Ophthalmic Research最新文献

Introduction: To determine which donor characteristics, like previous diseases and surgeries, influence the graft preparation difficulty of the Descemet membrane (DM)/endothelial lamella in DMEK-surgery and to analyze the impact on the one-year clinical outcome.

Methods: 1051 eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany were included in this single-center and retrospective study. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, that contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively and postoperative clinical follow-up. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous disease and surgeries. Also, outcome parameters, like visual acuity, endothelial cell density and graft survival were correlated to the graft preparation group.

Results: Donor diabetes was found as significant predictor for central adhesions (p<0.001). Diabetes patients are 2-times more likely to have central adhesions complicating preparation than non-diabetes patients (OR =2.2). Previous cataract surgery was significantly associated with difficult stripping and preparation (p <0.001), with an estimated 1.07 fold increase in stripping difficulty (95% CI 0.80-1.34) and overall 1.99 fold increase in preparation difficulty (95% CI 1.71-2.29). Chronic kidney disease (p=0.012) and previous cataract-surgery (p=0.005) show significant associations to tissue loss. Donor diagnosis such as Diabetes Mellitus type 2, chronic ischemic heart disease and respiratory insufficiency have a significant association with the preparation group (p=0.001; p=.004 and p=0.032, respectively). No interactions were found between preparation difficulties and visual acuity (p=0.122), rebubbling rate (p=0.780) or endothelial cell density (p=0.886) nor graft survival (p value=0.157) one year postoperatively.

Conclusions: Donor diabetes mellitus, heart failure, hypertension, respiratory insufficiency, kidney disease and previous cataract surgery are associated with difficult DMEK graft preparation, the latter two also with tissue loss. No impact of donor factors on clinical outcome was found.

Background Meibomian gland dysfunction (MGD) is a chronic and widespread abnormality of the meibomian glands that often results in symptoms such as eye irritation and blurred vision, significantly affecting patients' daily activities. While conventional treatments like warm compresses and meibomian gland expression remain widely used, their limitations have driven the development of novel therapeutic technologies. Summary This review synthesizes evidence from 71 clinical and experimental studies in Medline databases on both established and emerging therapeutic strategies for MGD, including physical interventions (warm compresses, eyelid cleansing, probing and expression, thermal pulsation systems such as LipiFlow®, and intense pulsed light (IPL)) and pharmacological approaches. Across these modalities, most interventions improve symptoms, tear film stability, and meibum quality primarily by enhancing glandular outflow and modulating ocular surface inflammation. Device-based physical therapies typically offer greater and more long-lasting improvements than conventional methods but are limited by cost, access, and a lack of long-term safety data. Key Messages Though the current range of MGD treatments cannot regenerate affected glands, their secreting functions can be greatly improved. Clinicians should therefore individualize treatment options according to disease stage, meibography findings, comorbid ocular surface conditions, and patient-specific factors such as tolerance, adherence, and cost.

Objective: To systematically compare the accuracy of artificial intelligence and traditional intraocular lens (IOL) calculation formulas in cataract eyes after vitrectomy with silicone oil tamponade.

Methods: PubMed, Cochrane, Embase, and Web of Science databases were searched to select relevant studies published up to October 29, 2025. 12 formulas (SRK/T, Hoffer Q, Hoffer QST, Haigis, Barrett Universal II, Holladay I, Holladay II, RBF, LSF, EVO, Kane, and Pearl-DGS) were included for final comparison. The primary outcomes were the percentage of eyes with prediction errors (PE) within ±0.50D and ±1.00D.

Results: This meta-analysis included 7 studies comprising 1060 eyes. Overall, compared to traditional formulas, newer formulas demonstrated relatively higher accuracy. The results indicated that among all the formulas being compared, the optimal formula was Kane. For the percentage of eyes with PE within ±0.50 D, Kane had the highest precision. For the IOL power percentage within ±1.00 D, EVO performed the best, with Kane also ranking highly, Furthermore, RBF also performed very well.

Conclusion: Kane and EVO appear to be better choices for silicone oil-filled eyes after vitrectomy.

Introduction: This study aimed to investigate the relationship between spectral domain optical coherence tomography (SD-OCT) structural findings and visual acuity in patients with retinitis pigmentosa (RP), with and without cystoid macular edema (CME), at baseline and 1-year follow-up.

