Search Results (2,548)

Background: Cerebrovascular accidents (CVAs) are among the most serious complications of intra-arterial chemotherapy (IAC) for retinoblastoma (RB). This study evaluated the incidence and potential risk factors of this rare event. Methods: A retrospective cohort study included RB patients who received IAC at a tertiary cancer center. Diagnosis of CVAs was based on clinical and/or neuroimaging findings. Data included demographics, tumor features, complications, and outcomes. Meta-analysis was not feasible due to heterogeneity. A systematic review following PRISMA guidelines was conducted across major databases up to December 2025, including studies reporting CVA after IAC. Results: The cohort included 33 children who underwent 104 IAC procedures (Melphalan). CVA occurred in three patients (3/33 (9%) of patients, and 3/104 (2.9%) of procedures). Two were confirmed by neuroimaging, while one was a transient ischemic attack. Two patients (67%) were girls, and 2 of 3 (67%) were younger than 1 year. All events occurred during the IAC procedure and were ipsilateral to the treated eye. Two patients had no residual neurological deficits, while one showed improvement with only a minor residual deficit. The systematic review included 14 studies with 932 patients and identified 11 CVA events (1.2%; Range 0–9.1% per patient and 0–2.2% per IAC procedure). All were ischemic with variable presentations. Younger age, repeated catheterization, vasospasm, and embolic events were common risk factors. Outcomes were generally favorable. Conclusions: CVA after IAC, though rare, may be underreported. Events are likely procedure-related and influenced by age, treatment intensity, and vascular toxicity. Careful technique, close monitoring, and standardized reporting are needed to recognize/reduce the real risk. Full article

Background/Objectives: The objective was to describe the one-year outcomes of salvage trabeculectomy (TLE) in eyes with persistent elevation of intraocular pressure (IOP) requiring early surgical intervention after failed minimally invasive glaucoma surgery (MIGS). Methods: This retrospective observational study included 38 eyes of 38 consecutive Japanese patients who underwent TLE within 100 days after Trabectome (TOM) or microhook ab interno trabeculotomy (μTLO) because of uncontrolled IOP despite maximally tolerated medical therapy. Surgical success was defined as (1) IOP reduction ≥30% from baseline, (2) 5 < IOP < 18 mmHg, (3) no additional glaucoma surgery, and (4) no loss of light perception. The Kaplan–Meier method was used to estimate the one-year success rate. Changes in IOP, medication use, best-corrected visual acuity (BCVA), and mean deviation (MD) were analyzed using the Wilcoxon matched-pairs signed-rank test and a linear mixed-effects model. Results: The median interval between MIGS and TLE was 41.5 days (interquartile range, 28–70 days). The one-year surgical success rate was 86.8% (Kaplan–Meier estimate). IOP and medication use were significantly reduced after TLE (p < 0.0001) and remained stable throughout the 12-month follow-up. BCVA did not differ significantly between baseline and 12 months after TLE, whereas a small but statistically significant difference in MD was observed. No serious vision-threatening complications were encountered. Conclusions: TLE performed shortly after failed MIGS achieved substantial IOP reduction with acceptable safety over a one-year follow-up period. TLE may be considered as one of the surgical options in cases where sufficient IOP reduction cannot be achieved after failed MIGS, and no effective alternative treatments are available. Full article

