International Ophthalmology最新文献

Background: To analyze the global scientific output, research trends, and thematic evolution related to choroidal thickness and choroidal vascularity index (CVI) using bibliometric methods and science mapping.

Methods: This bibliometric study analyzed research outputs on choroidal thickness and CVI retrieved from in the Web of Science database from 1990 up to 2025. The Science Mapping Analysis Tool (SciMAT) was used to visualize thematic structures and predict research trends in this field.

Results: The annual distribution of publications showed a marked increase in research output starting from 2010, with the highest number of publications observed in 2021 (n = 174). Turkey was the most productive country in this field (n = 411). The total number of citations was 41,929, with an average of 25.46 citations per publication. The most prolific author was Chhablani J (n = 29), while "Optical Coherence Tomography" was identified as the most frequently used keyword.

Conclusions: The growing body of literature on choroidal thickness and CVI reflects increasing interest in their clinical and research significance. This study not only identifies key contributors and trends but also reveals the thematic evolution and emerging research areas in the field. These insights may help researchers better understand the current landscape and guide future investigations.

Purpose: Accurate segmentation of tumor-infected regions in retinal Optical Coherence Tomography (OCT) images is critical for early diagnosis and clinical decision-making. However, conventional deep learning and transformer-based models often struggle to delineate overlapping and inter-dependent pixel features, leading to reduced segmentation precision. This study proposes a novel Dependent Inter-Feature Segmentation Method (DIFSM) to improve the localization and segmentation of retinal tumor regions in OCT images.

Methods: The proposed DIFSM framework integrates advanced image preprocessing, inter-feature dependency analysis, and a Vision Transformer (ViT) architecture to distinguish differentiable and non-differentiable features. Overlapping pixel regions are identified through inter-feature intensity and gradient analysis, which are indicative of tumor-affected areas. The Vision Transformer is trained using matched and unmatched inter-feature representations to enhance contextual learning and resolve feature ambiguities. Experiments were conducted on the OCTID dataset comprising high-resolution retinal OCT images, and performance was evaluated using Dice coefficient, Intersection over Union (IoU), precision, sensitivity, specificity, and Mean Square Matching Error (MSME). Comparative analysis was performed against state-of-the-art segmentation models.

Results: The proposed DIFSM model achieved a Dice coefficient of 96.2% and an IoU of 94.8%, demonstrating excellent spatial overlap with expert-validated tumor regions. Precision, sensitivity, and specificity reached 96.8%, 96.6%, and 96.7%, respectively, while MSME was reduced to 6.11%. Compared to existing methods, DIFSM improved segmentation accuracy by 14.39%, precision by 14.11%, and reduced MSME by 13.5%. The model consistently outperformed benchmark approaches in detecting macular hole and central serous retinopathy-associated tumor regions while maintaining robustness to noise and structural variability.

Conclusion: The proposed DIFSM framework effectively addresses the limitations of existing OCT segmentation methods by explicitly modeling inter-feature dependencies and resolving overlapping pixel ambiguities using a Vision Transformer. The significant improvements in segmentation accuracy and error reduction highlight its potential as a reliable and clinically applicable tool for automated retinal tumor detection in ophthalmic imaging. DIFSM offers a promising direction for enhancing OCT-based diagnostic systems and supporting ophthalmologists in early disease identification and treatment planning.

Background: To investigate the relationships between chord α and chord μ with age, ocular biometric indices, and wavefront aberrations in pre-operative refractive surgery candidates.

Methods: This cross-sectional study included 111 right eyes of 111 patients. Ocular biometrics and chord values were measured using the ZEISS IOLMaster 700. Corneal and ocular aberrations were assessed with the PERAMIS pyramidal aberrometer. Data were analyzed using Pearson's correlation, ANOVA, and simple linear regression to evaluate the interplay between variables.