Methods: This retrospective chart review included 30 patients with RP treated at the University of Florida Health Eye Center from 2014 to 2020. Patient records were analyzed for SD-OCT structural features and visual acuity outcomes. Statistical analyses included descriptive statistics, χ2 tests, independent t tests, and Pearson's correlation tests. Main outcome measures were best corrected visual acuity (BCVA), presence of the ellipsoid zone (EZ) in the fovea and macula, central retinal thickness (CRT), total macular volume (TMV), and presence of an epiretinal membrane (ERM).

Results: The study included 30 patients (21 female, 9 male) with an average age of 46.83 ± 18.86 years (range, 10-80 years). The average follow-up period between visits was 11.9 ± 1.6 months (range, 9-15 months). Among the 60 eyes analyzed, 50% had CME. Eyes with CME had a greater CRT at the follow-up visit (p = 0.029). No significant differences were found in BCVA or TMV between RP patients with and without CME. Correlation analyses revealed a significant relationship between CRT and BCVA at both visits (p = 0.001, p = 0.004) in RP patients without CME, but not in RP patients with CME. EZ foveal sparing consistently predicted BCVA outcomes (p < 0.001) and CRT (p ≤ 0.001) at both visits in RP patients with and without CME. Greater TMV at both visits (p = 0.009, p = 0.012) and the presence of an ERM at the follow-up visit (p = 0.046) were significantly associated with a decline in BCVA between visits in RP patients without CME.

Conclusions: EZ foveal sparing is a significant predictor of visual acuity in RP patients regardless of the presence of CME. While CRT correlates with visual acuity in patients without CME, it does not predict outcomes in those with CME. TMV may serve as a marker for preclinical CME, and both increased TMV and ERM presence may predict visual decline in RP patients with undetectable CME on SD-OCT.

Introduction: Diabetes mellitus (DM) is frequently associated with microvascular complications, including diabetic peripheral neuropathy (DPN). The cornea, one of the most densely innervated tissues in the body, has been proposed as a surrogate marker for small fiber neuropathy. Patients with DM often present with ocular surface disease (OSD) and corneal sensitivity impairment, but the relationship between DPN, ocular surface alterations, and inflammatory biomarkers remains unclear. This study aimed to evaluate ocular surface parameters between patients with type 2 DM with and without DPN and to explore the associations among corneal sensitivity, ocular surface inflammation (matrix metalloproteinase-9 [MMP-9]), and dry eye-related parameters.

Methods: In this cross-sectional observational study, 158 eyes of 79 patients with type 2 DM were categorized based on the presence or absence of DPN, diagnosed via electromyography. Corneal sensitivity was evaluated using the Brill esthesiometer, and tear MMP-9 levels were assessed with the InflammaDry test. Additional assessments included the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer test, noninvasive tear break-up time, and meibography. Corneal impairment was defined as esthesiometry levels 4-6 or pressure thresholds ≥8 mbar in either eye.

Results: Patients with DPN exhibited significantly reduced corneal sensitivity (6.98 ± 2.25 mbar vs. 5.62 ± 2.53 mbar; p = 0.014) and higher OSDI scores (median 26 vs. 10; p < 0.001). MMP-9 positivity was more common in patients with corneal sensory impairment (81.8% vs. 54.3%; p = 0.0215). A significant negative correlation was observed between tear osmolarity and corneal sensitivity (r = -0.182, p = 0.022). Multivariable regression showed that both DPN (β = 1.20) and MMP-9 positivity (β = 1.24) were independently associated with reduced sensitivity.

Conclusions: Reduced corneal sensitivity was significantly associated with the presence of DPN and with MMP-9 positivity and showed a negative correlation with tear osmolarity. Corneal sensitivity testing combined with tear MMP-9 assessment may provide complementary information on ocular surface changes in diabetic patients, although current variability and limited reproducibility prevent their use as standalone screening tools for neuropathy.

Introduction: The aim of the study was to evaluate functional and anatomical changes at the 44-week follow-up in patients with naïve neovascular age-related macular degeneration (nAMD) treated with faricimab intravitreal injections (IVIs).

Methods: Fifty-four eyes of 54 patients with naïve active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University "G. d'Annunzio," Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI. Each patient underwent complete ophthalmic examination including best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts and optical coherence tomography. All measurements were evaluated at baseline, at week 20 and then according to fixed retreatment interval up to week 44. Fluorescein angiography and indocyanine green angiography were also performed at baseline. Main outcome measures were changes in BCVA, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), intraretinal fluid presence, subfoveal subretinal fluid presence and thickness, the presence of pigment epithelial detachments (PEDs), and its maximum height (PED-MH).

