BACKGROUNDComitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment approaches and help establish realistic expectations for patients and clinicians.METHODSRetrospective chart review of adults 18-60 years old who underwent surgery for comitant exotropia between 2014 and 2024 at a single institution. Patients were classified as intermittent (X(T)) or constant exotropia (XT) and divided into three groups: basic exotropia (BXT), divergence excess (DEXT) and convergence insufficiency (CIXT). Surgical motor success was defined as a postoperative deviation≤10 prism dioptres (PDs) and sensory success as resolution of diplopia.RESULTS165 patients (mean age 38.2±12.1 years, 50.3% male) were included. The mean preoperative deviation was 44.8±17.5 PD at distance and 48.3±20.1 PD at near. After initial surgery, the overall motor success was 62.4%, highest in BXT (69.4%), followed by CIXT (52.8%) and DEXT (50%) (p=0.08). Motor success was significantly higher in X(T) than XT (69.2% vs 52.2%, p=0.026), and in cases with adjustable sutures rather than non-adjustable (p=0.033), however, similar in unilateral recess-resect and bilateral lateral rectus recessions (62.7% vs 59.1%, p=0.81). Preoperative diplopia was present in 28.5% (47/165) and resolved in 89.4% (42/47). The final motor success was 66.7% after a second surgery in nine patients.CONCLUSIONSThe motor outcomes in adults are comparable to those reported in children. Higher motor success is found in X(T) and with the use of adjustable sutures. Surgical intervention provides relief of diplopia and meaningful gains in stereopsis.
背景：成人共同性外斜视存在明显的手术挑战，与儿科病例相比，研究较少。评估这一人群的手术结果可以为治疗方法提供信息，并有助于为患者和临床医生建立切合实际的期望。方法回顾性分析2014年至2024年在同一医院接受共同性外斜视手术的18-60岁成人患者。患者分为间歇性外斜视（X(T)）和恒常性外斜视（XT），并分为原发性外斜视（BXT）、发散过度（DEXT）和收敛不全（CIXT）三组。手术运动成功定义为术后偏差≤10棱镜屈光度（PDs），感觉成功定义为复视的解决。结果共纳入165例患者，平均年龄38.2±12.1岁，男性50.3%。术前平均距离偏差为44.8±17.5 PD，近距离偏差为48.3±20.1 PD。初始手术后，整体运动成功率为62.4%，BXT最高（69.4%），其次是CIXT（52.8%）和DEXT (50%) （p=0.08）。X(T)组的运动成功率明显高于X(T)组（69.2% vs 52.2%, p=0.026），缝线可调节组的成功率明显高于缝线不可调节组（p=0.033），然而，单侧凹陷切除和双侧直肌消退组的成功率相似（62.7% vs 59.1%, p=0.81）。术前复视发生率为28.5%(47/165)，复视发生率为89.4%（42/47）。9例患者在第二次手术后，最终运动成功率为66.7%。结论：成人的运动预后与儿童的相似。在X(T)和使用可调节缝线时，运动成功率较高。手术干预可以减轻复视，并在立体视觉方面取得有意义的进展。
{"title":"Surgical outcomes of intermittent and constant exotropia in an adult population between 18 and 60 years old.","authors":"Jiaxing Wang,Charlotte Tibi,Craig McKeown,Hilda Capó","doi":"10.1136/bjo-2025-328132","DOIUrl":"https://doi.org/10.1136/bjo-2025-328132","url":null,"abstract":"BACKGROUNDComitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment approaches and help establish realistic expectations for patients and clinicians.METHODSRetrospective chart review of adults 18-60 years old who underwent surgery for comitant exotropia between 2014 and 2024 at a single institution. Patients were classified as intermittent (X(T)) or constant exotropia (XT) and divided into three groups: basic exotropia (BXT), divergence excess (DEXT) and convergence insufficiency (CIXT). Surgical motor success was defined as a postoperative deviation≤10 prism dioptres (PDs) and sensory success as resolution of diplopia.RESULTS165 patients (mean age 38.2±12.1 years, 50.3% male) were included. The mean preoperative deviation was 44.8±17.5 PD at distance and 48.3±20.1 PD at near. After initial surgery, the overall motor success was 62.4%, highest in BXT (69.4%), followed by CIXT (52.8%) and DEXT (50%) (p=0.08). Motor success was significantly higher in X(T) than XT (69.2% vs 52.2%, p=0.026), and in cases with adjustable sutures rather than non-adjustable (p=0.033), however, similar in unilateral recess-resect and bilateral lateral rectus recessions (62.7% vs 59.1%, p=0.81). Preoperative diplopia was present in 28.5% (47/165) and resolved in 89.4% (42/47). The final motor success was 66.7% after a second surgery in nine patients.CONCLUSIONSThe motor outcomes in adults are comparable to those reported in children. Higher motor success is found in X(T) and with the use of adjustable sutures. Surgical intervention provides relief of diplopia and meaningful gains in stereopsis.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"56 30 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna Saade,Wajiha J Kheir,Mahdi Hassoun,Sally Al Hassan,Alaa Bou Ghannam,Bahaa' Noureddine,Ziad Bashshur,Shady T Awwad,Rola Nazih Hamam,Ahmad M Mansour,Randa Haddad,Vicky Massoud,Jeremiah E Gendy,Ali Khalil,Hanadi Ibrahim,Jana Tabaja,Yara Bteich,Ahmad Ismail,Ramzi M Alameddine
