration until the onset of endophthalmitis, procedure types of original surgeries, and pre- and postoperative best-corrected visual acuity. Results:Mean patient age was 79.23 years (range 62-88). A significant correlation was found between interocular photopic flicker latency difference and BCVA improvement (p = 0.04, < 0.05). Patients with ≤ 8 ms latency difference showed significantly better visual recovery (≥ 2-line gain). No significant correlations were found with diabetes status, original surgical procedure types, or time to symptom onset. Conclusion:In this hypothesis-generating pilot study of acute postoperative endophthalmitis, a smaller interocular flicker ERG latency difference at presentation is associated with better visual recovery. These preliminary findings suggest that this rapid, noninvasive functional test may have potential as a prognostic biomarker and warrants further validation in larger cohorts, complementing existing clinical and microbiological parameters in the management of this sight-threatening infection.
Neovascular glaucoma (NVG) secondary to diabetic retinopathy (DR) is a severe complication driven by ischemia-induced angiogenesis. Current evidence indicates that the pathogenesis begins with retinal hypoxia caused by hyperglycemia-induced capillary occlusion, which stabilizes hypoxia-inducible factor-1α (HIF-1α) and upregulates vascular endothelial growth factor (VEGF). VEGF-A and placental growth factor (PlGF) drive abnormal angiogenesis in the retina, iris, and anterior chamber angle. Downregulation of endogenous inhibitors such as pigment epithelium-derived factor (PEDF) may exacerbate this process. Concomitant inflammation mediated by cytokines including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), followed by transforming growth factor-β (TGF-β)-induced fibrotic angle closure, collectively leads to refractory intraocular pressure elevation and optic nerve damage. Clinical outcomes are influenced by genetic polymorphisms, renal comorbidities, and the aqueous humor biomarker profile. Current anti-VEGF monotherapy is limited by its inability to control fibrosis and inflammation, highlighting the need for multifaceted therapeutic strategies incorporating anti-inflammatory and antifibrotic agents. Critical knowledge gaps remain in longitudinal human data and preclinical models. To improve the prognosis of this devastating disease, shifting toward systemic metabolic management and prospective multiomics-based risk stratification may represent future directions.
