American Journal of Ophthalmology最新文献

{"title":"Comment on: Glucagon-Like Peptide-1 Receptor Agonist Use and Risk of Cataract Development.","authors":"Ha-Neul Yu, Isdin Oke, Julius T Oatts","doi":"10.1016/j.ajo.2025.11.050","DOIUrl":"10.1016/j.ajo.2025.11.050","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877474","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":"Association of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists With Risk of Cataract","authors":"Bing-Hua Lin ,&nbsp;Shu-Han Chuang ,&nbsp;Lien-Chen Wu ,&nbsp;Yu-Pin Chen ,&nbsp;Yi-Jie Kuo ,&nbsp;Cheng-Hsien Chang","doi":"10.1016/j.ajo.2025.12.025","DOIUrl":"10.1016/j.ajo.2025.12.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of age-related cataract (ARC) among patients with type 2 diabetes mellitus (T2DM) using sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA) as second-line antihyperglycemic agents.</div></div><div><h3>Design</h3><div>Population-based retrospective cohort study.</div></div><div><h3>Participants</h3><div>Adults aged over 40 years with a diagnosis of T2DM between January 2015 and June 2025 were identified from the TriNetX Global Network. The patients were categorized into three cohorts: (1) SGLT2i plus metformin, (2) GLP-1 RA plus metformin, and (3) metformin monotherapy. Patients with aphakia or pseudophakia, orbital injuries, secondary cataracts, or congenital ocular malformations were excluded.</div></div><div><h3>Methods</h3><div>Pairwise comparisons were performed with a 3-year follow-up. Baseline characteristics were balanced using 1:1 propensity score matching for demographics, comorbidities, T2DM severity, and cataract risk factors. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the incidence of ARC events, defined as a diagnosis of ARC or cataract surgery, with stratified analyses conducted by demographics, glycemic control, and comorbidities.</div></div><div><h3>Results</h3><div>After matching, three pairwise comparisons included 34,259 (SGLT2i vs metformin; mean age, 62.8 years; 35.1% female), 50,877 (GLP-1 RA vs metformin; mean age, 58.3 years; 54.8% female), and 23,022 (SGLT2i vs GLP-1 RA; mean age, 61.0 years; 40.8% female) patients. Adjunctive SGLT2i or GLP-1 RA was associated with a reduced risk of ARC events (SGLT2i, HR: 0.82, 95% CI: 0.76-0.89; GLP-1 RA, HR: 0.93, 95% CI: 0.87-0.99). The protective effect of SGLT2i was greater than that of GLP-1 RA (HR: 0.84, 95% CI: 0.76-0.92). However, in patients with advanced age, obesity, or diabetic retinopathy, the association attenuated. When analyzed as separate outcomes, adjunctive use of SGLT2i and GLP-1 RA remained associated with a reduced risk of ARC diagnosis, while the risk of cataract surgery did not differ significantly (SGLT2i, HR: 1.14, 95% CI: 0.95-1.34; GLP-1 RA, HR: 1.01, 95% CI: 0.79-1.26).</div></div><div><h3>Conclusions</h3><div>Adjunctive use of SGLT2i or GLP-1 RA was associated with a lower risk of ARC, with a stronger effect for SGLT2i; however, neither agent reduced the risk of cataract surgery. Further studies are needed to clarify the underlying biological pathways and validate our findings.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 66-77"},"PeriodicalIF":4.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844794","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 AJO and Academic Freedom: Then and Now","authors":"Richard K. Parrish","doi":"10.1016/j.ajo.2025.12.023","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.12.023","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844795","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":"2025-12-24","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}

{"title":"Geographic and Phenotypic Variability in RHO-Associated Retinopathy: Evidence From a Chinese Cohort and Global Literature","authors":"CHENYUE HANG ,&nbsp;TIANYUAN ZHAO ,&nbsp;ZHIXUAN CHEN ,&nbsp;HONG WANG ,&nbsp;LIN CHEN ,&nbsp;TING ZHANG ,&nbsp;YUTIAN JIAO ,&nbsp;TONG LI ,&nbsp;JUNRAN SUN ,&nbsp;SUQIN YU ,&nbsp;YUANYUAN GONG ,&nbsp;HAO ZHOU ,&nbsp;XUJUN JIANG ,&nbsp;XINXIN LIU ,&nbsp;HUIXUN JIA ,&nbsp;KAIRONG ZHENG ,&nbsp;XIAOLING WAN ,&nbsp;JIEQIONG CHEN ,&nbsp;XIAODONG SUN","doi":"10.1016/j.ajo.2025.12.020","DOIUrl":"10.1016/j.ajo.2025.12.020","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the genotype-phenotype correlation in <em>RHO</em>-associated retinopathy, with a focus on delineating an ethnic-specific variant spectrum and comparing clinical severity across biological classes and common variants.</div></div><div><h3>Design</h3><div>Retrospective cohort study and literature review.</div></div><div><h3>Methods</h3><div>We systematically reviewed all published cases of <em>RHO</em>-associated retinal diseases (2196 patients, 1278 probands) and analyzed clinical, genetic, and imaging data from our institutional cohort (80 probands). Variants were categorized by type and by biological class (Class 1-7), and phenotypes were compared across different biological classes and three common variants.</div></div><div><h3>Results</h3><div>A marked geographic divergence was observed: P23H was common in North America but rare in other populations, whereas P347L and R135W were major common variants in European and Asian populations. Genotype-phenotype analysis revealed that Class 2 variants were associated with later onset and slower visual decline, whereas Class 1 and Class 3 variants correlated with earlier onset (<em>P</em> &lt; .0001) and more aggressive phenotypes. Notably, R135W (Class 3) emerged as an under-recognized but highly aggressive variant, with earlier onset (<em>P</em> &lt; .01) and potentially earlier macular involvement.