Results: A moderate positive correlation was found between chord α and chord μ (r = 0.60, p < 0.001). Chord α demonstrated moderate positive correlations with subjective spherical refraction (r = 0.45) and spherical equivalent (r = 0.41), and moderate negative correlations with anterior chamber depth (r = - 0.53) and axial length (r = - 0.40) (all p < 0.001). In contrast, correlations involving chord µ were exclusively weak, though it showed significant associations with several higher-order aberrations, including corneal trefoil (r = 0.35) and ocular coma (r = 0.31). Refractive status significantly affected both chord values (p ≤ 0.02), with severely myopic eyes showing the lowest values. Regression analysis identified anterior chamber depth as the strongest anatomical predictor for chord α (R² = 0.28).

Conclusion: Chord α serves as a more robust indicator of the eye's anatomical characteristics than the more variable chord µ. Our findings underscore the clinical importance of optical decentration in surgical planning, as larger chord values may indicate a greater risk of pre-existing aberrations and potential impacts on visual quality.

Introduction: This study aims to evaluate the long-term outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) at a tertiary care center in Saudi Arabia over a 15-year period, focusing on the graft survival, visual improvement, complications rates, and graft insertion techniques.

Methods: This is a retrospective study that included all patients who underwent DSAEK at King Abdulaziz University Hospital (KAUH), Riyadh, between 2009 and 2024. Data were collected on demographics, surgical details, visual acuity, graft survival, and complications. Primary and secondary graft failures were clarified, and risk factors were analyzed using univariate and multivariate Cox regression. Kaplan-Meier survival curves were used to represent the grafts survival, and surgical techniques (Lens Glide vs. Busin Glide) were compared.

Results: A total of 179 eyes from 163 patients were included. The overall graft survival rate was 69.3%, with cumulative survival of 81.0% at 1 year, 63.8% at 3 years, and 51.7% at 5 years. Visual acuity improved in 46.9% of patients, and 22.0% achieved 20/40 or better. Postoperative complications occurred in 38.5% of cases, with endothelial rejection being the leading cause of graft failure (49.1%). In multivariate analysis, postoperative complications were the only independent risk factor for failure (HR = 2.67, 95% CI: 1.71-4.18, p < 0.001). Although not statistically significant, a trend toward decreasing survival rates was evident with repeated DSAEK. Among surgical techniques, the lens glide group had no primary failures in the single-surgeon subgroup and demonstrated higher success rates than busin glide (p = 0.026).

Conclusions: DSAEK provides favorable long-term outcomes, though prior surgeries, glaucoma, and postoperative complications, specifically endothelial rejection, can negatively impact graft survival. Surgical technique may influence early failure rates, emphasizing the importance of gentle tissue handling and surgeon expertise.

Purpose: To evaluate the anatomical and refractive outcomes of secondary in-the-bag intraocular lens (IOL) implantation following phacovitrectomy with anterior capsule polishing, by comparing it with primary IOL implantation.

Methods: Fifty-two patients who underwent phacovitrectomy were included in this prospective study and divided into two groups based on IOL implantation timing. Postoperative IOL tilt, decentration, objective optical quality, and refractive prediction error were compared between the secondary and primary groups at 3 months postoperatively.

Results: The mean IOL tilt and decentration were 4.93 ± 1.52° and 0.23 ± 0.21 mm in the secondary group, and 4.75 ± 1.82° and 0.23 ± 0.14 mm in the primary group (P > 0.05 for both). For objective optical quality, no significant differences were found in intraocular and ocular higher-order aberrations, higher-order modulation transfer function, and Strehl ratio between the two groups for 3 mm and 5 mm pupils. The primary group exhibited a slight hyperopic shift, with a mean prediction error of 0.54 ± 0.41 D, which was significantly higher than that of the secondary group (- 0.05 ± 0.70 D; P = 0.001). However, there was no difference in mean absolute error between the two groups.

Conclusion: Secondary in-the-bag IOL implantation is a viable option following phacovitrectomy with anterior capsule polishing, offering a good IOL position and satisfactory refractive outcomes.

Purpose: We aim to assess epiretinal membrane (ERM) prevalence in pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG) eyes and examine its correlation with choroidal thickness (CT) in these individuals.

