American Journal of Ophthalmology最新文献

{"title":"Isolated Haab Striae Point to a Pressured Past","authors":"Ronak Singh , Wallace L.M. Alward , Erin A. Boese","doi":"10.1016/j.ajo.2025.12.001","DOIUrl":"10.1016/j.ajo.2025.12.001","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"282 ","pages":"Page e9"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680586","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":"Retinal Pigment Epithelium Disruption Lesions on Optical Coherence Tomography in Patients With Vitreoretinal Lymphoma","authors":"Wenwen Chen ,&nbsp;Tingting Jiang ,&nbsp;Junxiang Gu ,&nbsp;Shixue Liu ,&nbsp;Xinyi Zhou ,&nbsp;Qing Chang","doi":"10.1016/j.ajo.2025.11.044","DOIUrl":"10.1016/j.ajo.2025.11.044","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the imaging characteristics and clinical relevance of retinal pigment epithelium (RPE) disruption lesions observed on optical coherence tomography (OCT) of patients with biopsy-proven vitreoretinal lymphoma (VRL).</div></div><div><h3>Design</h3><div>Retrospective interventional case series.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with VRL at the Eye and ENT Hospital of Fudan University between July 2017 and June 2024.</div></div><div><h3>Methods</h3><div>The clinical characteristics, outcomes, and multimodal retinal imaging findings of the eligible VRL patients were collected and studied. RPE disruption lesions were defined as full-thickness RPE discontinuities on OCT and were categorized as major (&gt;300 µm) or minor (&lt;300 µm) based on OCT-measured width.</div></div><div><h3>Main Outcome Measures</h3><div>The associated features of RPE disruption lesions on OCT.</div></div><div><h3>Results</h3><div>Totally 158 eyes of 81 patients were included in the analysis. RPE disruption lesions were detected in 51 of 65 affected eyes of 36 patients. Most of the lesions (47/51 eyes) were detected at initial presentation or disease onset. On OCT scans, 17 eyes had major RPE disruption lesions, and 34 eyes only had minor disruption lesions. The RPE disruption lesions were colocalized with intraretinal or subretinal infiltration. Among the eyes with full-thickness intraretinal infiltration, 14 eyes (14/24) exhibited perivascular infiltration. Major RPE disruption lesions showed a stronger association with subretinal infiltration (<em>P</em> = .041), while minor disruptions demonstrated preferential correlation with intraretinal infiltration (<em>P</em> = .036). On fundus autofluorescence, the RPE disruption lesions sometimes manifest as characteristic hypo-autofluorescent spots accompanied by hyper-autofluorescent rings. Eyes with minor RPE disruption lesions showed a better visual outcome compared to those with major lesions (<em>P</em> = .013), with statistically significant improvement from baseline after treatment (<em>P</em> = .00017). The median recovery time for the RPE disruption lesions was 2.0 months (IQR 1.5-4.0 months). The accompanied retinal infiltration vanished with the recovery of RPE disruption lesions.</div></div><div><h3>Conclusions</h3><div>RPE disruption lesions represent frequently occurring yet underrecognized OCT findings in VRL. Notably, the lesions provide diagnostic clues for VRL identification and may reveal a potential migration pathway for lymphocytic infiltrates between sub-RPE and subretinal/intraretinal spaces.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 100-108"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680581","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":"ChatGPT-Assisted Glaucoma Diagnosis: A Health-Equitable Multi-Ancestry Analysis Using Visual Field and Optical Coherence Tomography Data","authors":"ANDY S. HUANG ,&nbsp;ANTHONY FAM ,&nbsp;HETINCE ZHAO ,&nbsp;NICOLE PAULESCU ,&nbsp;ANNA FABCZAK-KUBICKA ,&nbsp;JANEY L. WIGGS ,&nbsp;NAZLEE ZEBARDAST ,&nbsp;DAVID S. FRIEDMAN ,&nbsp;RON DO ,&nbsp;KANZA AZIZ ,&nbsp;JAE HEE KANG ,&nbsp;TOBIAS ELZE ,&nbsp;MENGYU WANG ,&nbsp;ALON HARRIS ,&nbsp;TAK YEE TANIA TAI ,&nbsp;JAMES C. TSAI ,&nbsp;LOUIS R. PASQUALE","doi":"10.1016/j.ajo.2025.11.046","DOIUrl":"10.1016/j.ajo.2025.11.046","url":null,"abstract":"<div><h3>Purpose</h3><div>Early glaucoma detection is challenging due to variable ocular anatomy, non-glaucomatous optic neuropathy impacting optical coherence tomography (OCT) results, and the subjective nature of visual field (VF) tests. Multimodal large language models may overcome these challenges to provide equitable and accurate screening diagnoses across ancestries and glaucoma genetic predispositions. We evaluated ChatGPT o1 Pro’s accuracy in identifying glaucoma using circumpapillary retinal nerve fiber layer (RNFL) OCT and VF data, and its consistency across ancestries and glaucoma polygenic risk scores (PRS).