</div></div><div><h3>Conclusions</h3><div>Our study represents the largest study integrating ethnic, genotypic, and clinical data in <em>RHO</em>-associated retinopathy. The findings highlight substantial inter-ethnic differences in common variants and underscore the clinical relevance of biological classification in predicting disease course. In particular, R135W and P347L warrants closer clinical attention due to their aggressive trajectory, which may inform prioritization in gene therapy trials and individualized patient management.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 1-11"},"PeriodicalIF":4.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823647","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":"2025-12-23","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":"Gonioscopy Assisted Transluminal Trabeculotomy (GATT) as a viable intervention for Neovascular Glaucoma","authors":"Avilasha Mohapatra,&nbsp;Vyshak Suresh,&nbsp;Sushmita Kaushik","doi":"10.1016/j.ajo.2025.12.016","DOIUrl":"10.1016/j.ajo.2025.12.016","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages e1-e2"},"PeriodicalIF":4.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822821","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":"Interpreting Imaging in the Era of Artificial Intelligence: Future Possibilities in Ocular Inflammatory Disease","authors":"K. MATTHEW MCKAY ,&nbsp;LEOPOLD SCHMETTERER ,&nbsp;SRINIVAS R. SADDA ,&nbsp;LUCIA SOBRIN","doi":"10.1016/j.ajo.2025.12.019","DOIUrl":"10.1016/j.ajo.2025.12.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Uveitis encompasses a heterogeneous group of ocular inflammatory diseases with a high risk of permanent vision loss. Accurate diagnosis and disease monitoring are dependent on integrating disparate clinical data from patient history, examination findings and multimodal imaging, which is complex and time-consuming. The advent of artificial intelligence (AI) in the field of ophthalmology has provided new opportunities for automation of data gathering and interpretation, particularly for imaging data through deep learning algorithms. This article will review the current abilities, limitations, and future promise for the application of AI to the interpretation of multimodal imaging in the field of uveitis.</div></div><div><h3>Methods</h3><div>Review article.</div></div><div><h3>Results</h3><div>AI has provided new opportunities for automation of data gathering and interpretation in the field of uveitis, particularly for analysis of imaging data using deep learning techniques. Tools for diagnostic support, grading of intraocular inflammation, and quantification of disease features by multimodal imaging are under development.</div></div><div><h3>Conclusion</h3><div>Application of AI in the field of uveitis is in its infancy but holds promise for improving efficiency and quality of patient care.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 291-298"},"PeriodicalIF":4.2,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822823","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":"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":"2025-12-20","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":"The Relationship Between Corneal Stiffness Distribution and Tomography in Keratoconus Patients","authors":"Nan-Ji Lu ,&nbsp;Marta Jiménez-García ,&nbsp;Ahmed Elsheikh ,&nbsp;Ahmed Makarem ,&nbsp;Carina Koppen ,&nbsp;Jos J. Rozema","doi":"10.1016/j.ajo.2025.12.011","DOIUrl":"10.1016/j.ajo.2025.12.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize the regional distribution of corneal stiffness in keratoconus (KC) and explore its relationship with tomographic parameters.</div></div><div><h3>Design</h3><div>Prospective, cross-sectional observational study.</div></div><div><h3>Subjects</h3><div>One hundred eleven eyes from 111 KC patients.</div></div><div><h3>Methods</h3><div>All eyes underwent Scheimpflug-based tomography and air-puff tonometry (Pentacam and Corvis). Stress-Strain Index (SSI) maps were generated to quantify overall and regional stiffness. Maximum, minimum, and mean SSI values, as well as regional values, were correlated with keratometric and pachymetric indices.</div></div><div><h3>Main Outcome Measures</h3><div>Regional SSI values and their correlations with keratometric and pachymetric parameters.</div></div><div><h3>Results</h3><div>SSI maps showed non-uniform stiffness, with the lowest values predominantly in the inferior-temporal region. The mean SSI at the thinnest pachymetry point (Pmin; 0.68 ± 0.16) was higher than at the steepest keratometry point (Kmax; 0.63 ± 0.19; <em>P</em> = .036). In overall analyses, the strongest correlation was between SSI-map minimum and Pmin (R² = 0.51), while mean SSI correlated weakly with tomography (R² = 0.11-0.19). In regional analyses, SSI correlated most strongly with Kmax in the central region (R² = 0.74), followed by the midperipheral inferior (R² = 0.38) and temporal (R² = 0.23) regions. SSI correlations with Pmin were most evident in the central (R² = 0.52), paracentral inferior (R² = 0.45), and inferior-temporal (R² = 0.31) regions.</div></div><div><h3>Conclusions</h3><div>Biomechanical weakening in KC varies regionally. Strong correlations with disease severity occurred in the central and inferior-temporal regions — especially with Kmax and Pmin, highlighting the role of regional mechanical stiffness and collagen architecture in corneal deformation.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 214-226"},"PeriodicalIF":4.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784491","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}