Results: BCVA improved and CMT reduced significantly from baseline to week 44 (p = 0.002 and p = 0.020, respectively) in the overall sample with a higher significant improvement from baseline to week 20 (p < 0.001 for both parameters) and no additional significant improvement from week 20 to week 44 in the overall sample (p = 0.348 and p = 0.146, respectively). At week 20, 72.3% of patients were in the Q12/Q16 interval. Patients in the Q8 interval showed significant improvement in BCVA (p < 0.001) and significant reduction of CMT (p = 0.008) from baseline to week 44, respectively. PED-MH as well showed a significant reduction from baseline to week 44 (p < 0.001). Patients in the Q12 interval showed significant improvement in BCVA (p = 0.030) and significant reduction of CMT, SFCT, and PED-MH from baseline to week 36 (p < 0.001). Patients in the Q16 interval showed significant reduction of BCVA during follow-up (p = 0.026). CMT, SFCT, and PED-MH were significantly reduced from baseline to week 44 (p < 0.001).

Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of many anatomical and functional parameters at 44 weeks, allowing the maintenance of a treatment regimen for most patients equal to or greater than 12 weeks.

Introduction: Corneal fluorescein (FL) staining is the most widely used efficacy endpoint in dry eye disease (DED) registrational trials, yet dye diffusion and variable readout timing can blur punctate staining, reducing the precision and consistency of grading. We assessed the performance of FL staining as an efficacy endpoint by analyzing endpoint success across FDA-reviewed DED trials and evaluated whether a standardized, diffusion-resistant dye could provide an alternative quantitative measure of corneal staining.

Methods: We conducted a synthesis of FDA-reviewed DED registrational clinical trials through April 2025 to determine the proportion of trials that met the corneal FL staining efficacy endpoint. Clinical relevance was assessed using a minimal clinically important difference (MCID) of ≥3 units on the 0-15 National Eye Institute (NEI) scale. In a clinical cohort of 50 DED patients (97 eyes), total corneal staining was compared after sequential instillation of 5 µL of 2% FL (readout ∼2.5 min) and 1% lissamine green (LG) (readout ≤30 s).

Results: Among 20 FDA-reviewed registrational trials that prespecified corneal FL staining as an efficacy endpoint, 10 (50%) failed to meet this endpoint. Of the seven trials in which FL staining served as a primary or co-primary endpoint, only one achieved MCID for corneal staining. Across all trials meeting the endpoint, treatment-vehicle differences were small (mean additional reduction 0.4-1.2 units; Cohen's d < 0.5), indicating that FL staining yielded uniformly small effect sizes. In the clinical cohort, 1% LG produced corneal staining that was strongly associated with 2% FL for mild (ρ = 0.99), moderate (ρ = 0.93), and severe (ρ = 0.69) disease (p < 0.001). Bland-Altman analysis showed that while the mean bias was negligible, the width of the 95% limits of agreement (-1.26 to 0.85) suggests the two corneal staining dyes are not fully interchangeable at the individual-measurement level.

Conclusions: Corneal FL staining demonstrates limited responsiveness as an efficacy endpoint in DED registrational trials. Because 1% LG provides corneal staining strongly associated with 2% FL while preserving discrete punctate detail and allowing standardized, early readouts, it may represent a suitable alternative vital dye for future DED efficacy and safety assessments.

Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss and requires long-term anti-vascular endothelial growth factor therapy. This study aimed to evaluate the efficacy and safety of faricimab in patients with nAMD.

Methods: This systematic review and meta-analysis were performed according to the PRISMA guidelines to identify studies assessing faricimab in nAMD. Primary outcomes included visual acuity, central macular thickness (CMT), and dry macula rate. Secondary outcomes included macular status, central choroidal thickness (CCT), and complications. A random-effects model was used to calculate pooled mean with 95% confidence intervals.