BACKGROUND/AIMSOn 17 September 2024, over 3000 pager devices containing explosives were remotely detonated across Lebanon in a coordinated mass-casualty event, causing unprecedented ocular trauma. This study aims to characterise the nature and extent of ophthalmic injuries treated at a tertiary care centre following this unique attack.METHODSA retrospective chart review was conducted of patients presenting to the American University of Beirut Medical Centre on the day of the explosion. Only patients who underwent ophthalmic surgical exploration were included. Data were collected from clinical notes, imaging and operative reports. Injuries were categorised using the Birmingham Eye Trauma Terminology (BETT) classification, and descriptive statistics were applied.RESULTS79 patients (158 eyes) underwent surgical exploration. Severe globe trauma was identified in 111 eyes (70.3%), including 61 eyes (55%) with open globe injuries and 50 (45%) with traumatic eviscerations. Bilateral injuries were noted in 45.6% of patients. Intraocular foreign bodies were confirmed in all traumatic eviscerations and 81.9% of open globe injuries. Evisceration was performed in 49 eyes (31%). Adnexal injuries requiring reconstruction occurred in 27.3% of eyes. Among eyes that underwent globe-sparing repair, 71.7% had postoperative visual acuity of no light perception or light perception.CONCLUSIONThis case series describes an unprecedented volume and severity of ocular injuries from a novel blast mechanism. The combination of thermal, chemical and penetrating trauma resulted in high rates of globe loss and poor visual outcomes. Preparedness for future unconventional mass-casualty scenarios must include rapid imaging, specialised ophthalmic teams and coordinated multidisciplinary care.
{"title":"Ocular injuries following the pager explosion mass casualty event in Lebanon: a large single-centre case series.","authors":"Joanna Saade,Wajiha J Kheir,Mahdi Hassoun,Sally Al Hassan,Alaa Bou Ghannam,Bahaa' Noureddine,Ziad Bashshur,Shady T Awwad,Rola Nazih Hamam,Ahmad M Mansour,Randa Haddad,Vicky Massoud,Jeremiah E Gendy,Ali Khalil,Hanadi Ibrahim,Jana Tabaja,Yara Bteich,Ahmad Ismail,Ramzi M Alameddine","doi":"10.1136/bjo-2025-328500","DOIUrl":"https://doi.org/10.1136/bjo-2025-328500","url":null,"abstract":"BACKGROUND/AIMSOn 17 September 2024, over 3000 pager devices containing explosives were remotely detonated across Lebanon in a coordinated mass-casualty event, causing unprecedented ocular trauma. This study aims to characterise the nature and extent of ophthalmic injuries treated at a tertiary care centre following this unique attack.METHODSA retrospective chart review was conducted of patients presenting to the American University of Beirut Medical Centre on the day of the explosion. Only patients who underwent ophthalmic surgical exploration were included. Data were collected from clinical notes, imaging and operative reports. Injuries were categorised using the Birmingham Eye Trauma Terminology (BETT) classification, and descriptive statistics were applied.RESULTS79 patients (158 eyes) underwent surgical exploration. Severe globe trauma was identified in 111 eyes (70.3%), including 61 eyes (55%) with open globe injuries and 50 (45%) with traumatic eviscerations. Bilateral injuries were noted in 45.6% of patients. Intraocular foreign bodies were confirmed in all traumatic eviscerations and 81.9% of open globe injuries. Evisceration was performed in 49 eyes (31%). Adnexal injuries requiring reconstruction occurred in 27.3% of eyes. Among eyes that underwent globe-sparing repair, 71.7% had postoperative visual acuity of no light perception or light perception.CONCLUSIONThis case series describes an unprecedented volume and severity of ocular injuries from a novel blast mechanism. The combination of thermal, chemical and penetrating trauma resulted in high rates of globe loss and poor visual outcomes. Preparedness for future unconventional mass-casualty scenarios must include rapid imaging, specialised ophthalmic teams and coordinated multidisciplinary care.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"42 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSETo clarify the associations of placental inflammatory response and oxidative stress with myopia in the offspring and explore the modifying role of outdoor time trajectories at early childhood.METHODSData were from the Ma'anshan Birth Cohort Study established in 2013. A total of 1256 mother-child pairs were analysed. Placental inflammation and oxidative stress biomarkers mRNA expression were tested using real-time quantitative PCR. Outdoor time was measured annually from 4 to 7 years. Children underwent cycloplegic refraction and ocular biometry to obtain spherical equivalent (SE) and axial length at 7-8 years. Binary logistic regression, generalised linear and Quantile g-Computation models were used to examine the associations.RESULTSAmong the children, 306 (24.4%) children were myopic. Each unit increase in monocyte chemoattractant protein-1 was correlated to a 1.6% higher risk of myopia (OR=1.016, p=0.025), 0.008 D lower SE (β=-0.008, p=0.024) and a 0.006 mm elongation in AL (β=0.006, p=0.014). Each unit elevate in interleukin-4 increased SE by 0.003 D (β=0.003, p=0.043) and decreased AL by 0.003 mm (β=-0.003, p=0.017), with similar trends in outdoor time declining trajectory. However, all associations were not significant after false discovery rate adjustment. Furthermore, each unit increase in the mixed exposure of oxidative stress was associated with a 0.070-0.074 D reduction in SE.CONCLUSIONSParsing insights into the potential relationships between placental inflammation and oxidative stress and myopia in the offspring and exploring the nurture effect of outdoor time based on life-cycle conceptual models will facilitate the early prevention of childhood myopia for clinical and public health practice.
