International Ophthalmology最新文献

Purpose: This study evaluates the effectiveness and safety profile of the iStent inject® combined with cataract surgery, with 3 years of follow-up in a large patient cohort (n = 464) of various glaucoma phenotypes and disease severity.

Methods: This retrospective, single-arm, multi-surgeon study included eyes undergoing iStent inject® with cataract surgery. Inclusion criteria was symptomatic cataract in addition to uncontrolled intraocular pressure (IOP) on ≥ 2 IOP lowering agents or contraindication and/or intolerance to IOP lowering medication. IOP, medications, safety profile and cumulative success rates were assessed.

Results: The mean IOP was 14.8 ± 4.5 mmHg at 3 years, compared to 18.3 ± 5.8 mmHg preoperatively, an IOP reduction of 19.1% (P < 0.001). The mean number of IOP lowering medications was 1.84 ± 1.40 at 3 years, compared to 2.49 ± 1.12 medications preoperatively. At 3 years 24% of eyes were medication free compared to 3% of eyes preoperatively (P < 0.001). At 3 years the cumulative probability of eyes achieving complete success; an IOP reduction of ≥ 20% and IOP 6-21 mmHg without medication was 37% and the cumulative probability of achieving this with medication (qualified success) was 67%. No cases of endophthalmitis, hypotony or other sight threatening complications were recorded. 5% of eyes required further glaucoma procedures.

Conclusions: This large, real-world cohort demonstrates a significant and sustained IOP reduction with an improvement in medication burden 3 years after iStent inject® and phacoemulsification. An excellent safety profile was displayed with a low rate of further glaucoma surgery required.

Purpose: To investigate the clinical outcome of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and its effect on corneal sensitivity, as well as corneal nerve parameters using in vivo confocal microscope (IVCM) in eyes with glaucoma.

Patients and methods: This was a prospective longitudinal study recruiting consecutive glaucoma patients who were scheduled to undergo MP-TSCPC for intraocular pressure (IOP) control in a tertiary center. Pre-operative and postoperative clinical parameters were compared including best-corrected visual acuity, IOP, number of topical glaucoma medication, requirement of oral acetazolamide and corneal sensitivity. Intraoperative and postoperative complications were recorded. Pre-operative and postoperative corneal nerve parameters measured using IVCM were analysed in both operated and non-operated eye. All clinical and imaging parameters were compared longitudinally between baseline, postoperative 2 weeks and 1 month.

Results: Twenty consecutive glaucoma patients who received MP-TSCPC between January 2024 and May 2024 were recruited. Postoperatively, there was a significant reduction in IOP (p = 0.000) and oral acetazolamide use (p = 0.001) while visual acuity were maintained (p = 0.710). However, there were reduced corneal sensitivity (p = 0.014), decrease in corneal nerve fibre density (CNFD) (p = 0.017) and corneal nerve branch density (CNBD) (p = 0.047) as detected by IVCM from baseline to 1 month in the operated eye.

Conclusion: MP-TSCPC is an effective glaucoma treatment in terms of IOP control and reduction of glaucoma medications. However, it may potentially result in reduced corneal sensitivity, corneal nerve fiber density and branch density at postoperative 1 month.

Background: Chronic hyperglycemia disrupts ocular surface homeostasis through oxidative stress, inflammation, autonomic neuropathy, and microvascular damage. These alterations contribute to dry eye disease, conjunctival changes, and corneal neuropathy, yet the underlying mechanisms are not fully understood. This review explores the molecular, cellular, and physiological pathways involved in diabetes-related ocular surface damage and summarizes current and emerging therapeutic approaches.

Methods: A narrative review of peer-reviewed literature was performed, integrating clinical, histological, and molecular findings on conjunctival alterations, tear film dysfunction, oxidative stress, microbiota changes, and corneal nerve impairment in diabetic patients. Both established treatments and therapies under clinical or preclinical development were examined.

