American Journal of Ophthalmology最新文献

{"title":"Potential Eye Disorders in People With and Without Type 2 Diabetes Mellitus Exposed to GLP-1 Receptor Agonists: An Examination of the FAERS (FDA Adverse Event Reporting System) Database","authors":"Mya Murray ,&nbsp;Fabrizio Schifano ,&nbsp;Stefania Chiappini ,&nbsp;John Martin Corkery ,&nbsp;Amira Guirguis","doi":"10.1016/j.ajo.2025.12.015","DOIUrl":"10.1016/j.ajo.2025.12.015","url":null,"abstract":"<div><h3>Purpose</h3><div>As use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for Type 2 diabetes (T2DM) and weight management increases, emerging research identifies various adverse drug reactions. This study aimed to expand this research base, focusing on eye disorders in people with and without T2DM, a novel consideration.</div></div><div><h3>Design</h3><div>A retrospective clinical cohort disproportionality analysis of reports made to the Food and Drug Administration Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>FAERS was queried regarding selected GLP-1RAs. Python 3.11 was adopted to develop a program, quantifying reported cases between January 2017 - September 2025 (January 2022-September 2025 for tirzepatide) meeting the criteria for cases with and without T2DM. Main outcome measures Reporting Odds Ratios (RORs) &gt;4.000 and 95% confidence intervals were calculated, with metformin and orlistat as controls.</div></div><div><h3>Results</h3><div>Compared to metformin, semaglutide showed increased reporting of optic ischemic neuropathy (ROR: 12.269 [0.915-1.967]), cataract (ROR: 31.879 [2.463-4.461]) and retinopathy (ROR: 5.185 [0.556-2.736]) in T2DM patients, and retinopathy (ROR: 9.424 [1.081-3.406]) and retinal hemorrhage (ROR: 10.253 [0.319-4.336]) in non-T2DM patients. Tirzepatide showed increased reporting of optic ischemic neuropathy (ROR: 4.619 [0.726-2.335]) and macular degeneration (ROR: 15.579 [0.554-4.938]) in T2DM patients and eye swelling (ROR: 6.475 [0.407-3.329]) in non-T2DM patients. Liraglutide showed increased reporting of cataract (ROR: 53.866 [2.945-5.028]), diabetic retinopathy (ROR: 18.162 [1.753-4.045]) and macular degeneration (ROR: 26.261 [1.076-5.460]) in T2DM patients and cataract (ROR: 9.628 [1.387-3.142]) and macular degeneration (ROR: 9.557 [0.110-4.405]) in non-T2DM patients.</div></div><div><h3>Conclusions</h3><div>These results provide a signal of increased reporting of various eye disorders with GLP-1RA use compared to metformin across T2DM and non-T2DM patient cases. Further research is required to support these findings and confirm a biological causation.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 279-290"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Failure in Minimally Invasive Bleb Surgery: A Systematic Review","authors":"Minsu Jung ,&nbsp;Ying Zhi Kong ,&nbsp;Abdus Samad Ansari ,&nbsp;Mitchell Lawlor ,&nbsp;Jeremy C.K. Tan","doi":"10.1016/j.ajo.2025.11.045","DOIUrl":"10.1016/j.ajo.2025.11.045","url":null,"abstract":"<div><h3>Purpose</h3><div>Minimally invasive bleb surgery (MIBS) reduces intraocular pressure (IOP) and IOP-lowering medication use, with a safer adverse effect profile compared to traditional filtration surgery. This review examined risk factors for surgical failure following MIBS.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>A systematic review (Prospero ID: CRD42024572750) of Embase, Web of Science, and MEDLINE identified studies which reported ophthalmic or demographic factors significantly associated with surgical failure following MIBS. Risk of bias was evaluated using Quality in Prognostic Studies (QUIPS), evidence quality using Centre for Evidence-Based Medicine (CEBM), and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).</div></div><div><h3>Results</h3><div>Of 394 articles identified, 18 studies comprising 19 cohorts (9580 eyes of 9281 subjects) were included. Twelve cohorts evaluated the XEN Gel Stent and 7 examined the PreserFlo MicroShunt. Non-White ethnicity (Asian and non-Hispanic Black) and lower intraoperative dosing/omission of intra-operative Mitomycin-C was associated with higher risk of failure; both associations had low certainty of evidence. Associations between glaucoma diagnosis and surgical failure were conflicting, with very low certainty of evidence; several studies described higher risk of failure for pseudoexfoliative/pigmentary, angle closure, uveitic, and normal tension subtypes of glaucoma. Conversely, lower risk of failure was reported among ocular hypertension/open-angle suspects. Most studies had low risk of bias and evidence quality was low to moderate.