Current Opinion in Ophthalmology最新文献

Glaucoma remains one of the leading causes of irreversible blindness worldwide with 80 million people affected and 3 million people blind from glaucoma [1]. Early diagnosis is critical for sight preservation and imaging modalities such as optical coherence tomography assist with the identification and quantification of glaucomatous changes. While widely used in the clinical setting, optical coherence tomography (OCT) has only more recently been optimized for use intraoperatively, in both portable and microscope-integrated forms. Intraoperative OCT (iOCT) provides visualization of both anterior and posterior structures in the eye. Gaining prominence in corneal and vitreoretinal surgery, iOCT has been shown to enhance surgical decision-making and improve outcomes in these fields. In glaucoma, iOCT has uses during tube shunt placement, minimally invasive glaucoma surgery, and trabeculectomy. This review highlights recent updates in iOCT use for glaucoma surgery.

Purpose of review: The purpose of this review was to summarize the literature on preclinical and clinical studies demonstrating the impact of the intestinal microbiome in noninfectious uveitis.

Recent findings: Preclinical studies using the experimental autoimmune uveitis (EAU) model have shown commensals such as Desulfovibrio and Prevotella, as well as Ruminococcaceae, associated with uveitis, which overlap with some clinical studies in uveitis patients. Interventions that target the microbiome that can be developed for the treatment of uveitis include antibiotics, fecal metabolites or metabolite agonists that are protective in uveitis, probiotics, dietary interventions, or fecal microbial transplant.

Summary: There is significant data supporting the importance of the intestinal microbiome in noninfectious uveitis through enrichment or depletion of certain gut bacteria as well as their metabolites. Targeting the intestinal microbiome or their metabolites might be a viable option for the treatment of noninfectious uveitis.

Purpose of review: Marfan syndrome is a connective tissue disorder with several vision-threatening ocular manifestations. This study synthesizes recent advances in the surgical approach to ocular complication of Marfan syndrome including ectopia lentis, early cataract, glaucoma, and retinal detachment.

Recent findings: Recent literature highlights advances in capsular support devices and alternative fixation methods for ectopia lentis, including long-term outcomes with modified capsular tension rings, suture-less scleral fixation, and iris-claw intraocular lenses. Pediatric cohorts underscore elevated risks of retinal detachment following lens removal, particularly when capsular remnants persist, emphasizing the importance of complete removal and vigilant follow-up. In highly myopic Marfan eyes, modern intraocular lens power calculation formulas demonstrate improved refractive predictability, though pediatric patients remain prone to progressive myopic shift. For glaucoma, tailored modifications to trabeculectomy and tube shunt techniques address the challenges of thin sclera and ocular surface fragility. Contemporary retinal detachment series reveal high lifetime risk, with surgical success often requiring multiple procedures, and outcomes closely tied to macular status and presence of proliferative vitreoretinopathy.

Summary: Advances across anterior and posterior segment surgery have improved visual outcomes for Marfan patients, but long-term risks remain substantial. Individualized surgical planning, early detection of complications, and long-term surveillance are essential to optimize outcomes in this high-risk population.

Purpose of review: Rapid advances in large language models (LLMs) have led to the emergence of agentic artificial intelligence (AI) systems capable of autonomously performing complex scientific tasks. This review examines recent developments in agentic AI, highlighting their transformative potential for ophthalmology research and clinical practice, and discusses associated ethical considerations.

Recent findings: Recent studies demonstrate that agentic AI systems can autonomously execute tasks traditionally performed by human researchers, including peer review, hypothesis generation, systematic reviews, and experimental design. Notable examples include AI-generated manuscripts accepted through peer review, automated systematic reviews outperforming human accuracy and efficiency, and performing complex biomedical analyses across diverse domains. Although direct ophthalmology-specific applications remain nascent, the field's data-rich nature positions it ideally for adopting agentic AI in several areas such as automated chart review, health economics modeling, and enhanced image analysis.

Summary: Agentic AI represents a paradigm shift in scientific research, offering significant opportunities to enhance productivity, rigor, and innovation in ophthalmology. However, integration into clinical and research workflows necessitates careful consideration of ethical issues, including authorship attribution, data privacy, bias mitigation, and accountability. Clear governance frameworks, rigorous validation standards, and interdisciplinary training will be essential to responsibly harness agentic AI in ophthalmology.

Purpose of review: Modern presbyopia-correcting intraocular lenses (IOLs) offer a potential solution to address the rising postoperative demand and expectations for spectacle independence following cataract surgery. However, IOL calculation and selection becomes more complex when presented with previous corneal refractive surgery (CRS) or co-existing corneal conditions. This review explores the use of presbyopia-correcting IOLs in eyes with co-existing corneal conditions or surgically altered corneas.

Recent findings: Careful consideration and selection is required in patients with co-existing corneal conditions who desire spectacle independence. Presbyopia-correcting IOLs have been shown to be safe and provide good uncorrected vision in eyes with previous CRS. Modern biometry formulas have improved predictability in eyes with previous CRS, though evidence related to presbyopia-correcting IOLs is limited. Pinhole IOLs may be suitable for eyes with irregular/aberrated corneas. Further evidence regarding presbyopia-correcting IOLs is required in eyes with dry eye disease, keratoconus, and corneal graft. Knowledge of the range of available IOLs are key to optimizing visual quality and achieving spectacle independence.

Summary: Patients with prior CRS or co-existing corneal disease(s) present unique challenges when considering presbyopia-correcting IOLs. While promising options are available, successful outcomes depend on careful patient selection, thorough corneal assessment, and realistic management of patient expectations.