Methods: In this retrospective, observational study, we examined 165 eyes of 94 PXG patients, 157 eyes of 82 POAG patients, and 150 eyes of 75 healthy individuals. We conducted a comprehensive ophthalmological assessment, including measurements of retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and macular CT using swept-source optical coherence tomography. We also evaluated and categorized posterior vitreous detachment (PVD) presence. ERM staging was performed for eyes with ERM. Lastly, we analyzed the association between ERM presence and CT across all groups.

Results: BCVA and mean RNFL were lower in PXG and POAG groups compared to controls (both p < 0.001). Mean CMT was significantly thinner in PXG versus controls (p < 0.001) and POAG (p = 0.002). ERM prevalence was higher in POAG versus controls and highest in PXG versus both groups. PVD was least in controls, more in POAG, and most in PXG. In PXG with ERM, temporal and nasal CT were higher (p = 0.022, p = 0.016). In the POAG subgroup, eyes receiving prostaglandin analogue therapy had significantly greater subfoveal CT (SFCT) compared with those not undergoing this treatment (p = 0.032).

Conclusion: According to our study, CMT is thinner in PXG eyes. ERM and PVD frequencies increase in POAG and PXG, with higher prevalence in PXG. PXG eyes with ERM exhibit increased nasal and temporal choroidal thickness, and in POAG eyes receiving prostaglandin analogue therapy, SFCT is higher compared to those not receiving this treatment.

Purpose: To present anatomical and functional outcomes of human amniotic membrane (hAM) grafting for the repair of chronic and refractory macular holes (MH).

Methods: Twenty-four eyes with chronic or persistent MH were included. Eleven patients had a history of failed pars plana vitrectomy (PPV) to repair the MH and underwent secondary hAM grafting (Group 1). Thirteen patients underwent primary PPV combined with hAM grafting (Group 2). Chronic MH was defined as symptom duration > 12 months or persistence after previous unsuccessful PPV. A cryopreserved hAM graft was placed underneath the MH edges with the chorionic side facing the retinal pigment epithelium (RPE). Air tamponade was used for all patients, with 24-h face-down positioning.

Results: The mean age of the patients was 68.8 ± 6.1 (55-78) years; male/female ratio was 8/16. The mean best-corrected visual acuity (BCVA) improved from 1.3 ± 0.1 (2-0.7) LogMAR preoperatively to 0.7 ± 0.8 (2-0.2) LogMAR postoperatively (p < 0.01). Median basal MH diameter was 1501.8 ± 351.1 (1043-2550) µm; minimum MH diameter was 727.8 ± 198.7 (517-1230) µm. Type 1 closure was achieved in 79.2% and type 2 closure in 20.8% of cases; several type 2 closures evolved into type 1 over time. Closure rate was 100% with a single surgery in both groups.

Conclusion: hAM grafting is an effective technique for closure of chronic or persistent MH, achieving 100% anatomic success. Type 2 closures may evolve into type 1 over time, suggesting dynamic postoperative healing. Further studies with larger cohorts and longer follow-up are warranted.

Purpose: To evaluate the efficacy of botulinum toxin-A (BoNTA) injection for treating functional epiphora after lacrimal surgery.

Materials and methods: Patients with persistent epiphora following anatomically successful 3-snip punctoplasty or external dacryocystorhinostomy (ex-DCR) received transconjunctival BoNTA injections into the lacrimal gland. Symptom severity and tear production were assessed using the Munk score, Schirmer I test, and Watery Eye Quality of Life (WeQoL) questionnaire at baseline, and at 1, 3 months, and final follow-up after injection. Outcomes were compared pre- and post-injection and between surgical subgroups.