目的了解胎盘炎症反应和氧化应激与后代近视的关系，探讨幼儿期户外时间轨迹的调节作用。方法数据来自2013年建立的马鞍山出生队列研究。总共分析了1256对母子。采用实时定量PCR检测胎盘炎症和氧化应激生物标志物mRNA表达。在4到7年期间，每年测量一次户外时间。儿童在7-8岁时接受睫状体麻痹性屈光和眼生物测量以获得球等效（SE）和眼轴长度。使用二元逻辑回归、广义线性和分位数g-计算模型来检验相关性。结果儿童近视306例（24.4%）。单核细胞趋化蛋白-1每增加一个单位，近视风险增加1.6% (OR=1.016, p=0.025)， SE降低0.008 D (β=-0.008, p=0.024)， AL延长0.006 mm （β=0.006, p=0.014）。白细胞介素-4水平每升高1个单位，SE升高0.003 D (β=0.003, p=0.043)， AL降低0.003 mm (β=-0.003, p=0.017)，室外时间下降趋势相似。然而，在调整错误发现率后，所有的关联都不显著。此外，混合氧化应激暴露每增加一个单位，SE降低0.070-0.074 D。结论基于生命周期概念模型，深入了解胎盘炎症和氧化应激与后代近视的潜在关系，探索户外时间的养育效应，将有助于儿童近视的早期预防，为临床和公共卫生实践提供依据。
{"title":"Reshaping ocular health: How does outdoor time in early life counteract intrauterine environmental risk of myopia susceptibility?","authors":"Shuman Tao,Juan Tong,Mengjuan Lu,Dongqing Zhu,Liu Jiang,Guopeng Gao,Shuangqin Yan,Xiaoyan Wu,Kun Huang,Fang-Biao Tao","doi":"10.1136/bjo-2025-328469","DOIUrl":"https://doi.org/10.1136/bjo-2025-328469","url":null,"abstract":"PURPOSETo clarify the associations of placental inflammatory response and oxidative stress with myopia in the offspring and explore the modifying role of outdoor time trajectories at early childhood.METHODSData were from the Ma'anshan Birth Cohort Study established in 2013. A total of 1256 mother-child pairs were analysed. Placental inflammation and oxidative stress biomarkers mRNA expression were tested using real-time quantitative PCR. Outdoor time was measured annually from 4 to 7 years. Children underwent cycloplegic refraction and ocular biometry to obtain spherical equivalent (SE) and axial length at 7-8 years. Binary logistic regression, generalised linear and Quantile g-Computation models were used to examine the associations.RESULTSAmong the children, 306 (24.4%) children were myopic. Each unit increase in monocyte chemoattractant protein-1 was correlated to a 1.6% higher risk of myopia (OR=1.016, p=0.025), 0.008 D lower SE (β=-0.008, p=0.024) and a 0.006 mm elongation in AL (β=0.006, p=0.014). Each unit elevate in interleukin-4 increased SE by 0.003 D (β=0.003, p=0.043) and decreased AL by 0.003 mm (β=-0.003, p=0.017), with similar trends in outdoor time declining trajectory. However, all associations were not significant after false discovery rate adjustment. Furthermore, each unit increase in the mixed exposure of oxidative stress was associated with a 0.070-0.074 D reduction in SE.CONCLUSIONSParsing insights into the potential relationships between placental inflammation and oxidative stress and myopia in the offspring and exploring the nurture effect of outdoor time based on life-cycle conceptual models will facilitate the early prevention of childhood myopia for clinical and public health practice.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"44 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos Solera-de-Andrés, Paula Spang-Valencia, Jesús Peralta-Calvo
Background: Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual outcomes following this treatment. This study evaluates final visual acuity (VA) in patients with RB treated with IAC, identifying factors contributing to vision loss.
Methods: A retrospective review was conducted at La Paz University Hospital in Madrid, including 71 eyes from 60 patients treated with IAC from 2016 to 2025. Data collected included the International Classification of Retinoblastoma and foveal involvement at diagnosis. VA was assessed using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR). The primary outcome was VA. The secondary outcome was the incidence of choroidal occlusive vasculopathy (COV).
Results: Of the 71 eyes, 24 belonged to patients too immature for VA assessment, and 20 were enucleated due to disease progression. Among the 27 eyes with measurable VA, 7 had a healthy fovea at diagnosis. 23 (85.2%) had a VA≥1.0 logMAR, including 10 (37%) with no light perception. Only four eyes (14.8%) achieved a VA<1.0 logMAR, all with a healthy fovea at diagnosis. Linear regression showed significant association between foveal involvement at diagnosis and reduced final VA. 16 of 71 eyes (22.5%) developed COV, with statistically significant correlation with the number of IAC cycles.
Conclusion: IAC is effective for tumour control and eye preservation but often yields poor visual outcomes in advanced RB due to pre-existing damage and complications like COV. These findings emphasise the importance of counselling families regarding the visual limitations of IAC treatment.