</div></div><div><h3>Conclusion</h3><div>This review identified demographic and preoperative factors associated with MIBS failure, especially non-White ethnicity and reduced/no MMC use. These findings may guide patient selection and future studies; however, the low certainty of evidence warrants cautious interpretation.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 55-71"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural History of CNGA1-Associated Retinitis Pigmentosa in a Large Chinese Cohort Revealing an Optimal Intervention Window","authors":"YUE LIU ,&nbsp;DINGDING ZHANG ,&nbsp;YUNYU ZHOU ,&nbsp;YAMEI LI ,&nbsp;XIAOXU HAN ,&nbsp;ZIXI SUN ,&nbsp;XING WEI ,&nbsp;HUI LI ,&nbsp;XUAN ZOU ,&nbsp;RUIFANG SUI","doi":"10.1016/j.ajo.2025.12.018","DOIUrl":"10.1016/j.ajo.2025.12.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To detail the natural history, clinical manifestations, and molecular characteristics of a large Chinese cohort of patients with <em>CNGA1</em>-associated retinitis pigmentosa (<em>CNGA1-RP</em>).</div></div><div><h3>Design</h3><div>Single-center, retrospective case series.</div></div><div><h3>Participants</h3><div>A total of 58 Chinese patients with <em>CNGA1-RP</em> from 52 families were enrolled between 2011 and 2025.</div></div><div><h3>Methods</h3><div>Longitudinal data were available for 20 individuals, with the longest follow-up of 11 years. All participants underwent comprehensive clinical evaluations and genetic analysis. The impact of age on best-corrected visual acuity (BCVA) and visual field (VF) was evaluated using restricted cubic spline (RCS) analysis. Retinal multimodal imaging was acquired, including optical coherence tomography (OCT), ultra-widefield (UWF) scanning laser ophthalmoscope (SLO) and UWF fundus autofluorescence (FAF). Moreover, electroretinogram (ERG) was performed.</div></div><div><h3>Main Outcome Measures</h3><div>Clinical symptoms, age-related changes in BCVA and VF, retinal multimodal imaging features, molecular characteristics.</div></div><div><h3>Results</h3><div>Night blindness was the universal initial symptom, with most patients (88%) experiencing onset during childhood. BCVA remained stable (0.09 logMAR) until age of 30.7 years, followed by a progressive decline at 0.029 logMAR per year; by age of 72 years, 32% of patients had developed blindness (BCVA <strong>&gt;</strong> 1.30 logMAR). VF impairment began in childhood and progressed to tunnel vision (VF ≤ 10°) at a median age of 39.4 years. A high degree of interocular symmetry was observed for both BCVA and VF. FAF imaging revealed a macular hyper-autofluorescent (hyperAF) ring in 73% of patients. Genetic analysis identified 14 novel pathogenic variants in <em>CNGA1</em>, and c.265delC was confirmed as a hotspot variant with an allele frequency of 72% in the Chinese population. Furthermore, homozygous carriers of this hotspot variant exhibited more severe phenotypes.</div></div><div><h3>Conclusions</h3><div>Our study characterized the natural history of <em>CNGA1</em>-RP and identified c.265delC as a hotspot variant in the Chinese population. Based on the quantitative data, VA loss in <em>CNGA1</em>-RP is late-onset and slow-progressing, whereas VF loss occurs earlier and more severely. The optimal window of intervention for <em>CNGA1</em>-RP in the Chinese population appears to be between the 3rd and 4th decade of life.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 299-312"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strabismus Increases Glaucoma Risk in California Medicare Beneficiaries","authors":"Martin Ramirez ,&nbsp;Ying Zheng ,&nbsp;Victoria L. Tseng ,&nbsp;Fei Yu ,&nbsp;Joseph L. Demer ,&nbsp;Anne L. Coleman","doi":"10.1016/j.ajo.2025.12.009","DOIUrl":"10.1016/j.ajo.2025.12.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the associations between strabismus subtypes and glaucoma subtypes in California (CA) Medicare beneficiaries.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects</h3><div>All 2019 CA Medicare beneficiaries who were ≥65 years old, had both Parts A &amp; B coverage, and had ≥1 Part B claim.