Acta Ophthalmologica最新文献

Purpose: To evaluate the incidence, outcomes, and risk factors of numerical hypotony (NH) and choroidal effusion (CE) following standalone PRESERFLO MicroShunt (PMS) implantation.

Methods: Primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PXG) patients with uni- or bilateral surgery at a tertiary university hospital were retrospectively evaluated. Kaplan-Meier estimates of first-operated eyes were used to analyse the cumulative incidence of NH (intraocular pressure [IOP] of <6 mmHg), CE, and CE requiring intervention. Risk factor analyses were performed using generalised linear mixed models on the patient level, including bilateral cases.

Results: In total, 370 patients (235 POAG and 135 PXG) and 435 eyes (288 and 147) were included. The PXG group had a significantly higher incidence of NH (83.7% vs. 69.4%) and CE (34.6% vs. 20.6%). Interventions for CE were required significantly more in PXG patients (20.7% vs. 7.4%). The median CE duration was significantly longer in the PXG group (14 days vs. 7 days). The following risk factors were identified: PXG (development of NH, CE, and CE requiring intervention); spherical hyperopic refractive error (CE and CE requiring intervention); male sex and higher age (CE); number of preoperative medications (CE requiring intervention), lower preoperative IOP (NH), and higher postoperative IOP drop (CE). The 6-month visual outcomes were not influenced by the hypotony criteria, but significantly more eyes treated for CE required subsequent bleb revisions.

Conclusion: PXG and hyperopic eyes were at risk for developing postoperative CE requiring intervention. They should be monitored more closely and would benefit from primary intraluminal stenting.

Purpose: To describe the clinical characteristics and 1-year follow-up of patients with neovascular AMD (nAMD) without drusen in either eye.

Methods: This is a multicentre retrospective cohort study in three tertiary referral centres in The Netherlands. We included patients of 55 years or older with nAMD in one or both eyes, without the presence of drusen or signs of another underlying disease in either eye. The medical charts and multimodal imaging (MMI) were evaluated by two independent graders. Eyes were divided into two groups: polypoidal choroidal vasculopathy (PCV)-associated macular neovascularization (MNV) and non-PCV MNV. We evaluated the visual acuity (VA) at baseline and 1 year after baseline; complete resolution of macular fluid on optical coherence tomography (OCT) during 1 year of follow-up; required treatments to achieve a complete resolution of macular fluid on OCT; complication rate.

Results: We included 106 eyes of 99 patients, with a median age of 73 years. Seventy-one eyes had PCV-associated MNV, and 35 eyes had non-PCV MNV. The overall median baseline VA was 0.22 logMAR (Snellen 20/30), and 0.15 logMAR (Snellen 20/28) at 1 year follow-up. Subretinal haemorrhage was more common in PCV-associated MNV compared to non-PCV MNV, both at initial presentation (21% vs. 17%) and during the 1 year follow-up period (23% vs. 11%). In total, 31 out of 48 eyes (65%) achieved complete resolution of macular fluid on OCT during follow-up, most commonly achieved with combined photodynamic therapy (PDT) + intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Conclusion: nAMD can occur without the presence of drusen in either eye. Treatment with anti-VEGF injections, PDT or a combination thereof appears to be effective, but more research is warranted.

Purpose: To determine the histological differences between Fuchs endothelial corneal dystrophy (FECD) cases with and without the most common genetic risk factor, expansion of a CTG repeat (CTG18.1) within the TCF4 gene.

Methods: Formalin-fixed paraffin-embedded corneal tissues were compared retrospectively, and CTG18.1 status was determined from blood-derived gDNA. Cases were defined as expansion-positive (Exp⁺) if at least one CTG18.1 allele had ≥ 50 repeats. Tissue was assigned as either 'typical' if there were several prominent exophytic or buried guttae or 'not typical' if there were only a few shallow guttae or no status could be confidently assigned.

Results: In total, 72 unrelated corneal specimens (43 from endothelial keratoplasty and 29 from penetrating keratoplasty) with corresponding genetic data were analysed. We assigned a 'typical' histopathological guttae appearance to 88% (53/60) of Exp⁺ and 83% (10/12) of Exp^- cases. No significant difference was observed between the proportion of 'typical' and 'not typical' assignments within these genotypically distinct groups (Fisher's exact test; odds ratio [OR], 1.5; 95% CI: 0.14-9.7; p = 0.6393). Without adjustment for multiple testing, 'not typical' samples were more likely to be from males (7/9 vs. 17/63; OR, 0.11; 95% CI: 0.01-0.65; p = 0.005017) and more frequently from cases with coexisting keratoconus (4/9 vs. 3/63; OR = 0.07; 95% CI: 0.01-0.54; p = 0.004208).

Conclusion: Histopathological guttae appearance was not found to correlate with CTG18.1 expansion status. However, male sex or coexisting keratoconus was more frequently associated with histology categorised as 'not typical'.

Purpose: To evaluate a modified full-thickness corneal graft technique as a remedial strategy for advanced corneal melting following Boston type I keratoprosthesis (KPro) implantation.