Background: Dry Eye Disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and inflammation. Cyclosporine A, an immunomodulator, and Diquafosol sodium, a mucin secretagogue, represent two distinct therapeutic pathways. However, current evidence directly comparing their clinical efficacy is inconsistent. This meta-analysis aimed to compare treatment outcomes and efficacy between 0.05% Cyclosporine A and 3% Diquafosol sodium in patients with moderate-to-severe DED. Methods: In January 2026, we conducted a systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials directly comparing 0.05% Cyclosporine A to 3% Diquafosol sodium in adult patients with moderate-to-severe DED. For the meta-analysis, we used R 4.5.0 with R Studio 2024.12.1+563. Results: We included six RCTs with a total of 859 patients. No significant differences were found between Cyclosporine A and Diquafosol sodium in Tear Break-Up Time (TBUT) at 4, 8, or 12 weeks. Cyclosporine A showed a suggestive greater improvement in Schirmer test scores at 4 weeks (SMD = 0.35, 95% CI 0.07 to 0.63). A modest benefit in symptom scores favoring Diquafosol sodium was observed at 12 weeks (SMD = 0.23, 95% CI 0.06 to 0.41). Subgroup analysis suggested this symptomatic benefit may be more pronounced in patients with severe disease, although subgroup interaction tests were not statistically significant. There were no significant differences in corneal or conjunctival staining at any time point. The risk of adverse events did not differ significantly between treatments. Conclusions: Early improvement in tear production showed a potential benefit for Cyclosporine A, while longer-term symptomatic relief showed a potential benefit for Diquafosol sodium, with suggestive evidence in severe disease. However, these findings should be interpreted cautiously, given the methodological limitations and inconclusive TSA evidence for several outcomes. Future large-scale, standardized trials with extended follow-up are warranted to confirm these findings. Full article

Objectives: We aimed to descriptively evaluate the feasibility and clinical utility of TowardPi BO (4K ultra-HD microscope integrated with a 400 kHz swept-source intraoperative optical coherence tomography (SS-iOCT) system) in managing various ophthalmic surgical conditions in a real-world setting. Methods: We analyzed surgical videos and data from 123 consecutive cases that underwent elective surgery with the assistance of this SS-iOCT system at Beijing Tongren Hospital between 2 September 2025 and 10 February 2026. Cases were included when the iOCT provided critical, real-time information that directly influenced surgical decision-making or technique modification. Cases were excluded if iOCT served only routine confirmatory or educational purposes without altering the surgical plan. Results: A total of 72 surgical cases were included, comprising 7 intraocular lens implantations with ciliary sulcus fixation, 19 macular holes, 3 cases of macular hole retinal detachment (MHRD), 4 cases of macular schisis with or without foveal detachment (MSRD), 12 cases of submacular hemorrhage, 20 cases of rhegmatogenous retinal detachment (RRD), and 7 intraocular mass lesions. The 400 kHz SS-iOCT significantly aided in surgical visualization, guided real-time decision-making, and prompted modifications in surgical techniques. Conclusions: To our knowledge, this is the first real-world study to evaluate the application of a 400 kHz SS-iOCT system across a wide spectrum of ophthalmic conditions, including its novel use in intraocular tumors. From routine to complex surgical cases, SS-iOCT enhances surgical precision and facilitates real-time decision-making, ultimately contributing to improved surgical outcomes. Full article

Background/Objectives: Optical coherence tomography (OCT) and OCT angiography (OCT-A) provide detailed measurements of retinal structure and vasculature; however, age-related differences in how these parameters correlate with one another remain poorly understood. We hypothesized that vascular–structural integration in the macula is more pronounced in adults than in children. Our aim was to characterize correlation patterns in pediatric and adult populations to inform the development of age-specific clinical interpretation guidelines. Methods: This prospective cross-sectional observational study enrolled 37 healthy children (age 1–17 years) and 28 healthy adults (age 18–65 years). Eyes with ocular or systemic conditions affecting the retina or prior intraocular surgery were excluded. Standardized OCT and OCT-A acquisition protocols provided structural and vascular measures. Univariable correlation analyses applied a stringent threshold (p < 0.001) to identify robust associations. Significant univariable results were entered into multivariable regression models adjusting for age, gender, intraocular pressure, and axial length. A Group-wise Linkage Proportion quantified the percentage of potential significant correlations among eight predefined anatomical parameter groups. Results: Ninety univariable correlations met p < 0.001. Fourteen correlations were shared across age groups, notably foveal avascular zone metrics and vessel density, showing very large negative correlations (r = −0.70 to −0.87). The pediatric cohort displayed 40 unique correlations, primarily linking optic nerve head flow indices to retinal nerve fiber layer thickness. Adults exhibited 36 unique correlations, dominated by macular vascular–thickness coupling concentrated in the parafoveal region. After multivariable adjustment, 52 of 90 associations remained significant. Adult-specific associations lost significance more frequently (58%) than pediatric-specific associations (43%), whereas correlations shared across both groups showed complete stability (100%). The Group-wise Linkage Proportion indicated pronounced macular vascular–structural coupling in adults (48.4%) versus near absence in children (1.2%). Conclusions: Retinal parameter correlation patterns show fundamental differences between pediatric and adult eyes. While optic nerve head-macular thickness relationships remain consistent across ages, adults exhibit mature, localized integration of macular vascular and structural parameters absent in children. These findings suggest that pediatric and adult OCT/OCT-A measurements may benefit from separate reference standards, although prospective validation is required before clinical implementation. Full article