</div></div><div><h3>Design</h3><div>Cross-sectional diagnostic accuracy study.</div></div><div><h3>Settings and Participants</h3><div>We enrolled 204 participants from the Mount Sinai BioMe Biobank for a comprehensive ophthalmic examination from November 2022 to March 2025. This cross-sectional diagnostic accuracy study included 38% European (EUR) and 62% non-European (non-EUR) participants stratified by low/intermediate (<em>n</em> = 107) and high-risk glaucoma PRS (<em>n</em> = 97). Two glaucoma specialists masked to PRS status provided a consensus reference diagnosis. ChatGPT received only de-identified VFs and OCT-RNFL numerical outputs to determine glaucoma status. Performance metrics were compared with the reference diagnosis. Subgroup comparisons by ancestry (EUR versus non-EUR) and PRS (high versus low/intermediate) were conducted. We used logistic regression models to assess the impacts of ancestry, PRS and ocular parameters on classification accuracy.</div></div><div><h3>Main Outcome Measures</h3><div>ChatGPT o1 Pro’s diagnostic performance in detecting glaucoma compared to consensus specialist diagnoses, stratified by ancestry and genetic risk.</div></div><div><h3>Results</h3><div>ChatGPT o1 Pro exhibited 96.0% sensitivity (95% confidence interval (CI): 88.3%-100%), 83.7% specificity (95% CI: 78.3%-89.1%), 85.2% accuracy (95% CI: 80.3%-90.1%), an area under the receiver operator curve (AUC) of 0.899, a positive predictive value (PPV) of 45.3% (95% CI: 31.9%-58.7%), and a negative predictive value (NPV) of 99.3% (95% CI: 98.0%-100%); κ for agreement with the consensus reference was 0.538. No significant differences were observed between EUR and non-EUR subgroups (AUC: 0.894 vs 0.906, <em>P</em> = .79; accuracy: 88.3% vs 83.3%, <em>P</em> = .44) or high and low/intermediate-PRS subgroups (AUC: 0.889 vs 0.922, <em>P</em> = .45; accuracy: 85.4% vs 85.0%, <em>P</em> = .50). Global RNFL was the only determinant of reference disease classification (OR = 1.1 per micron, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>ChatGPT o1 Pro diagnosed glaucoma similarly to specialists using only VF and OCT data. The model performance was similar across ancestral groups and genetic predispositions to glaucoma.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 129-137"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680599","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":"2025-12-02","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":"Cataract Surgery with IOL Implantation in Children with Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) or Antinuclear Antibody (ANA)-Positive Uveitis: Mid-term Results and Predictors for Outcome","authors":"CHARLOTTE WORTMANN ,&nbsp;JOHANNA BACKES ,&nbsp;KAI ROTHAUS ,&nbsp;MAREN KASPER ,&nbsp;THABO LAPP ,&nbsp;CARSTEN HEINZ ,&nbsp;ARND HEILIGENHAUS","doi":"10.1016/j.ajo.2025.11.043","DOIUrl":"10.1016/j.ajo.2025.11.043","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the clinical course and 2-year outcome after cataract surgery with implantation of intraocular lenses (IOL) in children with juvenile idiopathic arthritis (JIA)-associated uveitis or chronic antinuclear antibody (ANA)-positive uveitis.</div></div><div><h3>Design</h3><div>Retrospective interventional clinical study.</div></div><div><h3>Subjects</h3><div>Children with cataract surgery at ≤10 years of age.</div></div><div><h3>Methods</h3><div>Comprehensive uveitis-related data (defined by Standardization of Uveitis Nomenclature standards) were collected before, during and 6 weeks, 1 and 2 years after surgery. Surgical procedures involved small incision phacoemulsification, insertion of foldable acrylic IOLs with a sharp-edge design into the capsular bag, 25 G anterior vitrectomy, posterior capsulectomy, and intravitreal triamcinolone injection. Surgical technique was modified individually according to pre-existing uveitis-related morphological abnormalities.</div></div><div><h3>Main Outcome Measures</h3><div>Best-corrected visual acuity (BCVA) and postoperative complications.