Methods: Eleven patients with significant corneal melting and >180° KPro exposure underwent corrective surgery. A donor graft, matching the primary transplant diameter and with a 3-mm central aperture, was thinned circumferentially and positioned beneath the KPro optical cylinder after debridement of necrotic tissue.

Results: Over 6-12 months of follow-up, globe integrity was preserved in all cases. Two patients required repeat procedures for recurrence. Visual acuity improved in five patients; in others, it remained stable or declined due to comorbidities.

Conclusion: The modified full-thickness graft technique is a promising alternative for managing advanced corneal melting after Boston type I KPro. Further studies with larger cohorts and longer follow-up are warranted.

The current global prevalence has increased significantly in recent decades. The largest increase has been especially in Southeast Asian countries, where the prevalence of myopia exceeds 80% among school leavers (Morgan et al., 2012). An increasing trend has been observed in other countries as well. However, the increase has been significantly less; for example, in Nordic countries, where the prevalence of myopia in young adults is around 25% (Pärssinen et al., 2025).

The recent systematic review and meta-analysis of data from 14 countries reported that myopia prevalence in Europe is lower than in Asia, with a less pronounced increase that disappears after stratifying by cycloplegic refraction and age (Moreira-Rosário et al., 2025).

It is generally accepted that myopia is associated with more near work, higher education and less time spent outdoors. However, there is no definite knowledge of the mechanisms by which various external factors cause axial elongation and myopia. The joint World Health Organization–Brien Holden Vision Institute global meeting in Sydney, Australia, in 2015 (WHO, 2016) drew attention to the worldwide increase of myopia and its complications and predicted that, by 2050, myopia prevalence would rise to 4.9 billion people (52% of the world population), of whom 925 million people (10% of the world population) would have high myopia (≤−5 D; WHO, 2016). After that, studies on myopia and publications have significantly increased.

From 2004, Acta has published 191 studies on myopia, and submissions per year have steadily increased through the years and peaked in 2021. Articles in this Special Issue can be divided into four different subtypes of myopia research, namely, epidemiology, pathophysiology, treatment and complications.

The study of Bro (2025) showed that, from 1975 to 1995, the prevalence of myopia among Swedish conscripts increased from 22% to 29%. A higher level of education and higher verbal and visuospatial ability were risk factors for myopia.

The meta-analysis of Martinez-Perez et al. (2025) investigated the effectiveness of outdoor activities in reducing the onset of myopia in children and adolescents. Their study shows that outdoor activities, especially with prolonged exposure to intense light, effectively reduce or delay the onset of myopia in children and adolescents.

Pärssinen (2025) in his study, reviews the historical studies of Cohn in Germany and Widmark in Sweden. In both countries, the prevalence of myopia in the 1800s was high at the highest grades of schools. In Sweden, between the periods 1822–1883 and 1904–1905, the mean myopia prevalence decreased from 22.2% to 9.8% and from 45.3% to 17.4% in the highest grades of these same schools. Widmark suggested that the main factors causing the myopia decrease were improved lighting due to electric lights, Fraktur fo

Purpose: The retinal pigment epithelium (RPE) is critical in the pathophysiology of retinal diseases, such as age-related macular degeneration. Adaptive optics transscleral flood illumination (AO-TFI) offers rapid, detailed morphometric characterization of the RPE layer. This study evaluated AO-TFI's efficacy and feasibility to detect clinically relevant morphological characteristics in a clinical setting.

Methods: A total of 230 participants, categorized by their central retinal health, underwent comprehensive examination including SD-OCT, fundus imaging and AO-TFI using the Cellularis® prototype 2.0. Image quality control and RPE layer quantification were performed with an AO-TFI-specific automated segmentation algorithm. Density and area of hyper- and hyporeflective regions in the RPE layer plane, and, if detectable, RPE cell density, were quantified. We hypothesized that the RPE cell density would be lower in diseased retinas than in healthy retinas. Imaging results of healthy participants were statistically compared to those of diseased eyes. Additionally, generalized linear and logistic regression mixed-effect models identified associations between ocular characteristics and imaging parameters.

Results: After quality evaluation, high-quality images from 200 subjects (87%) were selected and segmented. The number of hyperreflective regions and their mean surface area were significantly higher in diseased than in healthy eyes (68 ± 40/mm² vs. 51 ± 39/mm²; p < 0.001; 302 ± 196 μm² vs. 155 ± 55 μm²; p < 0.001). The RPE distinct mosaic pattern was more often visible in healthy retinas (n = 103 vs. n = 30, p < 0.0001). The mean RPE cell density was 6354 ± 695/mm², with comparable counts for healthy and diseased, 6327 ± 687/mm² vs. 6532 ± 725/mm² (p = 0.1).

Conclusion: AO-TFI detected differences between healthy and diseased eyes, indicating its potential as a promising clinical modality providing quantitative and qualitative insights into RPE layer dynamics.