Results: Out of the 365 studies identified, 21 studies were included, comprising a total sample size of 1,864 eyes of 1,791 patients. Post-operatively, there was a statistically significant improvement in corrected distance visual acuity (standardized mean difference [SMD]: -0.122, 95% p = 0.039) and CMT (SMD: -3.672, p = 0.010). Similarly, there was a significant improvement in the rate of dry macula at the final follow-up visit (event rate: 0.529; p < 0.05). For the secondary outcomes, there was a statistically significant improvement in CCT (SMD: -0.199, p = 0.026) and in the rate of macular exudates (0.452, p < 0.05), specifically intraretinal fluid (0.140, p < 0.05) and subretinal fluid (0.271, p < 0.05). Complications secondary to faricimab injections included hemorrhagic pigment epithelial detachment with a rate of 0.120 (p < 0.05) and retinal pigment epithelium tear with a rate of 0.025 (p < 0.05).

Conclusions: The use of faricimab injection in patients with nAMD is safe and effective, resulting in significant improvements in a myriad of visual measures and OCT parameters.

Introduction: This study evaluated changes of Schlemm's canal (SC) and trabecular meshwork (TM) dimensions from digital ocular massage in high myopia.

Methods: Healthy participants with either high myopes (≤-6.00 D) or with refractive errors ≥ -3.00D were recruited. Right eyes underwent digital ocular massage. Intraocular pressure (IOP) was monitored using rebound tonometry. Anterior chamber angle was imaged using swept-source optical coherence tomography. IOP, SC, and TM were compared before and immediately after digital ocular massage.

Results: Sixteen eyes from 16 high myopes (-6.00 D to -8.125 D) and 18 eyes from 18 control participants (+0.50 D to -2.875 D) were included. There was no difference in age and gender distribution between the two groups. The two groups shared similar IOP, SC area, SC length, TM length, and TM thickness at baseline. Both groups had significant IOP drop from a baseline of around 15 mm Hg to 9 mm Hg after ocular massage. High myopia demonstrated a mild enlargement of the SC area (from 10,655.60 ± 4,362.02 µm2 to 12,632.40 ± 4,393.19 µm2, p = 0.098), not reaching statistical significance. The TM thickness was reduced from 160.21 ± 26.29 µm to 151.77 ± 26.91 µm, p = 0.018). Control eyes showed significant enlargement of SC area (from 8,540.71 ± 3,905.98 µm2 to 11,686.53 ± 4,586.37 µm2, p = 0.001) and SC length (from 240.47 ± 69.96 µm to 280.40 ± 59.37 µm, p = 0.041).

Conclusion: Control eyes showed significant enlargement of SC in responding to IOP drop while high myopia did not.

Introduction: Age-related macular degeneration (AMD) is a major cause of irreversible vision loss in middle-aged and older populations worldwide. Understanding its long-term epidemiological trends is essential for anticipating future healthcare needs and guiding preventive strategies. This study characterizes the global, regional, and national burden of AMD in adults aged ≥45 years, with a focus on sex disparities, aging effects, and projected trends.

Methods: Using data from the Global Burden of Disease Study 2021, we analyzed the prevalence and disability-adjusted life years (DALYs) of AMD across age, sex, region, country, and Socio-Demographic Index (SDI) groups. We applied an age-period-cohort model to disentangle the effects of aging, temporal changes, and birth cohort on AMD risk. Frontier analysis was conducted to identify best-practice benchmarks in disease burden reduction. The association between SDI and AMD burden was assessed to evaluate health inequities. An autoregressive integrated moving average (ARIMA) model was used to project age-standardized DALY rate (ASDR) and prevalence rate from 2022 to 2036.

Results: Between 1990 and 2021, the absolute number of AMD cases and DALYs nearly doubled. In 2021, both prevalence and DALY rates increased exponentially with age, with females exhibiting consistently higher rates across all age groups. The age-period-cohort model indicated a declining trend in AMD risk over successive birth cohorts, suggesting potential improvements in early-life or cumulative risk factors. Notably, the highest age-standardized rates were observed in low-SDI regions, highlighting significant global inequities in disease burden. ARIMA projections suggest a modest but concerning increase in the global ASDR, rising to 6.80 (95% CI: 5.82-7.78) by 2036, with female ASDR reaching 7.46 (95% CI: 6.29-8.63).

Conclusion: The burden of AMD remains substantial and is projected to grow, particularly among aging populations and in low-resource settings. The persistent sex disparity, especially the elevated burden in elderly women, calls for targeted screening and intervention programs. These findings emphasize the need for equitable, age- and sex-sensitive public health strategies to mitigate the rising impact of AMD in the coming decades.