The progression of myopia in the pediatric population is currently highly prevalent. Thus, there is a need to look for new, effective methods that might suppress this pathological process. It not only affects visual comfort but also increases the risk of developing further ocular complications. The aim of the study is to review the literature and summarize contemporary methods for preventing the progression of myopia in children. The review is based on publications available on PubMed from the past 17 years, supplemented by the current literature on advanced digital technologies in ophthalmology. This article highlights that among other treatments such as orthokeratology, low-dose atropine or specialized lenses, there are also further beneficial options, including increased outdoor time, reduced screen time or the implementation of the latest medical innovations. The results indicate that defocus spectacle lenses may reduce myopia progression by approximately 50–67%, while orthokeratology has been associated with about a 46% reduction in axial elongation. Although there is a broad spectrum of therapeutic strategies, it is essential to develop novel approaches to myopia prevention in children to improve their quality of life from childhood into adulthood. Full article

Background/Objectives: To evaluate the clinical outcomes and prognostic factors of Baerveldt glaucoma implant (BGI) surgery performed as a primary filtering procedure in eyes without prior glaucoma filtering surgery. Methods: This retrospective cohort study included 148 eyes of 148 patients who underwent BGI surgery with a 350-mm² endplate at a single tertiary center. Surgical success was defined using three intraocular pressure (IOP)-based criteria: IOP > 21 mmHg (criterion A), >17 mmHg (criterion B), or >14 mmHg (criterion C), failure to achieve ≥ 20% IOP reduction, need for additional glaucoma surgery, loss of light perception, or persistent hypotony. Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate surgical outcomes and prognostic factors. Results: The 5-year cumulative probability of surgical success was 70.6%, 49.8%, and 27.6% for criteria A, B, and C, respectively. Mean IOP decreased significantly from 33.5 ± 10.0 mmHg preoperatively to 13.9 ± 4.0 mmHg at 5 years (p < 0.01); number of glaucoma medications decreased from 4.0 ± 1.2 to 1.8 ± 1.9 (p < 0.01). Younger age was associated with a higher risk of surgical failure (criterion A: hazard ratio [HR] 0.97, p < 0.01; criterion B: HR 0.98, p = 0.011; criterion C: HR 0.97, p < 0.01). More previous intraocular surgeries were associated with failure under criterion B (HR 1.30, p = 0.048). Early and late postoperative complications occurred in 34.5% and 14.2% of eyes, respectively; 20.9% required additional postoperative interventions. Conclusions: BGI surgery performed as a primary filtering procedure demonstrated favorable long-term IOP control in eyes without prior glaucoma filtering surgery. Younger age was identified as a consistent risk factor for surgical failure. Full article