</div></div><div><h3>Methods</h3><div>The primary exposures were any strabismus and its subtypes including paralytic and vertical strabismus, esotropia, and exotropia, as defined by International Classification of Diseases, 10th revision (ICD-10) codes. Primary outcomes were any glaucoma, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG), defined by ICD-10 codes. The associations between strabismus and glaucoma were estimated using multivariable logistic regression models adjusting for age, sex, race and ethnicity, hyperopia, myopia, hyperthyroidism, and systemic disease burden defined by Charlson Comorbidity Index (CCI) score. The effect estimate was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).</div></div><div><h3>Main Outcome Measures</h3><div>Odds ratios between exposures and outcomes.</div></div><div><h3>Results</h3><div>The study population included 2,716,629 beneficiaries. Of those, 220,664 (8%) had glaucoma and 19,899 (1%) had strabismus. In the adjusted logistic regression models, beneficiaries with paralytic strabismus had a 78% increased odds of POAG (OR: 1.78; 95%; CI: 1.60-1.98; <em>p</em> &lt; .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.10-3.62; <em>p</em> &lt; .0001). Beneficiaries with vertical strabismus had an 80% increased odds of POAG (aOR: 1.80; 95% CI: 1.60-2.02; <em>p</em> &lt; .0001) and 203% increased odds of NTG (aOR: 3.03; 95% CI: 2.28-4.02; <em>p</em> &lt; .0001). Beneficiaries with esotropia had an 84% increased odds of POAG (aOR: 1.84; 95% CI: 1.66-2.03; <em>p</em> &lt; .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.12-3.60; <em>p</em> &lt; .0001). Beneficiaries with exotropia had a 170% increased odds of POAG (aOR: 2.70; 95% CI: 2.45-2.96; <em>p</em> &lt; .0001) and 198% increased odds of NTG (aOR: 2.98; 95% CI: 2.24-3.97; <em>p</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>In the 2019 CA Medicare population, beneficiaries with strabismus and its subtypes were all associated with greater odds of POAG and NTG. Further investigations are needed to characterize the mechanisms between these associations, and future studies are needed to examine optimal glaucoma screening and management strategies in patients with strabismus.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 199-206"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OCT Imaging of Macular Hole Containing a Gas Bubble after Retinal Detachment Repair","authors":"Lauren C. Kiryakoza ,&nbsp;Jason Fan","doi":"10.1016/j.ajo.2025.12.036","DOIUrl":"10.1016/j.ajo.2025.12.036","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Page e5"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrophy Advisor: A Clinical Tool for Dry Macular Degeneration With Geographic Atrophy","authors":"Avery F. Kerwin ,&nbsp;Elliot M. Perlman ,&nbsp;David J. Browning","doi":"10.1016/j.ajo.2025.11.037","DOIUrl":"10.1016/j.ajo.2025.11.037","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and evaluate Atrophy Advisor, a clinical decision tool integrating geographic atrophy (GA) progression and personalized lifespan estimates to help clinicians considering complement factor inhibitor injections for dry macular degeneration with GA.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Fifty consecutive patients with GA secondary to nonexudative age-related macular degeneration, seen at Wake Forest-affiliated retina clinics from May 2013 to June 2025.</div></div><div><h3>Methods</h3><div>Fundus images at two or more time points were analyzed using ImageJ to measure the distance from the fovea to the nearest GA edge. Pixel-to-micron conversion was made using an assumed vertical disk diameter of 1800 microns. Demographics, comorbidities, and corrected visual acuities were extracted from records. Lifespan estimates were calculated using University of Connecticut and Social Security Administration algorithms and compared to observed outcomes.</div></div><div><h3>Main Outcome Measures</h3><div>GA edge–to–fovea distance, GA progression rate, corrected visual acuity, and predicted vs observed lifespan.</div></div><div><h3>Results</h3><div>Median age was 78 years (IQR: 74-82); 64% were female. Baseline median GA–to–fovea distance was 792 µm (IQR: 508-1213 µm), declining to 395 µm (IQR: 194-702 µm) at last follow-up. Median GA progression was 122 µm/y (range 2-626 µm/y), with a direct relationship between initial distance and progression rate (<em>P</em> = .006, <em>R</em>² = 0.146). Lifespan calculators (University of Connecticut and Atrophy Advisor) yielded median estimates of 11.9 and 11.0 years, respectively, influencing treatment guidance in 4% of cases.