Results: Hyperglycemia induces the accumulation of advanced glycation end-products, activates RAGE signaling, and increases ROS production, leading to endothelial dysfunction, goblet cell loss, and epithelial barrier compromise. Tear film instability results from lacrimal gland microvascular injury, Meibomian gland dysfunction, and reduced corneal sensitivity secondary to neuropathy. Corneal neuropathy-marked by reduced sub-basal nerve density, nerve tortuosity, punctate keratitis, and delayed healing-affects up to 70% of patients and may precede diabetic retinopathy. Treatments include lubricants, autologous serum, topical insulin, amniotic membranes, and tarsorrhaphy. Promising experimental therapies include neurotrophic factors, α-lipoic acid, PEDF, resolvins, GLP-1-based agents, and gene-based strategies.

Conclusion: Diabetes profoundly impacts the ocular surface through oxidative, inflammatory, neurogenic, and microvascular mechanisms that compromise tear film stability and corneal health. Early detection and targeted management are crucial to prevent progression to neurotrophic keratopathy. Further research is needed to refine mechanism-driven therapies.

Purpose: To determine the risk of sympathetic ophthalmia (SO) among ocular surgery patients with and without a history of ocular trauma.

Methods: This cohort study used the multi-institutional TriNetX platform to enroll ocular surgery patients with and without a history of ocular trauma from January 1, 2005, to December 31, 2023. The primary outcome was the risk of developing SO in the ocular trauma group compared to those without.

Results: A total of 16,198 patients who underwent ocular surgery with prior ocular trauma (mean [SD] age, 45.59 [23.26] years; 28.58% female) and 16,198 without trauma history (46.49 [25.13] years; 28.74% female) were included. Patients with prior trauma had a higher risk of SO, with increased risk evident from 3 months after the index date (HR, 13.45; 95% CI, 1.77-102.20) and persisting through 18 years (7.21; 2.83-18.37). Stratified analyses showed elevated risk after anterior segment surgery (21.62; 2.91-160.40) and vitreoretinal surgery (5.84; 1.31-26.08). Increased risk was also observed for both closed globe injury (21.97; 2.96-163.00) and open globe injury (10.80; 2.54-45.92). Subgroup analysis showed higher SO risk among patients aged 18-39 years (5.70; 1.28-25.48) and 40-64 years (17.71; 2.36-132.60), in both males (12.96; 3.07-54.59) and females (9.10; 1.15-71.82), and among White patients (19.28; 2.58-144.00).

Conclusions: Our findings suggest that patients who have undergone ocular surgery with histories of ocular trauma should be closely monitored for the development of SO.

Purpose: To narratively review clinical use of topical and periocular tacrolimus in ophthalmology, with emphasis on allergic keratoconjunctivitis (VKC/AKC), ocular GVHD, post‑keratoplasty prophylaxis, and selected keratitis/uveitis indications.

Methods: Narrative search of PubMed/Scopus through October 2025 focusing on prospective, randomized, and comparative studies of topical/periocular tacrolimus; recent formulation advances (nanoemulsions, in‑situ gels, cyclodextrin complexes) were included.

Results: Across VKC/AKC, tacrolimus (0.03-0.1% ointment; 0.05-0.1% solutions/suspensions) improves signs/symptoms and reduces steroid burden; comparative data suggest faster epithelial healing than topical corticosteroid in shield ulcers. In ocular GVHD, pilot randomized data demonstrate symptom relief with acceptable safety. Observational studies suggest benefit as post‑keratoplasty adjunct in high‑risk grafts. Emerging delivery systems address solubility, residence time, and tolerability and show promising preclinical pharmacokinetics.

Conclusion: Tacrolimus is a practical steroid‑sparing therapy for severe ocular surface inflammation. Priority trials should be formulation‑specific with standardized outcomes and pharmacokinetic endpoints, alongside pediatric safety registries and head‑to‑head comparisons versus cyclosporine 2% and soft steroids.

Purpose: To establish a retinal break localization (RBL) formula and determine its reliability and influencing factors.

Methods: A trigonometric function was used to develop a formula for the distance CB from the limbus (C) to the apex of the retinal breaks (B) based on a model eye, ultra-wide-field fundus (UWF) images, and optical biometric data. The CB values of 43 eyes were compared with the measurement obtained during operation, CB1. The influential and correlating factors analyzed were the axial length (AL), types of the break, macula (off or on), anterior chamber depth (ACD), and white to white corneal diameter (WTW) measurements.

