Jeremy C K Tan, Colin Clement, Paul Healey, Ridia Lim, Andrew White, Joshua Yuen, Ashish Agar, Mitchell Lawlor
Aim: To compare the long-term effectiveness of combined phacoemulsification and Hydrus microstent (phaco-Hydrus) versus iStent inject (phaco-iStent) using microinvasive glaucoma surgery-specific surgical success definitions in a large observational cohort.
Methods: Retrospective study of eyes in the Fight Glaucoma Blindness registry that underwent phaco-Hydrus or phaco-iStent with a minimum of 48 months follow-up. The prespecified primary endpoint was ≥20% intraocular pressure (IOP) decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline at 48 months with no preoperative washout. Propensity score matching of baseline covariates was used to examine outcomes in a subcohort (matched cohort).
Results: 431 eyes (98 phaco-Hydrus: 331 phaco-iStent) were included in the overall cohort and 177 eyes (59 phaco-Hydrus: 118 phaco-iStent) in the matched cohort. There was no significant difference in the rate of surgical success between each group in achieving the primary endpoint at 48 months (adjusted overall cohort, 41.2% vs 43.0% in phaco-Hydrus vs phaco-iStent respectively, p=0.81; matched cohort, 44.1% vs 43.2%, p=0.99). There was no significant difference in degree of IOP reduction, medication reduction and adjusted secondary outcomes between the phaco-Hydrus and phaco-iStent groups in both overall and matched cohorts. The incidence of adverse events and secondary procedures was similar between both groups.
Conclusion: There was no significant difference in surgical success between phaco-Hydrus and phaco-iStent groups at 48 months. Over 40% of eyes maintained the primary success endpoint of ≥20% IOP decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline without the need for secondary glaucoma surgery.
目的：在一个大型观察队列中，使用微创青光眼手术特定手术成功的定义，比较联合超声乳化和Hydrus微支架（phaco-Hydrus）与iStent注射（phaco-iStent）的长期疗效。方法：回顾性研究在抗青光眼失明登记的眼睛，进行了至少48个月的随访。预先指定的主要终点是48个月时眼内压（IOP）下降≥20%，IOP≤21 mm Hg或用药降低≥1，术前无冲洗。基线协变量的倾向评分匹配用于检查亚队列（匹配队列）的结果。结果：整体队列共纳入431只眼（98只phaco-Hydrus: 331只phaco-iStent），配对队列共纳入177只眼（59只phaco-Hydrus: 118只phaco-iStent）。两组在48个月时达到主要终点的手术成功率无显著差异（调整后的总队列，phaco-Hydrus组和phaco-iStent组分别为41.2%和43.0%,p=0.81；匹配队列，44.1%和43.2%,p=0.99）。在整体队列和匹配队列中，phaco-Hydrus组和phaco-iStent组的IOP降低程度、药物减少程度和调整后的次要结局均无显著差异。两组间不良事件和二次手术的发生率相似。结论：在48个月时，phaco-Hydrus组和phaco-iStent组的手术成功率无显著差异。超过40%的眼睛维持了IOP降低≥20%和IOP≤21 mm Hg或与基线相比药物降低≥1的主要成功终点，而无需进行继发性青光眼手术。
{"title":"Long-term comparative outcomes of Hydrus versus iStent inject microinvasive glaucoma surgery implants combined with cataract surgery.","authors":"Jeremy C K Tan, Colin Clement, Paul Healey, Ridia Lim, Andrew White, Joshua Yuen, Ashish Agar, Mitchell Lawlor","doi":"10.1136/bjo-2025-327359","DOIUrl":"10.1136/bjo-2025-327359","url":null,"abstract":"<p><strong>Aim: </strong>To compare the long-term effectiveness of combined phacoemulsification and Hydrus microstent (phaco-Hydrus) versus iStent inject (phaco-iStent) using microinvasive glaucoma surgery-specific surgical success definitions in a large observational cohort.</p><p><strong>Methods: </strong>Retrospective study of eyes in the Fight Glaucoma Blindness registry that underwent phaco-Hydrus or phaco-iStent with a minimum of 48 months follow-up. The prespecified primary endpoint was ≥20% intraocular pressure (IOP) decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline at 48 months with no preoperative washout. Propensity score matching of baseline covariates was used to examine outcomes in a subcohort (matched cohort).</p><p><strong>Results: </strong>431 eyes (98 phaco-Hydrus: 331 phaco-iStent) were included in the overall cohort and 177 eyes (59 phaco-Hydrus: 118 phaco-iStent) in the matched cohort. There was no significant difference in the rate of surgical success between each group in achieving the primary endpoint at 48 months (adjusted overall cohort, 41.2% vs 43.0% in phaco-Hydrus vs phaco-iStent respectively, p=0.81; matched cohort, 44.1% vs 43.2%, p=0.99). There was no significant difference in degree of IOP reduction, medication reduction and adjusted secondary outcomes between the phaco-Hydrus and phaco-iStent groups in both overall and matched cohorts. The incidence of adverse events and secondary procedures was similar between both groups.</p><p><strong>Conclusion: </strong>There was no significant difference in surgical success between phaco-Hydrus and phaco-iStent groups at 48 months. Over 40% of eyes maintained the primary success endpoint of ≥20% IOP decrease and IOP ≤21 mm Hg or ≥1 medication reduction versus baseline without the need for secondary glaucoma surgery.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"52-58"},"PeriodicalIF":3.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882237","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}