Purpose: To evaluate the demographic and clinical characteristics, treatment indications, long-term outcomes and prognostic factors in patients with congenital x-linked retinoschisis (CXLR) managed conservatively or surgically.

Methods: This retrospective, international, multicentre study included data from retina specialists across 14 centres in 9 countries. Demographic information, best corrected visual acuity (BCVA), phenotype, optical coherence tomography (OCT) findings and disease management were analysed. Surgical indications, techniques and anatomical and visual outcomes were evaluated.

Results: A total of 635 eyes of 318 patients were included. Median age at presentation was 9 years (range: 0-81). Observation was preferred in 73.5% of eyes, laser photocoagulation (LPC) in 9.3% and vitreoretinal surgery in 18.1%. Surgical patients presented younger (7 vs. 10 years; p = 0.002) and with worse baseline BCVA (1.50 vs. 0.50 LogMAR; p < 0.0001). Disease symmetry was lower in surgical cases (24.4%) than in conservative and LPC groups (p < 0.0001). Vitreous veils, peripheral pigmentary changes and white spiculations were predictive of surgical need, particularly in eyes with rhegmatogenous retinal detachment (RRD) and vitreous haemorrhage (VH). OCT predictors of peripheral progression included absence of ganglion cell layer cysts and presence of outer plexiform layer cysts. Single-surgery anatomical success was 68.7%, increasing to 94.7% with additional procedures. Inner-wall retinectomy significantly improved outcomes in macula-threatening retinoschisis (p = 0.026). Visual acuity improved significantly after surgery in RRD and VH cases (p = 0.003).

Conclusion: CXLR shows a broad clinical spectrum requiring individualized care. Fundus and OCT features effectively predicted progression and surgical need. Surgical management achieved high success, with inner-wall retinectomy beneficial in certain cases.

Purpose: To study ocular fundus morphology and its relation to growth in adolescents born moderate-to-late preterm (MLP) and full term.

Methods: This prospective and population-based cohort study included 50 MLP adolescents (26 girls, mean age 16.5 years) and 50 full-term controls (30 girls, mean age 16.7 years). Optical coherence tomography measurements were studied in relation to gestational age, auxological data, insulin-like growth factor-I (IGF-I) and IGF-binding protein 3 (IGFBP-3).

Results: The MLP group showed an increased central macular retinal thickness (MRT) compared with controls in right eye (RE) (249.7 ± 21.0 vs. 239.9 ± 16.4 μm, p = 0.019). Moreover, the MLP group showed a thinner total peripapillary retinal nerve fibre layer (ppRNFL) thickness in RE (104.3 ± 8.5 vs. 109.1 ± 8.3, p = 0.0011). Nasal ppRNFL thickness was thinner in both RE (79.4 ± 13.2 vs. 85.0 ± 10.8, p = 0.0012) and left eye (LE) (77.0 ± 13.8 vs. 81.7 ± 13.4, p = 0.025) compared with controls. A weak association between total ppRNFL thickness and IGF-I levels was found (RE, r = 0.28, p = 0.032; LE, r = 0.27, p = 0.048), as well as between central MRT and a ratio between IGF-I and IGFBP-3 levels (RE, r = 0.30, p = 0.022). Additionally, there was a correlation between optic cup/disc area ratio and birth weight (RE: r = -0.44, p = 0.0006; LE: r = -0.30, p = 0.026).

Conclusion: The present study suggests that growth and MLP birth may impact ocular fundus morphology. The MLP adolescents were shown to have thinner ppRNFL thickness and greater MRT, compared with full-term controls. Furthermore, a weak association between these structures and growth factors was found. In addition, the current study proposes that birth weight may impact optic disc parameters.

Purpose: To investigate the associations between paper-based reading and writing time, screen-based time at ages 2, 3, 6 and 9 years and myopia at age 9 in the GUSTO birth cohort.

Methods: The GUSTO study recruited pregnant women from two Singapore public maternity hospitals between 2009 and 2010. Parent-reported reading and writing time, screen time and outdoor time were collected at ages 2, 3, 6 and 9 years. Cycloplegic autorefraction and axial length were measured at age 9. Myopia was defined as a spherical equivalent ≤-0.5 D. Associations between near work exposures and myopia were examined using multivariable regression with generalised estimating equations.

Results: Among 471 children (942 eyes), 37.3% were myopic at age 9 years. Greater reading and writing time at ages 6 and 9 were associated with higher odds of myopia at age 9 (OR [95% CI] = 1.20 [1.02-1.42] and 1.11 [1.02-1.22] per h/day, respectively). Children spending >3 h/day reading and writing at age 9 had 76% higher odds of myopia than those spending ≤3 h/day (OR = 1.76, 95% CI: 1.08-2.85). Reading and writing time at ages 2 and 3 years, and screen time at all age groups showed no significant association with myopia at age 9.

Conclusions: Traditional paper-based reading and writing, but not screen time, were associated with myopia in Singaporean children. Future studies with larger samples and objective screen time measures are needed to evaluate the distinct role of screen time in myopia.