Results: Compared to CB1, CB was longer in the group of all cases (p = 0.032) and the groups with AL ≥ 26 mm (p = 0.007). In the three other AL groups (AL < 26, 25, 24 mm), there were no significant differences between CB and CB1 (p = 0.200, 0.599, 0.246). The categories of the breaks and macula had no significant effect on the reliability of the formula (p = 0.121, 0.085). There was a positive correlation between the AL and the difference between CB and CB1 (Pearson correlation = 0.662, p < 0.001).

Conclusion: The proposed formula has value for locating retinal breaks in cases of AL less than 26 mm and provides a new quantitative metric.

Purpose: This study aims to investigate the protective effects of luteolin on Müller cells under high glucose conditions and to elucidate its potential mechanisms of action.

Methods: Firstly, Primary rat retinal Müller cells were divided into three groups: a control group (Control), a high glucose group (HG), and a high glucose plus luteolin group (HG + luteolin). To confirm that ferroptosis is indeed involved in cell death, cells were divided into another three groups: Control, HG), and high-glucose + Ferrostatin-1 (HG + Fer-1). Additionally, to further establish ferroptosis as the specific target of luteolin treatment, cells were divided into another three groups: Control, ferroptosis activator (RSL3), and RSL3 + luteolin group (RSL3 + luteolin). Cell apoptosis was assessed using flow cytometry and TUNEL staining. Intracellular levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) were quantified with biochemical assay kits. Mitochondrial morphology was examined via transmission electron microscopy. The expression of ferroptosis-related factors xCT and GPX4 was evaluated through quantitative polymerase chain reaction and Western blotting.

Results: The HG group showed increased apoptosis, ROS, MDA, mitochondrial damage and reduced levels of SOD, GSH, xCT and GPX14 compared to the control group. The HG + luteolin group reversed these effects, reducing apoptosis and oxidative stress while restoring mitochondrial health and increasing protective gene expression. Fer-1 inhibits high glucose-induced apoptosis and promotes cellular xCT and GPX4 protein expression. Luteolin inhibited RSL3-induced cellular iron apoptosis and promoted cellular xCT and GPX4 protein expression.

Conclusion: The results demonstrate that high glucose levels induce ferroptosis in Müller cells. Conversely, luteolin intervention has been shown to alleviate high glucose-induced Müller cell damage by inhibiting cellular ferroptosis.

Background: In 2020, 76 million people around the world had glaucoma, and by 2040, that number is predicted to rise to 111.8 million. Minimally invasive glaucoma surgery (MIGS) has become an effective method to treat open-angle glaucoma. It lowers the pressure inside the eye by improving the drainage mechanism of the eye's aqueous humor. MIGS devices, such as the iStent® and Hydrus®, aid in aqueous outflow and patency maintenance. However, their long-term safety and efficacy require ongoing post-market surveillance across diverse patient populations. It's important to know how safe implanted devices like MIGS are over a long period of time.

Objective: To conduct a five-year retrospective analysis of adverse events associated with the Hydrus® Microstent and iStent® trabecular micro-bypass MIGS devices, as reported in the U.S. Food and Drug Administration (FDA)'s Manufacturer and User Facility Device Experience (MAUDE) database, and to characterize the spectrum and reporting patterns of device- and patient-related complications to better define their real-world safety profile in glaucoma management.

Study design: A retrospective case-series.

Methods: All MAUDE reports submitted between January 1, 2020, and October 31, 2024, containing product codes "OGO" and "KYF" were screened. A total of 784 eligible reports involving Hydrus and various iStent models were analyzed for device-related and patient-related adverse events. Descriptive statistics were used to summarize event types and frequencies. Heatmaps and visualizations were also created using Python Google Colab.

Results: Among 784 reports, injuries accounted for 63.1% of cases, and malfunctions for 36.9%. A total of 503 device-related and 1,012 patient-related problems were identified. Among device-related problems, malposition was the most commonly reported issue (37.3% of device problem reports), followed by breakage (23.5%) and obstruction (9.0%). Frequent patient-related events included increased IOP (19.4%), hyphema (12.1%), and foreign body in patients (10.6%). Among Hydrus®-related reports, malposition was the most frequently reported device issue; among iStent® Inject W reports, breakage predominated.