Purpose of review: To review recent advances in the surgical management of dense white cataracts, focusing on preoperative assessment, biometry, capsulotomy techniques, phacoemulsification systems, and surgical outcomes.

Recent findings: Swept-source optical coherence tomography (SS-OCT) biometers now achieve nearly universal axial length measurements even in dense lenses, improving refractive predictability. Anterior segment OCT and Scheimpflug imaging facilitate detection of intralenticular fluid pockets and capsular thinning, guiding decompression strategies to prevent anterior capsule tears. Innovations in manual capsulorhexis, preoperative Nd:YAG (neodymium-doped yttrium aluminum garnet) decompression, and device-based techniques (precision pulse capsulotomy and selective laser capsulotomy) have improved reproducibility and reduced Argentinian flag sign incidence. Low-energy femtosecond laser-assisted cataract surgery further enhances endothelial safety in selected cases. In phacoemulsification, newer platforms with advanced fluidics and tips have decreased cumulative energy use, turbulence, and endothelial cell loss. For very dense nuclei, manual small-incision cataract surgery remains a practical alternative with lower endothelial trauma in specific settings.

Summary: Advances in ocular imaging, biometry, capsulotomy, and phacoemulsification technology have significantly improved the safety and predictability of dense white cataract surgery. Incorporating these innovations into surgical practice has reduced the incidence of intraoperative complications, including anterior capsular tears, posterior capsule ruptures, and endothelial cell loss, while enhancing refractive outcomes.

Purpose of review: Diabetes mellitus may influence different stages of cataract surgery, from preoperative evaluation to postoperative recovery. With the rapid increase in the global prevalence of diabetes, understanding evidence-based strategies for optimizing surgical outcomes is critical.

Recent findings: Studies have found that fixed glycated hemoglobin (HbA1c) thresholds alone should not be used to determine the timing of surgery. Instead, a macula-first approach, integrating retinal co-management and optical coherence tomography (OCT) for diabetic patients, allows for tailored decision-making. Key advancements include ocular surface optimization to enhance biometry accuracy, proactive perioperative anti-inflammatory regimens combining NSAIDs and corticosteroids, and selective use of intravitreal anti-VEGF or corticosteroid therapy for diabetic macular edema (DME). Lens choice should refrain from multifocal optics in eyes with diabetic macular diseases. Emerging equity frameworks underscore the need to replace systemic cut-offs with risk-based protocols to enhance access and outcomes.

Summary: Modern cataract surgery in patients with diabetes requires an individualized retina-integrated approach that emphasizes inflammation control and macular preservation. Embedding equity-driven, OCT-based pathways ensures that surgical excellence extends to populations most affected by diabetes-related vision loss.

Purpose of review: To provide an updated review of manual small incision cataract surgery (MSICS), including training innovations, advancements in surgical techniques, system-level performance, and equity implications in global cataract care.

Recent findings: As global cataract burden continues to rise, MSICS has gained traction as a cost-effective and scalable solution, particularly in low and middle-income countries (LMICs). Simulator-based training and new surgical tools have enhanced early proficiency among trainees. Recent data highlight MSICS as a procedure with comparable complication rates and patient-reported satisfaction to phacoemulsification, assuming proficiency of the surgeon. Key research gaps persist in skill transferability, long-term outcomes, and sex disparities in access.

Summary: MSICS remains a pivotal surgical technique in the fight against global cataract blindness. Its affordability and adaptability to resource-limited settings make it a critical part of international efforts to expand cataract surgical coverage and promote equitable eye care delivery.

Purpose of review: Cataract surgery in keratoconus remains one of the most challenging settings in anterior segment surgery. This review summarizes recent evidence (2020-2025) on intraocular lens (IOL) power calculation, surgical strategies, and adjunctive treatments, highlighting current limitations and future perspectives.

Recent findings: Advances in keratoconus-specific formulas such as Barrett True-K and Kane-KC, particularly when posterior corneal curvature is measured, have improved refractive accuracy compared with conventional formulas, though prediction errors remain higher than in normal eyes. Toric IOLs are effective in carefully selected mild-to-moderate cases, with multimeasurement calculators improving astigmatic prediction and a 2025 systematic review confirming safety and stability. Small-aperture optics (IC-8) may increase depth of focus, but keratoconus-specific evidence is limited. Staged approaches, including intracorneal ring segments, cross-linking, and DALK in advanced disease, improve safety and predictability. Emerging technologies such as artificial intelligence-based calculators and premium IOLs show promise but require further validation.

Summary: Despite significant progress, outcomes in keratoconus remain less predictable than in normal eyes. Careful patient selection, keratoconus-adjusted formulas, and staged surgical strategies are essential. Future priorities include prospective validation of formulas, integration of artificial intelligence tools, and evaluation of adjustable optics.

Purpose of review: Toric intraocular lenses (IOL) predictably correct corneal astigmatism and are an important part of the cataract and refractive surgeon's toolbox.

Recent findings: Advances in toric IOL technology, preoperative biometry, IOL power calculations, and IOL alignment have resulted in excellent visual outcomes and achievement of spectacle independence. Despite these advancements, the primary challenges faced in toric IOL use remain choosing the optimal IOL toricity and properly aligning the IOL.

Summary: Toric IOL are an effective way to correct corneal astigmatism, and advancements in lens selection and design have improved their functionality for patients. This review summarizes these advances and reports on upcoming technologies.