</div></div><div><h3>Conclusions</h3><div>Atrophy Advisor is feasible for combining GA progression kinetics and lifespan estimates to inform treatment decisions. Variability in progression rates and lifespan predictions highlights the need for personalized approaches. Limitations include measurement variability and retrospective design; future studies should validate the tool in larger, prospective cohorts.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 81-90"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting 10 Year Glaucoma Using Anterior Segment Biometry for Infants with Unilateral Congenital Cataract","authors":"Claudia Wong ,&nbsp;Urjita Das ,&nbsp;He Forbes ,&nbsp;Taylor Kolosky ,&nbsp;Euna Cho ,&nbsp;Shaiza Mansoor ,&nbsp;Sera Chase ,&nbsp;Madi Kore ,&nbsp;Riva Menon ,&nbsp;Moran Roni Levin ,&nbsp;Larry Magder ,&nbsp;Carolyn Drews-Botsch ,&nbsp;Scott R. Lambert ,&nbsp;Janet L. Alexander","doi":"10.1016/j.ajo.2025.12.010","DOIUrl":"10.1016/j.ajo.2025.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Glaucoma following congenital cataract surgery is the most common secondary form of glaucoma in children and a serious sight-threatening complication following congenital cataract surgery. Therefore, risk assessment for future glaucoma is integral to the management of infants undergoing cataract surgery. Biometry of the anterior segment may offer the opportunity to enhance estimation of an infant’s risk of developing glaucoma. This study aims to use preoperative anterior segment biometry to predict future glaucoma among infants undergoing congenital cataract surgery and provide a risk calculator based on predictive models.</div></div><div><h3>Design</h3><div>Posthoc cohort analysis from a multicenter randomized controlled trial in the United States (NCT00212134).</div></div><div><h3>Participants</h3><div>This cohort included 114 participants with unilateral congenital cataract who underwent cataract surgery between 2004 and 2007 and were followed for 10.5 years as part of the Infant Aphakia Treatment Study. A total of 110 participants were analyzed. A total of 88 participants had at least one biometry measurement available. Overall, 41% of the cohort was diagnosed as glaucoma or glaucoma suspect by study endpoint.</div></div><div><h3>Methods</h3><div>Preoperative biometry measured on the day of cataract surgery was used to collect anterior chamber depth (ACD) and lens thickness. Subject characteristics, corneal diameter, and axial length were included in logistic regression analysis. ACD was the primary predictor of interest, and glaucoma or glaucoma suspect status at 10.5 years was the primary outcome of interest.</div></div><div><h3>Main Outcome Measures</h3><div>The main outcome measures were model coefficients and odds ratios with 95% confidence intervals for glaucoma or glaucoma suspect diagnosis at 10.5 years following congenital cataract surgery.</div></div><div><h3>Results</h3><div>Subjects with glaucoma had ACD of 2.76 ± 0.48 mm compared to 3.08 ± 0.38 mm among subjects without glaucoma or glaucoma suspect (mean difference = 0.32 mm, <em>P</em> = .003). Logistic regression models found shallower ACD was a strong predictor of glaucoma (OR 5.8 [1.8, 18.9], <em>P</em> = .004), compared to shorter axial length (OR 1.0 [0.7, 1.4], <em>P</em> = .9), thinner lens (OR 1.5 [0.7, 3.1], <em>P</em> = .3), decreased corneal diameter (OR 1.6 [0.95, 2.9], <em>P</em> = .08), and younger age (OR 1.01 [1.0, 1.02], <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>ACD has a significant association with glaucoma following congenital cataract surgery.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 207-213"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Right to Women’s Sight: Global, Regional, and National Burden of Blindness and Vision Loss in Women, 1990 to 2021","authors":"Lan Xia ,&nbsp;Wuhong Weng ,&nbsp;Jing Wang ,&nbsp;Lingyu Dai ,&nbsp;Suo Guo ,&nbsp;Yanlin Pu ,&nbsp;Tao Cai ,&nbsp;Peizeng Yang","doi":"10.1016/j.ajo.2025.12.005","DOIUrl":"10.1016/j.ajo.2025.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify global, regional, and national burdens of blindness and vision loss among females from 1990 to 2021 and to assess age patterns, trends, causes, and risk factors contributing to sex disparities.