</div></div><div><h3>Results</h3><div>All 100 surgeries (81 patients, 100% ANA-positive, 69% female, 90.1% JIA, mean age at JIA diagnosis 4.26 ± 2.35 years) involved insidious-onset anterior uveitis (mean age at uveitis onset 4.6 ± 2.1 years). Surgery was performed at a mean age of 8.2 ± 3.3 years (SD 3.2), and under treatment with conventional synthetic disease-modifying anti-rheumatic drugs (DMARD; 90%), or 45% biologicals. Prior to surgery, uveitis-related complications were present alongside cataract in 99% of patients (eg. lens fibrotic membrane and pupil contraction). BCVA (logMAR) was 1.57 ± 1.24 before surgery, and was 0.32 ± 0.51 and 0.3 ± 0.53 at 1 and 2 years after surgery, respectively (each, <em>P</em> &lt; .001). Fibrin formation was present in 39.6% of cases on the first day after surgery. After 1 and 2 years of surgery, macular edema was present in 4.6% and 9.4%, and glaucomatous optic discs in 17.3% and 18.9%, respectively. Preoperative predictors of poor 2-year visual outcome included poor BCVA, high laser flare (LF) values, unilateral uveitis, and glaucoma medication. Preoperative predictors of 2-year postoperative ocular complications included band keratopathy and a lack of methotrexate or adalimumab use.</div></div><div><h3>Conclusions</h3><div>According to our observations, IOL implantation can be considered for children with JIA-associated or ANA-positive uveitis, on the condition that their uveitis is well controlled with DMARD therapy and the surgical technique is appropriate. The long-term course of the inflammatory disease determines the occurrence of intraocular complications related to inflammation and the visual outcome.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 45-54"},"PeriodicalIF":4.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657303","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":"Limbal Epithelial Cells Detected in Stage III Limbal Stem Cell Deficiency by Multimodal Anterior Segment Imaging","authors":"CLEMENCE BONNET ,&nbsp;MEHRNOOSH MAALHAGHFARD ,&nbsp;SOPHIE X. DENG","doi":"10.1016/j.ajo.2025.11.041","DOIUrl":"10.1016/j.ajo.2025.11.041","url":null,"abstract":"<div><h3>Purpose</h3><div>Limbal stem cell deficiency (LSCD) is a potentially blinding corneal condition with heterogeneous clinical presentations. Anterior segment imaging, in particular anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) provide objective staging of LSCD. The goal of this study was to evaluate whether the fluorescein staining test is accurate in staging LSCD.</div></div><div><h3>Design</h3><div>Diagnostic and staging validity analysis.</div></div><div><h3>Subjects</h3><div>Subjects without eye diseases and those diagnosed with LSCD based on clinical exam, AS-OCT, and IVCM.</div></div><div><h3>Methods</h3><div>The severity of LSCD was staged clinically according to the global consensus guidelines using fluorescein staining. Multimodal imaging (AS-OCT and IVCM) was performed in the central cornea and four limbal quadrants (superior, inferior, nasal, and temporal). Imaging findings were correlated with clinical stage.</div></div><div><h3>Main Outcomes Measures</h3><div>Detection of morphologically limbal epithelial cells in eyes clinically graded as stage III LSCD, and AS-OCT characteristics corresponding to these identified clusters.</div></div><div><h3>Results</h3><div>A total of 220 eyes from 156 patients were analyzed. Based on fluorescein staining, 49 eyes (22.3%) were classified as stage I, 93 eyes (42.3%) as stage II, and 75 eyes (34.1%) as stage III LSCD. In all cases of stage III LSCD, AS-OCT confirmed severe central epithelial thinning, and IVCM demonstrated significantly reduced mean basal cell density in the central cornea. Despite this, clusters of limbal epithelial cells with normal morphology were detected by IVCM in 30 eyes (40.0%), appearing in one limbal quadrant in 26 eyes (86.7%) and in two quadrants in 4 eyes (13.3%). Correlation between IVCM and AS-OCT findings at the cluster locations was variable. Absence of hyporeflective epithelial layer was observed in 20 eyes (74.1%) and presence of hyporeflective layer was detected in 7 eyes (25.9%) by AS-OCT.</div></div><div><h3>Conclusions</h3><div>Despite being graded as total stage III LSCD by clinical exam using fluorescein staining, a significant proportion of eyes retained morphologically normal limbal epithelial cells. These findings highlight the importance of multimodal anterior segment imaging to achieve LSCD diagnostic accuracy, refine disease staging, and guide future personalized management strategies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 91-99"},"PeriodicalIF":4.