Background: Neovascular age-related macular degeneration (nAMD) remains a leading cause of irreversible central vision loss. Although anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed management, pivotal trials enrolled exclusively treatment-naïve patients, leaving clinicians without pooled evidence to guide switching decisions in previously treated eyes. This systematic review and meta-analysis assessed real-world visual, anatomical, durability, and safety outcomes following switching to aflibercept 8 mg in previously treated nAMD. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, CENTRAL, Scopus, and Google Scholar through April 2026. Studies reporting switching to aflibercept 8 mg with change in best-corrected visual acuity (BCVA), central subfield thickness (CST), or treatment interval were included. Continuous outcomes were pooled using random-effects models with Hartung–Knapp–Sidik–Jonkman adjustment; proportions were estimated using generalized linear mixed models. Methodological quality was evaluated using the JBI Critical Appraisal Checklist for Case Series. Certainty of evidence was assessed using GRADE. The protocol was registered with PROSPERO (CRD420261371334). Results: Twenty-one studies met inclusion criteria. BCVA remained stable (WMD: −0.017 logMAR; 95% CI: −0.027 to −0.007; +0.83 ETDRS letters; I² = 0%). CST decreased significantly (WMD: −21.5 µm; 95% CI: −29.3 to −13.7; I² = 56.0%), and treatment intervals extended by +1.79 weeks (95% CI: +1.32 to +2.27; I² = 74.3%). Intraretinal and subretinal fluid each resolved in 37.5% of eyes. Intraocular inflammation was rare across 9959 treated eyes, though this pool was not restricted to switched eyes, with no confirmed retinal vasculitis. Sensitivity analyses confirmed robustness across all co-primary estimates. GRADE certainty was low for BCVA and very low for CST and treatment interval. Conclusions: Low-certainty evidence suggests that switching to aflibercept 8 mg preserves visual acuity, while very-low-certainty evidence suggests reductions in central subfield thickness and modest extension of treatment intervals. Intraocular inflammation was rare, though safety denominators included non-switch eyes. These findings provide preliminary pooled estimates to inform switch decisions in previously treated eyes. Full article

Purpose: To report intraoperative safety and postoperative complications after small-incision lenticule extraction using the 2 MHz femtosecond platform (SMILE Pro; VisuMax 800) in routine practice. Methods: Retrospective consecutive case series at a single center. All planned SMILE Pro procedures were analyzed (916 eyes from 482 patients). Outcomes included completion rate, intraoperative events, postoperative complications stratified as <3 and >3 months, and retreatment rate. Results: Baseline age was 32.9 ± 6.9 years; average preoperative refraction was −3.60 ± 1.90/−0.87 ± 0.76 D (sphere/cylinder) with best corrected visual acuity of −0.08 ± 0.07 logMAR. Procedures were completed in 911 of 916 eyes (99.45%). Suction loss occurred in six eyes (0.66%); one was completed after redocking, four were converted (two ICL, two femtosecond LASIK) and one did not receive a second procedure. No failed lenticule separations occurred. Retreatment was performed in 14 eyes (1.54%): 11 re-LASIK, 2 ICL, and 1 cataract extraction. Early postoperative events (<3 months) were mainly superficial punctate keratitis (3.51%) and dry eye (1.32%); beyond 3 months, events remained uncommon (dry eye 1.65%, photopsia/halo/glare 0.88%). No severe or sight-threatening complications were observed. Conclusions: SMILE Pro on the VisuMax 800 showed a high completion rate, rare intraoperative disruption, low retreatment, and rare, mostly mild postoperative events. These findings support a favorable early safety profile in routine practice; longer-term follow-up is warranted. Full article

Purpose: To investigate whether the season in which photorefractive keratectomy (PRK) with mitomycin C (MMC) is performed influences postoperative corneal transparency considering seasonal variations in ultraviolet (UV) exposure. Methods: This retrospective study included 100 eyes of 50 patients who underwent MMC-assisted PRK for myopic refractive error. Patients were divided into two groups based on the season of surgery: winter (November–April, low UV exposure) and summer (May–October, high UV exposure). All patients were evaluated preoperatively and at 12 months postoperatively. Corneal transparency was objectively assessed using Scheimpflug-based corneal densitometry obtained with the Pentacam system, focusing on the central (0–2 mm) and paracentral (2–6 mm) zones. Postoperative densitometry values were compared between seasonal groups. Results: Corneal densitometry values showed a significant reduction postoperatively compared with preoperative measurements in both central and paracentral zones. When comparing seasonal groups, no statistically significant differences were observed in postoperative densitometry values between eyes operated on during summer and winter months. No clinically detectable corneal haze was observed in any patient throughout the follow-up period. Conclusions: Surgical season did not significantly influence postoperative corneal densitometry or clinically detectable haze formation after MMC-assisted PRK for low-to-moderate myopia, suggesting that deferral during high-UV months may not be necessary with standard postoperative UV protection. Full article