AIMSTo determine whether choroidal thickness influences the risk of clinically significant pseudophakic cystoid macular oedema (CME).METHODSWe performed a retrospective case-control study of non-diabetic adults who underwent uncomplicated cataract surgery at the Eye & ENT Hospital of Fudan University between June 2023 and December 2024. Electronic records were reviewed to estimate pseudophakic CME incidence. For each CME case diagnosed, age-matched and sex-matched patients without CME within 3 months postoperatively were randomly selected as controls. Potential ocular risk factors, including axial length (AL), central retinal thickness, subfoveal choroidal thickness (SFCT), posterior vitreous detachment (PVD) and others, were assessed with multivariable logistic regression. Treatment methods and prognosis of CME cases were also evaluated.RESULTSAmong 9793 eyes, CME occurred in 65 (0.66%). After age adjustment, eyes with AL <26 mm (age-related cataract, ARC) had higher CME risk than those with AL ≥26 mm (highly myopic catar, HMC) (OR=1.94, p=0.046). Compared with matched controls, CME cases had shorter AL, less PVD and thicker SFCT (all p<0.001). In multivariable analysis, only thicker SFCT remained associated with CME (OR=1.012, p<0.001). SFCT predicted CME with areas under the curve of 0.805 in HMC and 0.792 in ARC. Mean recovery time was 38.7±9.6 days with periocular steroid injection plus topical steroid and non-steroidal anti-inflammatory drugs versus 42.4±12.3 days with topical therapy alone. Cox regression confirmed faster recovery with the combined regimen.CONCLUSIONSThinner choroidal thickness, which is common in high myopia, acts as a protective factor against pseudophakic CME.
{"title":"Choroid thickness: a potential biomarker for pseudophakic cystoid macular oedema.","authors":"Wenwen He,Dongling Guo,Jitong Zhou,Xiaoxin Hu,Kaiwen Cheng,Jiao Qi,Yu Du,Jiaqi Meng,Yi Lu,Xiangjia Zhu","doi":"10.1136/bjo-2025-328615","DOIUrl":"https://doi.org/10.1136/bjo-2025-328615","url":null,"abstract":"AIMSTo determine whether choroidal thickness influences the risk of clinically significant pseudophakic cystoid macular oedema (CME).METHODSWe performed a retrospective case-control study of non-diabetic adults who underwent uncomplicated cataract surgery at the Eye & ENT Hospital of Fudan University between June 2023 and December 2024. Electronic records were reviewed to estimate pseudophakic CME incidence. For each CME case diagnosed, age-matched and sex-matched patients without CME within 3 months postoperatively were randomly selected as controls. Potential ocular risk factors, including axial length (AL), central retinal thickness, subfoveal choroidal thickness (SFCT), posterior vitreous detachment (PVD) and others, were assessed with multivariable logistic regression. Treatment methods and prognosis of CME cases were also evaluated.RESULTSAmong 9793 eyes, CME occurred in 65 (0.66%). After age adjustment, eyes with AL <26 mm (age-related cataract, ARC) had higher CME risk than those with AL ≥26 mm (highly myopic catar, HMC) (OR=1.94, p=0.046). Compared with matched controls, CME cases had shorter AL, less PVD and thicker SFCT (all p<0.001). In multivariable analysis, only thicker SFCT remained associated with CME (OR=1.012, p<0.001). SFCT predicted CME with areas under the curve of 0.805 in HMC and 0.792 in ARC. Mean recovery time was 38.7±9.6 days with periocular steroid injection plus topical steroid and non-steroidal anti-inflammatory drugs versus 42.4±12.3 days with topical therapy alone. Cox regression confirmed faster recovery with the combined regimen.CONCLUSIONSThinner choroidal thickness, which is common in high myopia, acts as a protective factor against pseudophakic CME.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746692","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}
This scoping review examines the existing literature on the application of artificial intelligence (AI) in screening for eye diseases, with a focus on evaluating whether AI-assisted diagnostic technologies enhance the availability, accessibility, acceptability and quality of screening services. 42 original studies were selected for in-depth analysis, including those employing health economic evaluations. Methodological quality was assessed using the Mixed Methods Appraisal Tool, with the majority of studies demonstrating high quality-24 scored 5/5, 15 scored 4/5 and the rest scored 3/5. Among the included studies, 34 compared manual screening with either AI-assisted or fully AI-driven approaches. Availability was the most frequently studied aspect (28 studies), followed by acceptability (12 studies), whereas accessibility and service quality were less commonly addressed. Overall, AI shows significant potential to improve the cost-effectiveness of eye care services and enhance patient access, particularly in remote or underserved regions. It was also well-accepted by patients, with high satisfaction and improved referral compliance. The findings suggest that AI holds promise for advancing eye disease screening, although large-scale, long-term trials are needed to effectively integrate AI into the reconstruction of screening processes and the reshaping of eye health service systems.