{"title":"Severe visual loss and ocular complications after intra-arterial chemotherapy for retinoblastoma.","authors":"Carlos Solera-de-Andrés, Paula Spang-Valencia, Jesús Peralta-Calvo","doi":"10.1136/bjo-2025-328113","DOIUrl":"https://doi.org/10.1136/bjo-2025-328113","url":null,"abstract":"<p><strong>Background: </strong>Retinoblastoma (RB) treatment aims to ensure survival, globe preservation and visual function. Intra-arterial chemotherapy (IAC) has improved globe salvage, but there remains limited information on visual outcomes following this treatment. This study evaluates final visual acuity (VA) in patients with RB treated with IAC, identifying factors contributing to vision loss.</p><p><strong>Methods: </strong>A retrospective review was conducted at La Paz University Hospital in Madrid, including 71 eyes from 60 patients treated with IAC from 2016 to 2025. Data collected included the International Classification of Retinoblastoma and foveal involvement at diagnosis. VA was assessed using the Snellen chart and converted to the logarithm of the minimum angle of resolution (logMAR). The primary outcome was VA. The secondary outcome was the incidence of choroidal occlusive vasculopathy (COV).</p><p><strong>Results: </strong>Of the 71 eyes, 24 belonged to patients too immature for VA assessment, and 20 were enucleated due to disease progression. Among the 27 eyes with measurable VA, 7 had a healthy fovea at diagnosis. 23 (85.2%) had a VA≥1.0 logMAR, including 10 (37%) with no light perception. Only four eyes (14.8%) achieved a VA<1.0 logMAR, all with a healthy fovea at diagnosis. Linear regression showed significant association between foveal involvement at diagnosis and reduced final VA. 16 of 71 eyes (22.5%) developed COV, with statistically significant correlation with the number of IAC cycles.</p><p><strong>Conclusion: </strong>IAC is effective for tumour control and eye preservation but often yields poor visual outcomes in advanced RB due to pre-existing damage and complications like COV. These findings emphasise the importance of counselling families regarding the visual limitations of IAC treatment.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oscar Kallay, Luxi Ji, Olalekan A Uthman, Edward J Mills, Alimuddin Zumla, Placide Mbala-Kingebeni, Jean-Jacques Muyembe-Tamfum, Elie Motulsky, Jean B Nachega
Background: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health.
Methods: We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180).
Results: Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals.
Conclusions: Mpox-related ophthalmic disease can cause substantial-and potentially preventable-visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II-particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.
背景：2024年8月14日，世卫组织将猴痘重新指定为国际关注的突发公共卫生事件。眼部疾病未得到充分认识，可导致不可逆转的视力丧失。澄清其负担、分支特异性模式和艾滋病毒相关风险对临床护理和公共卫生至关重要。方法：系统检索PubMed、Embase、Scopus、Web of Science和Cochrane Library自成立至2025年9月的文献，进行综合综述和meta分析。符合条件的研究是报告实验室确诊m痘病例的眼部表现的系统综述，按病毒分支I、II和IIb分层。采用随机效应荟萃分析和支系分层亚组分析估计合并比例。该协议已在PROSPERO （CRD420251137180）中注册。结果：纳入5项系统综述（36项初步研究，28139例患者）。结膜炎的合并比例为8.9% (95% CI 4.8 - 13.9)，其中I支系最高（21.9%），IIb支系最低（2.7%）。角膜炎（1.5%）、眼睑病变（3.3%）、结膜病变（8.4%）和角膜溃疡（3.3%）因进化支而异。视力障碍发生率为4.5%；单侧失明（0.9%）和双侧失明（0.4%）仅在进化支i中有报道。在综述中，晚期HIV感染者比HIV阴性个体经历了严重和持续的眼部并发症的比例更高。结论：与mpox相关的眼部疾病可导致实质性且有可能预防的视力障碍。与进化支ii（尤其是IIb）相比，进化支I感染与更大的眼部并发症负担相关。改善获得眼科保健服务的机会、早期识别和整合艾滋病毒和麻疹护理对于减少视力丧失至关重要，特别是在资源有限的环境中。
{"title":"Clade-specific ophthalmic manifestations of mpox: an umbrella review and meta-analysis of systematic reviews.","authors":"Oscar Kallay, Luxi Ji, Olalekan A Uthman, Edward J Mills, Alimuddin Zumla, Placide Mbala-Kingebeni, Jean-Jacques Muyembe-Tamfum, Elie Motulsky, Jean B Nachega","doi":"10.1136/bjo-2025-328294","DOIUrl":"https://doi.org/10.1136/bjo-2025-328294","url":null,"abstract":"<p><strong>Background: </strong>On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health.</p><p><strong>Methods: </strong>We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180).</p><p><strong>Results: </strong>Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals.</p><p><strong>Conclusions: </strong>Mpox-related ophthalmic disease can cause substantial-and potentially preventable-visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II-particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To elucidate changes of full-field electroretinography (ffERG) tests in active unilateral retinal vasculitis, using the unaffected fellow eye as an internal control. Despite no significant differences in best corrected visual acuity (p=0.100) or central subfield macular thickness (p=0.084) at baseline, ffERG showed significant reductions in five of eight amplitudes (i.e. DA10 a-wave, p<0.001) and delays in six of eight implicit times (i.e. light-adapted Flicker, p=0.002). At follow-up ffERG, following management for retinal vasculitis, the implicit times normalised, coinciding with inflammation reduction. However, the amplitude reductions persisted. In ffERG, the implicit time might be a sensitive biomarker for retinal vasculitis activity and the amplitude might be one for permanent functional loss.