Background/Objectives: This study aimed to evaluate the biomechanical characteristics of the cornea to assess their diagnostic accuracy in distinguishing normal eyes from those suspected keratoconus eyes. Methods: In this cross-sectional study, corneal elevation and curvature radius were measured in 217 participants using Pentacam. Average values were obtained based on the best-fit sphere (BFS) and the enhanced best-fit sphere (EBFS). The biomechanical characteristics of the cornea were assessed using the Corvis ST device. Receiver operating characteristic curve analysis was performed to determine the diagnostic accuracy. Results: The radii of the BFS in the anterior and posterior corneas were significantly larger in the normal group compared to the suspected keratoconus group. Conversely, EBFS elevation values in both the anterior and posterior corneas were lower in the normal group. The velocity at which the cornea was first flattened had the highest diagnostic accuracy for identifying suspected keratoconus. Conclusions: Eyes with suspected keratoconus had a significantly smaller corneal radius on both the anterior and posterior surfaces compared with normal eyes. In addition, due to the increased deformability and reduced resistance to a given force, these parameters serve as valuable biometric indicators for distinguishing suspect eyes from normal eyes. Full article

Background: Long-duration spaceflight (LDSF) poses unique challenges to ocular health as microgravity, radiation, and environmental changes can cause lasting visual and structural impairments that affect astronaut performance. Objective: This review synthesises current evidence on in- and post-flight ocular complications. It integrates clinical findings, terrestrial analogues, animal studies, and theoretical models to characterise the pathophysiology, risk factors, and countermeasures associated with spaceflight-induced ocular changes. Methods: A review of peer-reviewed literature was conducted, focusing on dry eye disease, corneal edema, ocular biometric shifts, spaceflight associated neuro-ocular syndrome (SANS), and radiation-induced cataractogenesis. Data from in-flight imaging, post-flight assessments, and ground-based analogues were analysed. Results: Spaceflight induces multifactorial ocular changes, including tear film instability, optic disc edema, posterior globe flattening, and hyperopic refractive shifts. These effects are thought to result from cephalad fluid shifts compartmentalised cerebrospinal fluid pressure, venous congestion, and impaired glymphatic system. Long-term risks, such as cataractogenesis, are linked to radiation exposure and genetic susceptibility. Although several countermeasures are being explored, no single approach fully prevents these complications. Conclusions: Ocular complications during LDSF remain a significant challenge for astronaut health and mission performance. A multimodal approach combining mechanical, nutritional, and diagnostic strategies will be essential for future exploration-class missions. Further research is needed to refine countermeasures and preserve astronauts’ visual function. Full article

Background: Intravitreal injections (IVI) are widely used for the management of retinal diseases, yet younger adults are underrepresented in clinical trials and real-world reports. Data on the etiologic distribution and treatment patterns of IVI in patients aged ≤50 years remain limited. This study aimed to characterize the indications, treatment strategies, and visual outcomes of IVI in this age group. Material and Methods: Retrospective, single-center observational study including adults aged 18–50 years who received IVI between January 2020 and December 2023 at a tertiary referral hospital in Spain. Demographic data, diagnosis, treatment modality, regimen, number of injections and best-corrected visual acuity (BCVA) were collected. One eye per patient was included for analysis. Visual outcomes were assessed as change in logMAR BCVA between baseline and final follow-up. Results: A total of 122 patients were included. The most frequent indications were diabetic macular edema (29.5%), macular neovascularization of various etiologies (21.3%), retinal vein occlusion (13.9%) and uveitis (9.8%). Anti-vascular endothelial growth factor (anti-VEGF) agents were used in 80.3% of eyes, corticosteroids in 6.6% and combination therapy in 13.1%. The mean number of injections per patient was 6.0 ± 5.3 over a mean follow-up of 3.0 ± 2.5 years. Overall BCVA improved significantly from 0.50 ± 0.59 to 0.38 ± 0.50 logMAR (p = 0.012). Conclusions: IVI in adults ≤ 50 years is uncommon but encompasses a broad etiologic spectrum. Diabetic macular edema and macular neovascularization of diverse etiologies were the leading indications. Anti-VEGF therapy represented the main treatment modality in this cohort. Full article