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis using publicly available, deidentified data from the Global Burden of Disease (GBD) 2021 study.</div></div><div><h3>Participants</h3><div>Females across 204 countries and territories included in GBD 2021. Sex-specific estimates were analyzed; no identifiable human subjects were involved.</div></div><div><h3>Methods</h3><div>Deidentified GBD 2021 data were analyzed using R (4.3.2) and Joinpoint regression. Prevalence and Years Lived with Disability (YLDs = prevalence × disability weight) were estimated globally and stratified by age, geography, and Sociodemographic Index. Descriptive analyses assessed trends from 1990 to 2021. Mapping illustrated regional distribution and estimated annual percentage change. Cause- and risk-factor analyses followed standardized GBD methods.</div></div><div><h3>Main Outcome Measures</h3><div>Age-standardized and age-specific prevalence and YLD rates; leading causes; risk-factor–attributable YLDs; and temporal patterns by estimated annual percentage change.</div></div><div><h3>Results</h3><div>In 2021, females had a 27.1% higher prevalence of blindness and vision loss and a 17.2% higher YLD rate than males. Age-standardized prevalence and YLDs were 14,510.97 and 17,010.96 per 100,000. Burdens were highest in low- and middle-Sociodemographic Index regions. Near vision loss, cataract, and refractive disorders were leading causes; major contributors included air pollution, high BMI, and household air pollution. Women ≥70 years bore the highest disability burden. Joinpoint analysis showed a persistent increase in female YLDs without a clear COVID-19–related inflection. Limitations include modeled estimates and regional data heterogeneity.</div></div><div><h3>Conclusions</h3><div>Females worldwide continue to experience a disproportionate burden of blindness and vision loss, especially in lower-resource settings and older age groups. Gender-responsive strategies and expanded access to eye care are urgently needed.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 227-255"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Modified Chitosan Medical Membrane on the Inflammation and Recurrence After Primary Pterygium Excision: A Prospective Randomized Clinical Study","authors":"Songlin Hou ,&nbsp;Xingchen Geng ,&nbsp;Jingfan Li ,&nbsp;Zhihua Guo ,&nbsp;Runan Dou ,&nbsp;Nan Zhang ,&nbsp;Xue Sun ,&nbsp;Jingguo Li ,&nbsp;Ruixing Liu ,&nbsp;Lei Zhu ,&nbsp;Zhanrong Li","doi":"10.1016/j.ajo.2025.11.035","DOIUrl":"10.1016/j.ajo.2025.11.035","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To explore the role of intraoperative implantation modified chitosan medical membrane (MCMM) in postoperative inflammation and recurrence for primary pterygium excision with adjunctive amniotic membrane transplantation (AMT).</div></div><div><h3>DESIGN</h3><div>Prospective, randomized, controlled, single-center clinical trial.</div></div><div><h3>METHODS</h3><div>We included 54 patients (54 eyes) with primary pterygium scheduled for pterygium excision. They were randomly divided into two groups. The cryopreserved amniotic membrane (AM) group accepted pterygium excision with adjunctive AMT, and the MCMM group received AMT with adjunctive subconjunctival MCMM implantation during surgery. A follow-up of 3 years was conducted to observe pterygium recurrence. Primary outcomes included recurrence rate and tear cytokine levels after surgery. Secondarily, epidemiological data, visual acuity change, intraocular pressure (IOP), and ocular surface score were also collected. Data were analyzed using SPSS software version 26.0. The χ² test and Student <em>t</em> test were used to compare qualitative and continuous quantitative variables, respectively.</div></div><div><h3>RESULTS</h3><div>A total of 54 subjects with 54 eyes were included, 26 in the AM group and 28 in the MCMM group. Corneal recurrence of pterygium occurred in 3 cases (11.5%), whereas 2 cases (7.7%) showed conjunctival recurrence in the AM group. Two cases (7.1%) experienced corneal recurrence, and 2 cases (7.1%) had conjunctival recurrence in MCMM group. Nonetheless, there was no significant difference in the recurrence rate of pterygium between the AM and the MCMM group (<em>P</em> = .903). In the 1-month and 3 to 6-month groups postoperatively, the MCMM group showed a significant reduction in the levels of interleukin-8 (IL-8) and tumor necrosis factor–α (TNF-α) in