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657309","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":"Effect of Angle Kappa on the Refractive Prediction Accuracy in Cataract Patients After Myopic LASIK/PRK","authors":"HAORUI YUAN ,&nbsp;JIAQING ZHANG ,&nbsp;YUXING ZHENG ,&nbsp;HAOWEN LIN ,&nbsp;XIAOHANG XIE ,&nbsp;XIAOFEI HU ,&nbsp;WENLU YU ,&nbsp;XIAOZHANG QIU ,&nbsp;ZHENZHEN LIU ,&nbsp;WEIRONG CHEN ,&nbsp;LIXIA LUO ,&nbsp;XUHUA TAN","doi":"10.1016/j.ajo.2025.11.042","DOIUrl":"10.1016/j.ajo.2025.11.042","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate the impact of angle kappa on prediction accuracy in patients after myopic laser-assisted in-situ keratomileusis (LASIK)/photorefractive keratectomy (PRK).</div></div><div><h3>DESIGN</h3><div>Retrospective, consecutive interventional case-series study.</div></div><div><h3>METHODS</h3><div>This study included 127 postmyopic-LASIK/PRK cataract patients (176 eyes). Three different keratometry (K) values measured by 2 devices were assessed, including simulated keratometry (SimK) obtained by IOLMaster 700 at 2.5 mm ring centered on corneal vertex and SimK derived from Pentacam AXL in 3 mm zone centered on corneal vertex (Pentacam [CV]) and pupil center (Pentacam [PC]). The performance of the Barrett True-K formula based on vertex-centered K values (IOLMaster 700; Pentacam [CV]) and pupil-centered K values (Pentacam [PC]) was compared. Subgroup analysis was performed using angle kappa (&lt;0.4 mm; ≥0.4 mm).</div></div><div><h3>RESULT</h3><div>The hyperopic prediction error (PE) of the IOLMaster 700 and Pentacam (CV) modes increased with larger angle kappa. Both in total and in eyes with angle kappa &lt;0.4 mm, compared with other modes, the IOLMaster 700 mode showed no systematic bias and relatively lower absolute PE. For eyes with angle kappa ≥0.4 mm, IOLMaster 700 and Pentacam (CV) modes demonstrated hyperopic PE (0.43-0.46 D, <em>P</em> &lt; .05), while the Pentacam (PC) mode displayed no systematic bias, relatively lower mean absolute PE (0.70 D vs 0.90-0.96 D) and the highest percentage of eyes with PE within ±0.5 D (51.22% vs 36.59%-41.46%).</div></div><div><h3>CONCLUSION</h3><div>In postmyopic-LASIK/PRK patients, the prediction accuracy decreased with greater angle kappa when using the corneal vertex-centered K values. The pupil-centered K values were preferred for these patients with angle kappa ≥0.4 mm.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 36-44"},"PeriodicalIF":4.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613715","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":"Pathogen-Associated Visual Outcomes Following Postprocedure Endophthalmitis","authors":"Marusha Ather ,&nbsp;Elizabeth Lyden ,&nbsp;Yue Zhan ,&nbsp;Rachana Haliyur ,&nbsp;Alina Sinha ,&nbsp;Saagar Patel ,&nbsp;Richard M. Feist Jr. ,&nbsp;Akbar Shakoor ,&nbsp;Albert T. Vitale ,&nbsp;David N. Zacks ,&nbsp;Steven Yeh ,&nbsp;Talisa E. de Carlo Forest ,&nbsp;Michael J. Huvard ,&nbsp;Christopher D. Conrady","doi":"10.1016/j.ajo.2025.11.038","DOIUrl":"10.1016/j.ajo.2025.11.038","url":null,"abstract":"<div><h3>Objective</h3><div>To report the anatomic and functional outcomes of a large, multicenter series of postprocedure acute endophthalmitis, stratified by pathogen virulence.</div></div><div><h3>Design</h3><div>Retrospective, interventional case series.</div></div><div><h3>Participants</h3><div>Two hundred forty adult patients diagnosed with postprocedural acute endophthalmitis from 2012 to 2022 at four tertiary, university-based care centers. Of these, 208 patients had adequate follow-up data for comparative analyses.</div></div><div><h3>Methods</h3><div>Medical records were reviewed for demographics, microbiology, treatment, and visual outcomes of patients that developed endophthalmitis following any intraocular procedure. Organisms were categorized into surface commensals (coagulase-negative <em>Staphylococcus</em> sp.) and nonsurface commensals (eg, <em>Streptococcus, Enterococcus</em> sp.) as a proxy for virulence. Visual acuity (VA) outcomes and complication rates were compared across groups using Fisher’s exact test and regression models adjusting for age, sex (male or female), comorbidities, and treatment modality for postinjection endophthalmitis.