Objectives: To prospectively compare the outcomes of external dacryocystorhinostomy (EX-DCR), endonasal dacryocystorhinostomy (EN-DCR), and laser-assisted transcanalicular dacryocystorhinostomy (TL-DCR) in patients with nasolacrimal duct obstruction (NLDO) and to evaluate the relationship between surgical outcomes and patient quality of life (QoL). Methods: This prospective comparative study included patients presenting with epiphora who were diagnosed with NLDO and scheduled for surgical treatment. Patients underwent EX-DCR, EN-DCR, or TL-DCR according to patient preference and nasal anatomical characteristics. All patients received bicanalicular silicone tube intubation. Follow-up examinations were performed on postoperative day 1, week 1, at month 1, and every three months thereafter. Anatomical success was defined as patency on nasolacrimal irrigation, and functional success was defined as a postoperative Munk score of ≤ 1 (complete or near-complete resolution of epiphora). QoL was assessed using the Lacrimal Symptom Questionnaire (Lac-Q) and the Glasgow Benefit Inventory (GBI). Statistical comparisons were performed between groups. Results: A total of 69 patients (45 women, 24 men; mean age 58.99 ± 14.86 years) were included, with a mean follow-up of 17.19 ± 4.07 months. The highest postoperative pain scores were observed in the EX-DCR group; with no significant intergroup differences. Anatomical success rates were 92% for EX-DCR, 90.5% for EN-DCR, and 91.3% for TL-DCR. Functional success rates were 88%, 90.5%, and 82.7%, respectively, with no statistically significant difference among techniques (p > 0.05). All groups showed postoperative improvement in Lac-Q and GBI scores. Numerically greater improvements were observed in the EN-DCR group, although intergroup differences were not statistically significant. Conclusions: EX-DCR achieved the numerically highest anatomical success rate, whereas EN-DCR demonstrated numerically greater improvement in patient-reported QoL outcomes. However, no statistically significant differences in anatomical success, functional success, or QoL measures were observed among the three techniques. Overall, all three procedures were effective surgical options for the treatment of NLDO. Full article

Background: Despite the rise of endoscopic approaches, the direct brow lift remains one of the most effective procedures for correcting brow ptosis for both functional and cosmetic indications. It continues to offer superior control when correcting brow shape, height, and asymmetry. However, visible scarring remains a concern. This systematic review was conducted to synthesize recent evidence on strategies that minimize visible scarring in direct brow lift surgery. Methods: A systematic literature search was performed to retrieve English-language publications from the past decade, discussing scar-minimization strategies in direct brow lift. A total of 124 records were identified through database searches in Ovid MEDLINE and Embase. Records were screened manually according to predetermined criteria, and those not in English, not addressing scarring, or not focused on direct brow lift were excluded. After this process, ten publications were included in the final qualitative synthesis. Results: The qualitative synthesis of all included publications (together comprising data on approximately 900 patients) revealed several strategies for scar minimization. (1) Incision beveling: A shallow cranially directed bevel between 20° and 45° preserves brow hair follicles and allows hair regrowth through the scar, providing natural camouflage. (2) Undermining: Gentle subcutaneous undermining in a limited 1–2 cm field, while preserving subcutaneous fat, allows tension-free advancement and maintains brow volume. (3) Periosteal suspension: Anchoring the mobilized brow flap to the frontal periosteum redistributes tension away from the dermal closure, maintaining elevation and improving scar quality. (4) Layered closure: Two- or three-layered wound closure with deep dermal anchoring and fine everting skin sutures minimizes dermal traction and scar widening. (5) Adjunctive measures: Evidence for topical silicone gel was inconclusive, whereas postoperative laser therapy and perioperative neuromodulator use demonstrated improved scar appearance. Across studies, outcomes were consistent, with high patient satisfaction, inconspicuous scars in over 85% of cases, and low complication or revision rates. Conclusions: Direct brow lift has historically been criticized for conspicuous scarring, contributing to the popularity of endoscopic techniques. Nevertheless, the traditional direct brow lift remains a fundamental skill in the oculofacial plastic surgeon’s armamentarium, offering unmatched accuracy in brow repositioning, reliability, and symmetry. Contemporary evidence demonstrates refinements that can markedly minimize scar visibility. This systematic review and qualitative synthesis allow us to continue to refine and improve our techniques to minimize scarring in direct brow lift to the benefit of our patients. Full article