{"title":"Analysis of full-field electroretinography parameters and potential for monitoring functional retinal deterioration in unilateral retinal vasculitis.","authors":"Sungwho Park,Woong-Sun Yoo,Irmak Karaca,Hassan Khojasteh,Amir Akhavanrezayat,Gunay Uludag,Anh Ngoc Tram Tran,Xun Lyu,Cigdem Yasar,Prapatsorn Ongpalakorn,Azadeh Mobasserian,Albert John Bromeo,Hashem Ghoraba,Yong Un Shin,Zheng Xian Thng,Ankur Sudhir Gupta,Anadi Khatri Kc,Jia-Horung Hung,Christopher Or,Diana V Do,Quan Dong Nguyen","doi":"10.1136/bjo-2025-328457","DOIUrl":"https://doi.org/10.1136/bjo-2025-328457","url":null,"abstract":"To elucidate changes of full-field electroretinography (ffERG) tests in active unilateral retinal vasculitis, using the unaffected fellow eye as an internal control. Despite no significant differences in best corrected visual acuity (p=0.100) or central subfield macular thickness (p=0.084) at baseline, ffERG showed significant reductions in five of eight amplitudes (i.e. DA10 a-wave, p<0.001) and delays in six of eight implicit times (i.e. light-adapted Flicker, p=0.002). At follow-up ffERG, following management for retinal vasculitis, the implicit times normalised, coinciding with inflammation reduction. However, the amplitude reductions persisted. In ffERG, the implicit time might be a sensitive biomarker for retinal vasculitis activity and the amplitude might be one for permanent functional loss.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"184 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Szanto,Brian Woods,Jui-Kai Wang,Michael Wall,Tobias Elze,Mark Kupersmith
AIMSWe characterised visual field (VF) spatial loss patterns in acute non-arteritic anterior ischaemic optic neuropathy (NAION) using archetypal analysis (AA).METHODSWe performed standard automated perimetry on 727 participants with acute NAION at screening, day 1 of enrolment, months 2, 6 and 12. We applied AA, an unsupervised machine learning technique, to identify and quantify distinct VF loss patterns (archetypes, ATs). We used Mann-Whitney U tests and Wilcoxon signed-rank tests to assess demographic differences and longitudinal changes in discrete variables, and linear regression to analyse continuous variables.RESULTSAA identified 10 distinct ATs, with three especially prevalent patterns: global VF loss (AT1), inferior altitudinal loss (AT2) and inferior altitudinal with macular sparing (AT3). Between day 1 and month 2, AT1 RW significantly increased from 15.7% to 28.1% (false discovery rate, FDR-adjusted p<0.001). Asian participants consistently exhibited greater RW for AT1 compared with White participants (day 1: 40.7% vs 17.7%; FDR-adjusted p<0.001). Sex differences emerged modestly at months 2 and 6, with females having a higher RW for superior altitudinal loss (FDR-adjusted p=0.049). Older participants showed slightly greater frequency of central horizontal and mild central depression patterns (FDR-adjusted p<0.001).CONCLUSIONSAA effectively quantifies distinct, clinically significant VF spatial loss patterns in NAION, revealing significant temporal changes and demographic differences. Global VF loss represents the predominant AT, increasing notably within 2 months of disease onset. Prominent racial disparities, particularly higher severity in Asian individuals, underscore potential differences in NAION aetiology or susceptibility. These findings provide a foundation for improved disease characterisation and prognosis.
目的：我们使用原型分析（AA）来描述急性非动脉性前缺血性视神经病变（NAION）的视野（VF）空间丧失模式。方法：我们在筛查、入组第1天、第2个月、第6个月和第12个月对727名急性NAION患者进行了标准的自动视野测量。我们应用了AA（一种无监督机器学习技术）来识别和量化不同的VF损失模式（原型，ATs）。我们使用Mann-Whitney U检验和Wilcoxon sign -rank检验来评估离散变量的人口统计学差异和纵向变化，并使用线性回归来分析连续变量。结果saa鉴定出10种不同的at，其中有三种特别普遍的模式：全局VF丧失（AT1）、下高度丧失（AT2）和下高度伴黄斑保留（AT3）。在第1天和第2个月之间，AT1 RW从15.7%显著增加到28.1%（错误发现率，经罗斯福校正p<0.001）。与白人受试者相比，亚裔受试者在AT1的RW始终表现出更高的水平（第1天：40.7% vs 17.7%；经罗斯福调整的p<0.001）。性别差异在第2个月和第6个月出现，女性的RW更高，海拔高度下降更严重（经fdr校正p=0.049）。年龄较大的参与者表现出稍高的中央水平和轻度中央抑郁模式的频率（经fdr校正p<0.001）。结论saa有效量化了不同的、具有临床意义的nion VF空间损失模式，揭示了显著的时间变化和人口统计学差异。整体VF丧失是主要的AT，在发病2个月内显著增加。突出的种族差异，特别是亚洲个体的严重程度较高，强调了NAION病因或易感性的潜在差异。这些发现为改善疾病特征和预后提供了基础。
{"title":"Archetypal analysis quantifies changes in patterns of visual field loss in eyes with acute non-arteritic anterior ischaemic optic neuropathy.","authors":"David Szanto,Brian Woods,Jui-Kai Wang,Michael Wall,Tobias Elze,Mark Kupersmith","doi":"10.1136/bjo-2025-328673","DOIUrl":"https://doi.org/10.1136/bjo-2025-328673","url":null,"abstract":"AIMSWe characterised visual field (VF) spatial loss patterns in acute non-arteritic anterior ischaemic optic neuropathy (NAION) using archetypal analysis (AA).METHODSWe performed standard automated perimetry on 727 participants with acute NAION at screening, day 1 of enrolment, months 2, 6 and 12. We applied AA, an unsupervised machine learning technique, to identify and quantify distinct VF loss patterns (archetypes, ATs). We used Mann-Whitney U tests and Wilcoxon signed-rank tests to assess demographic differences and longitudinal changes in discrete variables, and linear regression to