the tear fluid compared to the AM group, respectively (IL-8: <em>P</em> = .003, TNF-α: <em>P</em> = .044, for 1 month; IL-8: <em>P</em> = .016 for 3 to 6 months, respectively), indicating that MCMM has a significant inhibitory effect on ocular surface inflammation after surgery. When comparing the patients with recurrent and non-recurrent conditions within each group after the surgery, both TNF-α and IL-8 showed an increase 1 month after the operation (AM group: TNF-α, <em>P</em> = .039, and IL-8, <em>P</em> = .001; MCMM group: TNF-α, <em>P</em> = .003, and IL-8, <em>P</em> = .047). There was no significant difference in age, IOP, visual acuity, and length of pterygium head between the two groups.</div></div><div><h3>CONCLUSION</h3><div>MCMM effectively reduced IL-8 and TNF-α tear levels and postoperative ocular surface inflammation, although it did not significantly influence the long-term recurrence rates compared to traditional AMT. MCMM could be a promising option for reducing postoperative inflammation of pterygium and for avoiding extensive dissection or antimetabolites.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 26-35"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Retinal Neovascularization on Widefield Optical Coherence Tomography Angiography Predicts Complications in High-Risk Proliferative Diabetic Retinopathy","authors":"AN-LUN WU ,&nbsp;JINYI HAO ,&nbsp;LIQIN GAO ,&nbsp;YUKUN GUO ,&nbsp;TRISTAN T. HORMEL ,&nbsp;CHRISTINA J. FLAXEL ,&nbsp;MERINA THOMAS ,&nbsp;BENJAMIN K. YOUNG ,&nbsp;STEVEN T. BAILEY ,&nbsp;DONG-WOUK PARK ,&nbsp;YALI JIA ,&nbsp;THOMAS S. HWANG","doi":"10.1016/j.ajo.2025.12.017","DOIUrl":"10.1016/j.ajo.2025.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether retinal neovascularization (RNV) metrics derived from single-shot widefield swept-source OCT angiography (SS-OCTA) predict subsequent vision-threatening complications in eyes with high-risk proliferative diabetic retinopathy (PDR).</div></div><div><h3>Design</h3><div>Prospective case series.</div></div><div><h3>Participants</h3><div>Eyes clinically graded as high-risk PDR at a tertiary care center, followed up for at least 6 months.</div></div><div><h3>Methods</h3><div>Eligible eyes underwent single-shot 26 × 21-mm SS-OCTA imaging (DREAM OCT, Intalight Inc.). A validated deep learning-based algorithm segmented the vitreous cavity slab to generate <em>en face</em> OCTA images for automated detection and quantification of RNV membrane and the vascular areas. Lesions were classified as elevated when they were separated from the internal limiting membrane (ILM) and attached when there was no space between the lesion and the ILM. We analyzed baseline OCTA-derived metrics for their predicting eyes that developed new or recurrent vitreous hemorrhage (VH) or tractional retinal detachment (TRD) during follow-up.</div></div><div><h3>Main outcome measures</h3><div>Incidence of new or recurrent vitreous hemorrhage and traction retinal detachment.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 291 days (range, 180-466), 8 of 18 eyes (44.4%) developed complications, with 7 (38.9%) developing VH and 1 (5.6%) developing TRD. Among the 115 identified RNV lesions, 87 (75.7%) were located outside the arcades. Compared to eyes without complications, eyes with complications had a larger median total RNV membrane area (25.72 mm² vs 1.33 mm²; <em>P</em> = .006) and a larger median total RNV vascular area (9.72 mm² vs 0.76 mm²; <em>P</em> = .010). Eyes with complications had a larger elevated RNV membrane area (5.13 mm^² vs 0.10 mm²; <em>P</em> = .009) and vascular area (2.69 mm^² vs 0.05 mm²; <em>P</em> = .007), whereas attached RNV metrics were not significantly different between groups. Total RNV membrane area demonstrated the highest predictive performance for identifying eyes at risk of complications (AUC = 0.888), with a sensitivity of 87.5% and a specificity of 80.0% at a cutoff value of 3.40 mm².</div></div><div><h3>Conclusions</h3><div>Widefield SS-OCTA is useful for evaluating RNV burden and its axial relationship to the ILM in high-risk PDR. Elevated baseline RNV, incorporating spatial and anatomic features, predicts subsequent tractional complications such as VH and TRD. These imaging biomarkers may complement current clinical staging of PDR.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 268-278"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}