Results: The study included 41 eyes of 32 patients (20 ex-DCR, 21 punctoplasty). Mean follow-up was 26.06 ± 0.7 months. All outcome measures (Munk score, Schirmer I, and WeQoL) showed significant improvement after both the first and last BoNTA injections. Improvements at 1 and 3 months were similar. The ex-DCR group required fewer injections (2.75 ± 0.1 vs. 3.13 ± 0.12; p = 0.003) with longer intervals between treatments (6.1 ± 0.1 vs. 5.4 ± 2 months; p = 0.02). At the 3-month follow-up after final injections, all scores were significantly better in the ex-DCR group (p < 0.05 for most comparisons).

Conclusion: BoNTA injection is an effective short-term treatment for functional epiphora after lacrimal surgery, particularly with more durable results following ex-DCR compared to punctoplasty.

Purpose: Branch retinal vein occlusion (BRVO) is a common retinal vascular disorder that can cause visual impairment through macular edema and ischemia. The primary aim of this study was to investigate choroidal structural changes in treatment-naïve BRVO patients. The secondary aim was to assess the impact of serous macular detachment (SMD) on choroidal parameters.

Methods: This single-center, retrospective cross-sectional study included 88 patients with unilateral BRVO. Eyes with BRVO, fellow eyes, and age- and sex-matched controls were classified as Groups 1, 2, and 3, respectively; Group 1 was further subdivided by SMD presence. Choroidal assessment included best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal and parafoveal choroidal thicknesses-subfoveal choroidal thickness (SFCT), subfoveal nasal choroidal thickness (SFNCT), subfoveal temporal choroidal thickness (SFTCT), submacular nasal choroidal thickness (SMNCT), and submacular temporal choroidal thickness (SMTCT)-and choroidal vascularity index (CVI). Group comparisons used Student's t-test or Mann-Whitney U test for two groups, and one-way ANOVA or Kruskal-Wallis test for three groups. Correlations were analyzed using Pearson or Spearman coefficients. p < 0.05 was considered significant.

Results: Group 1 (BRVO eyes) showed significantly lower subfoveal and submacular CVI values compared with Groups 2 (fellow eyes) and 3 (controls) (p < 0.001). SFCT was significantly higher in Group 1 than in Groups 2 and 3 (p < 0.001 and p = 0.004, respectively). Within Group 1, eyes with SMD had lower BCVA and subfoveal CVI than those without SMD (p = 0.003 and p = 0.009, respectively).

Conclusion: Our findings suggest that in BRVO, the presence of SMD may be associated with reduced subfoveal CVI (SFCVI), indicating potential choroidal vascular alterations that may vary according to the type of macular edema. These observations warrant further investigation and may guide future, more comprehensive studies to better understand BRVO pathophysiology.

Purpose: To evaluate the long-term outcomes of the Şimşek technique, a modified Ahmed Glaucoma Valve (AGV) implantation using a scleral tunnel created with a 6-0 Prolene suture.

Methods: This retrospective, comparative study was conducted at a tertiary referral center and included glaucoma patients who underwent AGV implantation via either the Şimşek technique (Group 1) or the classic long scleral tunnel technique (Group 2), with at least 12 months of follow-up. Group 1 included 44 patients (mean age: 54.8 ± 19.3 years), and Group 2 consisted of 48 patients (mean age: 50 ± 22.8 years). Pre- and postoperative assessments included best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of anti-glaucomatous medications (NAGM), surgical success, and complications.

Results: Mean follow-up duration was 22.6 ± 7.6 months in Group 1 and 27.3 ± 14.9 months in Group 2. No statistically significant differences were found between groups in IOP reduction (p = 0.237), NAGM at final visit (p = 0.054), or surgical success (p = 0.79). Complication rates were 54.5% in Group 1 and 56.3% in Group 2 (p = 1.000). Notably, no cases of tube exposure were observed in Group 1. Group 1 showed a significant improvement in BCVA compared to Group 2 (p = 0.003).

Conclusions: The Şimşek Technique yielded comparable IOP control and surgical success to the conventional method, with significantly improved BCVA and reduced tube exposure risk. These findings suggest its suitability, especially in patients with thin conjunctiva or where visual function preservation is critical. Further prospective studies are warranted.