analyse continuous variables.RESULTSAA identified 10 distinct ATs, with three especially prevalent patterns: global VF loss (AT1), inferior altitudinal loss (AT2) and inferior altitudinal with macular sparing (AT3). Between day 1 and month 2, AT1 RW significantly increased from 15.7% to 28.1% (false discovery rate, FDR-adjusted p<0.001). Asian participants consistently exhibited greater RW for AT1 compared with White participants (day 1: 40.7% vs 17.7%; FDR-adjusted p<0.001). Sex differences emerged modestly at months 2 and 6, with females having a higher RW for superior altitudinal loss (FDR-adjusted p=0.049). Older participants showed slightly greater frequency of central horizontal and mild central depression patterns (FDR-adjusted p<0.001).CONCLUSIONSAA effectively quantifies distinct, clinically significant VF spatial loss patterns in NAION, revealing significant temporal changes and demographic differences. Global VF loss represents the predominant AT, increasing notably within 2 months of disease onset. Prominent racial disparities, particularly higher severity in Asian individuals, underscore potential differences in NAION aetiology or susceptibility. These findings provide a foundation for improved disease characterisation and prognosis.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"8 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDWhile anti-vascular endothelial growth factor (VEGF) therapies are effective for macular oedema secondary to retinal vein occlusion (RVO), there remains a need for additional treatment options. This study evaluated the novel anti-VEGF agent 601 versus ranibizumab in patients with branch RVO (BRVO) or central RVO (CRVO).METHODSIn two multicentre, randomised, double-masked, active-controlled phase IIa trials (NCT04667897, NCT04667910) conducted at 12 Chinese sites (2021-2022), 120 patients were assigned 1:1 to receive intravitreal 1.25 mg 601 or 0.5 mg ranibizumab every 4 weeks until week 20, followed by pro re nata dosing through week 48. Eligible patients had best-corrected visual acuity (BCVA) of 78-19 Early Treatment Diabetic Retinopathy Study letters and central subfield thickness ≥250 µm. The primary endpoint was change in BCVA at week 24.RESULTSAt week 24, the adjusted mean BCVA change from baseline was +16.52 letters for 601 versus +17.79 letters for ranibizumab (adjusted mean difference: -1.27 letters (95% CI -5.439 to 2.891 letters)) in BRVO, and +13.81 letters versus +16.79 letters (adjusted mean difference: -2.97 letters (95% CI -10.488 to 4.540 letters)) in CRVO. Central retina thickness (CST) reduction was similar for both treatments. Both groups showed sustained improvements from week 24 to 52 with similar adverse event profiles.CONCLUSIONSThese trials demonstrate that 601 is as effective and safe as ranibizumab for improving vision and reducing CST in RVO-related macular oedema. Phase III trials are warranted.
{"title":"Efficacy and safety of anti-VEGF monoclonal antibody 601 for macular oedema in retinal vein occlusion: two phase IIa randomised clinical trials.","authors":"Shuo Zhao,Miaoqin Wu,Jingxiang Zhong,Baihua Chen,Zongming Song,Zhang Ming,Quanhong Han,Suqin Yu,Hong Wang,Songtao Yuan,Jin Yao,Mingwei Zhao,Xiaohong Meng,Feng Wang,Jing Lou,Yanli Liu,Haomin Huang,Qinghong Zhou,Yuyu Xu,Hong Dai,Xiaorong Li","doi":"10.1136/bjo-2025-327845","DOIUrl":"https://doi.org/10.1136/bjo-2025-327845","url":null,"abstract":"BACKGROUNDWhile anti-vascular endothelial growth factor (VEGF) therapies are effective for macular oedema secondary to retinal vein occlusion (RVO), there remains a need for additional treatment options. This study evaluated the novel anti-VEGF agent 601 versus ranibizumab in patients with branch RVO (BRVO) or central RVO (CRVO).METHODSIn two multicentre, randomised, double-masked, active-controlled phase IIa trials (NCT04667897, NCT04667910) conducted at 12 Chinese sites (2021-2022), 120 patients were assigned 1:1 to receive intravitreal 1.25 mg 601 or 0.5 mg ranibizumab every 4 weeks until week 20, followed by pro re nata dosing through week 48. Eligible patients had best-corrected visual acuity (BCVA) of 78-19 Early Treatment Diabetic Retinopathy Study letters and central subfield thickness ≥250 µm. The primary endpoint was change in BCVA at week 24.RESULTSAt week 24, the adjusted mean BCVA change from baseline was +16.52 letters for 601 versus +17.79 letters for ranibizumab (adjusted mean difference: -1.27 letters (95% CI -5.439 to 2.891 letters)) in BRVO, and +13.81 letters versus +16.79 letters (adjusted mean difference: -2.97 letters (95% CI -10.488 to 4.540 letters)) in CRVO. Central retina thickness (CST) reduction was similar for both treatments. Both groups showed sustained improvements from week 24 to 52 with similar adverse event profiles.CONCLUSIONSThese trials demonstrate that 601 is as effective and safe as ranibizumab for improving vision and reducing CST in RVO-related macular oedema. Phase III trials are warranted.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"5 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefan Steiner,Florian Frommlet,Florian Schwarzhans,Georg Fischer,Maximilian Pirrung,Michael Pircher,Christoph Hitzenberger,Clemens Vass