</div></div><div><h3>Main Outcome Measures</h3><div>Final VA, number of interventions, and rates of vision-threatening complications, including phthisis, retinal detachment, enucleation/evisceration.</div></div><div><h3>Results</h3><div>Among culture-positive cases, patients infected with nonsurface commensal organisms had significantly worse final VA than those with coagulase-negative <em>Staphylococcus</em> (mean logMAR 2.14 vs 0.77, <em>P</em> &lt; .0001), as well as higher rates of third interventions (27.5% vs 10.1%, <em>P</em> = .017), phthisis (15.4% vs 1.1%, <em>P</em> = .0032), and enucleation/evisceration (12.8% vs 0%, <em>P</em> = .0022). In multivariable regression of postinjection endophthalmitis, virulent, nonsurface commensal organisms remained independently associated with poorer visual outcomes (<em>P</em> = .0005). Complication patterns were consistent whether culture-negative cases were included or not in the nonvirulent group. Most patients were initially treated with intravitreal injections (92.1%). An initial vitrectomy was uncommon and not significantly associated with better outcomes when performed.</div></div><div><h3>Conclusions</h3><div>Infections with virulent, nonsurface commensal organisms such as <em>Streptococcus</em> and <em>Enterococcus</em> are associated with significantly worse outcomes in postprocedure endophthalmitis, independent of presenting vision or treatment delay. These findings support a shift toward pathogen-informed management and underscore the need for timely identification of virulent organisms in postprocedural acute endophthalmitis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 72-80"},"PeriodicalIF":4.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611708","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":"2025-11-28","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":"Systemic and Metabolic Profile of Sagging Eye Syndrome: A Comparative Analysis","authors":"Veronika Yehezkeli ,&nbsp;Janice J. Kim ,&nbsp;Federico G. Velez ,&nbsp;Joseph L. Demer ,&nbsp;Stacy L. Pineles","doi":"10.1016/j.ajo.2025.11.040","DOIUrl":"10.1016/j.ajo.2025.11.040","url":null,"abstract":"<div><h3>Purpose</h3><div>Sagging eye syndrome (SES) is an acquired strabismus characterized by distance esotropia (ET) and cyclo-vertical deviation, affecting older people. This study identified demographic, systemic, and ocular factors associated with SES and compared them to other forms of ET in older adults.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Demographic data, systemic comorbidities, ocular history, and strabismus were reviewed in esotropic patients at least 55 years old diagnosed with SES between 2013 and 2024 at a single institution, and compared with age-matched controls diagnosed with other forms of ET.</div></div><div><h3>Results</h3><div>A total of 383 patients were studied, of whom 67 had SES, and 316 had ET without SES ET. Male SES patients were significantly older at 81.5 ± 10 years (standard deviation) than esotropic males without SES at 76 ± 10 years (<em>P</em> = .04), and symptom onset was significantly older for SES in both genders (male: 72 ± 10 years vs 68 ± 11 years, <em>P</em> = .02; female: 75 ± 9 years vs 69 ± 9 years, <em>P</em> = .04). Women with SES had significantly lower mean body mass index (BMI) at 23 ± 4 than esotropic women without SES at 25 ± 5 (<em>P</em> = .02). Logistic regression demonstrated that lower BMI was associated with higher odds of SES in women, with the odds of SES increasing by approximately 9.4% for each 1-unit decrease in BMI (odds ratios = 0.91, 95% confidence intervals [CI]: 0.84-0.99). Osteopenia was more prevalent at 77% among esotropic women with SES than women without osteopenia at 51% (<em>P</em> = .003), and remained an independent risk factor for SES after adjusting for age (odds ratios = 1.81, 95% CI: 1.02-3.23, <em>P</em> = .04) and BMI (95% CI, 1.14-6.18; <em>P</em> = .02). There were no significant differential associations with SES for gender, smoking, alcohol use, hypertension, hyperlipidemia, type 2 diabetes, cataract surgery, glaucoma, or use of progressive addition spectacles.</div></div><div><h3>Conclusions</h3><div>SES is associated with advanced age at symptom onset in both genders and with lower BMI and osteopenia in women.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 1-6"},"PeriodicalIF":4.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611842","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}