Conclusion: The Hydrus® and iStent® trabecular micro-bypass MIGS devices have shown generally favorable safety over five years of postmarket surveillance. However, device malposition and mechanical failures were frequently reported in voluntary submissions, though, due to the absence of denominator data, these reports cannot be interpreted as evidence of higher real-world incidence compared to clinical trials. These findings inform surgical training, patient counseling, and highlight the need for prospective real-world registries to establish true complication rates.

Purpose: Minimally invasive glaucoma surgery (MIGS) techniques have become increasingly popular due to their favorable safety profiles compared to traditional glaucoma procedures. Among these, gonioscopy-assisted transluminal trabeculotomy (GATT) has gained prominence in recent years. This study aimed to perform a comprehensive bibliometric and altmetric analysis of GATT-related literature published between 2014 and 2024, with comparisons to other major MIGS techniques.

Methods: A systematic search was conducted in the Web of Science Core Collection database for publications dated between January 1, 2014, and December 31, 2024, despite the data retrieval being performed on May 18, 2025. Boolean search strategies were applied to identify publications related to five MIGS procedures. VOSviewer software (version 1.6.20) was used for network visualization analyses. Citation counts and Altmetric Attention Scores (AAS) were compared between GATT and other MIGS groups.

Results: A total of 1,123 publications were identified, including 149 related to GATT. GATT demonstrated a sharp increase in publication volume after 2018, peaking in 2024. The mean total citation count for GATT publications was 14.75 ± 35.1, and the mean AAS was 2.01 ± 6.05. Although GATT had a significantly lower AAS compared to Hydrus (8.57 ± 20.4, p = 0.008) and iStent (5.89 ± 16.9, p = 0.002), its total citation count was not statistically significantly different from other MIGS techniques (p = 0.06). The top-cited GATT-specific publication was Grover's 2014 technique report (254 citations; Journal Impact Factor [JIF]: 13.2; Journal Citation Indicator [JCI]: 5.16), while the highest overall citation belonged to Richter's 2016 review on MIGS (276 citations; AAS: 65). Bibliometric mapping revealed that GATT-related keywords were centrally located and highly interconnected. Authors such as Davinder Grover and Zeynep Aktas were among the most influential contributors in the GATT literature.

Conclusion: GATT has emerged as a widely discussed and increasingly studied MIGS technique in the academic literature over the past decade. Nonetheless, bibliometric and altmetric metrics should be interpreted as reflections of scholarly attention rather than standalone indicators of scientific validity or clinical efficacy.

Purpose: To investigate the visual field (VF) characteristics of myopic patients and evaluate the application of Easyfield perimetry in preoperative glaucoma screening of corneal refractive surgery.

Methods: This is a cross-sectional study. The VF of 213 myopic patients (426 eyes) undergoing corneal refractive surgery were collected using Easyfield perimetry. All patients underwent ocular examinations, including intraocular pressure, manifest refraction, and fundus photography. 426 VF were classified into 4 major categories: normal, glaucoma-like defects, myopia-related defects and combined defects, and the associated factors were investigated.

Results: Mean defect (MD) of VF increased significantly with more positive spherical equivalent (β = 0.31, P < 0.001) and decreased significantly with increased axial length (AL, β = - 0.17, P = 0.011). Among the 426 VF tests, normal VF, glaucoma-like defects and myopia-related defects accounted for 88.7, 5.0, and 6.3%, respectively, and there were no combined defects. Both the prevalence of glaucoma-like VF defects and myopia-related VF defects were positively associated with longer AL (OR, 1.95; 95% CI, 1.37-2.77; P < 0.001 and OR, 2.41; 95% CI, 1.44-4.05; P = 0.001). Eyes with visual field defects within this cohort were more likely to demonstrate morphological changes such as tessellated fundus, peripapillary atrophy and tilted optic discs compared to those with a normal VF groups.

Conclusions: The VF changes observed in myopic patients can resemble those seen in glaucoma, and it is imperative to provide regular follow-up for these individuals. For patients undergoing corneal refractive surgery, Easyfield perimeter may play an important role in the preoperative screening of glaucoma.