BACKGROUND/AIMSTo describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes.METHODSThis prospective cross-sectional study of 50 early glaucoma and 139 healthy eyes analysed RNFL-S locally along retinal nerve fibre trajectories that were automatically traced and centred on 24-2 and 10-2 visual field (VF) test points. Corresponding virtual B-scans were extracted from stitched wide-field polarisation-sensitive optical coherence tomography images. A linear mixed-effects model (LMM) assessed the association between VFS and the factors RNFL-S, glaucoma status and age.RESULTSThe average VF mean deviation was -3.11±1.51 dB in glaucoma (mean age: 63.0±9.3 years) and -0.36±1.10 dB in healthy eyes (mean age: 47.9±16.3 years). In healthy subjects, VFS and the corresponding RNFL-S were 31.8±2.4 dB (12.5±2.9 µm/mm) in the upper hemisphere and 32.4±2.2 dB (12.5±2.5 µm/mm) in the lower hemisphere. In glaucoma patients, these values were significantly lower: 27.5±7.0 dB (8.6 ± 3.9 µm/mm, p<0.001) in the upper hemisphere and 30.1±4.3 dB (10.5±3.3 µm/mm, p<0.001) in the lower hemisphere. Significant point-wise Spearman correlation coefficients (up to r=0.61) were observed, particularly in the upper VF hemisphere within the central 10° and close to the optic nerve head. The LMM showed a positive association between VFS and RNFL-S (β=0.0415, SE=0.0023, p<0.001, R²=0.1885). Glaucoma was significantly associated with lower VFS (β=-2.468, SE=0.069, p<0.001). Age negatively correlated with VFS (β=-0.048, SE=0.002, p<0.001).CONCLUSIONLocal RNFL-S is significantly correlated with VFS, highlighting its potential as a biomarker for focal glaucoma damage.
{"title":"The retinal nerve fibre layer thickness slope: a localised biomarker of the structure-function relationship in early glaucoma.","authors":"Stefan Steiner,Florian Frommlet,Florian Schwarzhans,Georg Fischer,Maximilian Pirrung,Michael Pircher,Christoph Hitzenberger,Clemens Vass","doi":"10.1136/bjo-2025-328330","DOIUrl":"https://doi.org/10.1136/bjo-2025-328330","url":null,"abstract":"BACKGROUND/AIMSTo describe the relationship between the novel biomarker retinal nerve fibre layer thickness slope (RNFL-S), and visual field sensitivity (VFS) in healthy and early glaucoma eyes.METHODSThis prospective cross-sectional study of 50 early glaucoma and 139 healthy eyes analysed RNFL-S locally along retinal nerve fibre trajectories that were automatically traced and centred on 24-2 and 10-2 visual field (VF) test points. Corresponding virtual B-scans were extracted from stitched wide-field polarisation-sensitive optical coherence tomography images. A linear mixed-effects model (LMM) assessed the association between VFS and the factors RNFL-S, glaucoma status and age.RESULTSThe average VF mean deviation was -3.11±1.51 dB in glaucoma (mean age: 63.0±9.3 years) and -0.36±1.10 dB in healthy eyes (mean age: 47.9±16.3 years). In healthy subjects, VFS and the corresponding RNFL-S were 31.8±2.4 dB (12.5±2.9 µm/mm) in the upper hemisphere and 32.4±2.2 dB (12.5±2.5 µm/mm) in the lower hemisphere. In glaucoma patients, these values were significantly lower: 27.5±7.0 dB (8.6 ± 3.9 µm/mm, p<0.001) in the upper hemisphere and 30.1±4.3 dB (10.5±3.3 µm/mm, p<0.001) in the lower hemisphere. Significant point-wise Spearman correlation coefficients (up to r=0.61) were observed, particularly in the upper VF hemisphere within the central 10° and close to the optic nerve head. The LMM showed a positive association between VFS and RNFL-S (β=0.0415, SE=0.0023, p<0.001, R²=0.1885). Glaucoma was significantly associated with lower VFS (β=-2.468, SE=0.069, p<0.001). Age negatively correlated with VFS (β=-0.048, SE=0.002, p<0.001).CONCLUSIONLocal RNFL-S is significantly correlated with VFS, highlighting its potential as a biomarker for focal glaucoma damage.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna Mair,Lana Bush,Sophia Halliday,David McMaster,Edward Sellon,Marcus H Colyer,Scott F McClellan,Grant A Justin,Annette K Hoskin,Kara M Cavuoto,James Leong,Andrés Rousselot,Fasika Woreta,Kyle E Miller,William G Gensheimer,Thomas H Williamson,Felipe E Dhawahir-Scala,Peter Shah,Gangadhara Sundar,Robert A Mazzoli,Ferenc Kuhn,Malcolm Woodcock,Stephanie Watson,Renata S M Gomes,Rupesh Agrawal,Richard J Blanch
IMPORTANCEPrimary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB.OBJECTIVEThe primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion.DATA SOURCESA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov.STUDY SELECTIONProspective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023.DATA EXTRACTION AND SYNTHESISEleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool.MAIN OUTCOMES AND MEASURESSensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT.RESULTSCT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied.CONCLUSIONS AND RELEVANCECT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.
开放性球损伤（OGI）的初级修复通常是紧急进行的。影像学检查在术前评估中起着重要的作用，包括OGI的检测和眼内异物（IOFB）的存在。术前影像学在OGI和IOFB诊断中的应用尚缺乏证据。目的探讨术前影像学在OGI诊断中的作用。包括持续OGI患者并报告术前OGI评估中放射成像结果的研究符合纳入条件。根据PRISMA（系统评价和荟萃分析首选报告项目）声明进行系统评价，检索Cochrane中央对照试验注册库、PubMed、Medline和ClinicalTrials.gov.STUDY selection纳入报告OGI后术前影像学评估的前瞻性和回顾性研究，不受语言或开始日期限制，截止日期为2023年12月15日。资料提取与综合纳入11项研究，10项回顾性研究，1项前瞻性研究，共纳入1126例患者，其中8例评估OGI的CT检测，3例评估IOFB的超声检测。使用诊断准确性研究质量评估工具-2 （QUADAS-2）工具评估偏倚风险。CT检测OGI的敏感性与眼科医生的临床检查和以术中检查结果为金标准的IOFB检测相比较。术前B超（US）对IOFB检测的敏感性与CT比较。结果与临床诊断相比，sct检测OGI的敏感性为74% (95% CI 66.4% ~ 80.0%)，特异性为93% （95% CI 88.2% ~ 95.4%）。与OGI相关的CT表现包括巩膜畸形、前房（AC）深度改变、晶状体异常和玻璃体出血。以术中检查结果为金标准，CT对IOFB检测的敏感性为69% （95% CI为51.4% ~ 82.0%）。术前B扫描US未检查OGI检测，但与CT金标准相比，IOFB检测灵敏度为86% (95% CI为77%至92%)，但未研究球体挤压眼内内容物的安全性。结论：和relevance ect对OGI检测的敏感性中等，但特异性较高，因此不能取代眼科医生的临床评估。CT阴性不排除IOFB。
{"title":"Use of preoperative imaging in open globe injury management: a systematic review.","authors":"Joanna Mair,Lana Bush,Sophia Halliday,David McMaster,Edward Sellon,Marcus H Colyer,Scott F McClellan,Grant A Justin,Annette K Hoskin,Kara M Cavuoto,James Leong,Andrés Rousselot,Fasika Woreta,Kyle E Miller,William G Gensheimer,Thomas H Williamson,Felipe E Dhawahir-Scala,Peter Shah,Gangadhara Sundar,Robert A Mazzoli,Ferenc Kuhn,Malcolm Woodcock,Stephanie Watson,Renata S M Gomes,Rupesh Agrawal,Richard J Blanch","doi":"10.1136/bjo-2025-327387","DOIUrl":"https://doi.org/10.1136/bjo-2025-327387","url":null,"abstract":"IMPORTANCEPrimary repair of open globe injury (OGI) is typically undertaken urgently. Imaging plays an important role in the preoperative assessment, including detection of an OGI and presence of an intraocular foreign body (IOFB). Evidence is lacking on the utility of preoperative imaging in diagnosing OGI and IOFB.OBJECTIVEThe primary objective is to assess the role of pre-operative imaging in OGI. Studies including patients who had sustained an OGI and reporting the findings of radiologic imaging in pre-operative assessment of OGI were eligible for inclusion.DATA SOURCESA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, searching the Cochrane Central Register of Controlled Trials, PubMed, Medline and ClinicalTrials.gov.STUDY SELECTIONProspective and retrospective studies reporting preoperative imaging assessment after OGI were included with no restriction on language or start date up until 15 December 2023.DATA EXTRACTION AND SYNTHESISEleven studies, 10 retrospective and 1 prospective, with a total of 1126 patients were included, of which 8 assessed computed tomography (CT) detection of OGI and 3 assessed ultrasound for the detection of IOFB. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) tool.MAIN OUTCOMES AND MEASURESSensitivity of CT detection for OGI compared with clinical examination by an ophthalmologist and IOFB detection using intraoperative examination findings as gold standard. Preoperative B Scan ultrasonography (US) sensitivity for IOFB detection compared with CT.RESULTSCT was 74% sensitive (95% CI 66.4% to 80.0%) and 93% specific (95% CI 88.2% to 95.4%) in OGI detection compared with clinical diagnosis. CT findings associated with OGI included scleral deformity, altered anterior chamber (AC) depth, lens abnormality and vitreous haemorrhage. CT was 69% sensitive (95% CI 51.4% to 82.0%) for IOFB detection using intraoperative examination findings as the gold standard.Preoperative B Scan US was not examined for OGI detection but had 86% sensitivity for IOFB detection (95% CI 77% to 92%) compared with the gold standard of CT, but safety with respect to pressure on the globe extruding intraocular contents was not studied.CONCLUSIONS AND RELEVANCECT had moderate sensitivity but high specificity for OGI detection, and therefore cannot replace clinical assessment by an ophthalmologist. A negative CT does not exclude an IOFB.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"3 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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