{"title":"Impact of artificial intelligence on the availability, accessibility, acceptability and quality of ophthalmic disease screening services: a scoping review.","authors":"Senlin Lin,Juzhao Zhang,Catherine Jan,Liping Li,Yajun Peng,Dan Qian,Yao Yin,Mengjia Zhang,Jianxiu Feng,Mingguang He,Haidong Zou","doi":"10.1136/bjo-2024-325174","DOIUrl":"https://doi.org/10.1136/bjo-2024-325174","url":null,"abstract":"This scoping review examines the existing literature on the application of artificial intelligence (AI) in screening for eye diseases, with a focus on evaluating whether AI-assisted diagnostic technologies enhance the availability, accessibility, acceptability and quality of screening services. 42 original studies were selected for in-depth analysis, including those employing health economic evaluations. Methodological quality was assessed using the Mixed Methods Appraisal Tool, with the majority of studies demonstrating high quality-24 scored 5/5, 15 scored 4/5 and the rest scored 3/5. Among the included studies, 34 compared manual screening with either AI-assisted or fully AI-driven approaches. Availability was the most frequently studied aspect (28 studies), followed by acceptability (12 studies), whereas accessibility and service quality were less commonly addressed. Overall, AI shows significant potential to improve the cost-effectiveness of eye care services and enhance patient access, particularly in remote or underserved regions. It was also well-accepted by patients, with high satisfaction and improved referral compliance. The findings suggest that AI holds promise for advancing eye disease screening, although large-scale, long-term trials are needed to effectively integrate AI into the reconstruction of screening processes and the reshaping of eye health service systems.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746706","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}
Tessa Fayers,John S Vekinis,Laura Ah-Kye,David Parham,Priscilla Anketell,Justin Weir,Roger A'Hern,Ben Parkin
BACKGROUND/AIMSThe aim of this study was to compare tissue reactions and scarring produced by polypropylene (Prolene) versus polyglactin 910 (Vicryl) sutures in eyelid skin.METHODS47 patients with entropion were randomised to 6-0 Prolene or 6-0 Vicryl. Patients underwent everting sutures 1 month prior to definitive surgery involving wedge excision and retractor plication. Only the randomised suture type was used in both procedures. The study suture within the wedge was analysed histologically. Patients were assessed clinically 2 weeks and 6 months following definitive surgery.The primary outcome was histological inflammatory reaction diameter around the suture assessed by a masked histopathologist. Secondary outcomes were clinical scarring assessed using a validated scar grading questionnaire completed by patients and masked assessors and clinical photographs assessed by two masked oculoplastic surgeons.RESULTSMean inflammatory reaction diameter was 0.39 mm for Prolene and 0.56 mm for Vicryl. Median histological grade sum was 32 (IQR 22-37) for Prolene and 40 (IQR 27-46) for Vicryl. The median number of foreign body giant cells around the suture was 1 (IQR 0-3) for Prolene and 4 (IQR 3-8) for Vicryl. Only this last result was statistically significant; the lack of significance for other results may be due to the small sample size. One patient developed a clinical granuloma following surgery with Vicryl. There was no significant difference between suture scarring assessed by questionnaire responses or clinical photography.CONCLUSIONProlene may cause less histological inflammation than Vicryl in eyelid skin but clinical scarring is similar.TRIAL REGISTRATION NUMBERNCT04724512.
{"title":"Prospective randomised controlled trial to compare tissue reactions and scarring with polypropylene versus polyglactin 910 sutures in periocular skin.","authors":"Tessa Fayers,John S Vekinis,Laura Ah-Kye,David Parham,Priscilla Anketell,Justin Weir,Roger A'Hern,Ben Parkin","doi":"10.1136/bjo-2025-327724","DOIUrl":"https://doi.org/10.1136/bjo-2025-327724","url":null,"abstract":"BACKGROUND/AIMSThe aim of this study was to compare tissue reactions and scarring produced by polypropylene (Prolene) versus polyglactin 910 (Vicryl) sutures in eyelid skin.METHODS47 patients with entropion were randomised to 6-0 Prolene or 6-0 Vicryl. Patients underwent everting sutures 1 month prior to definitive surgery involving wedge excision and retractor plication. Only the randomised suture type was used in both procedures. The study suture within the wedge was analysed histologically. Patients were assessed clinically 2 weeks and 6 months following definitive surgery.The primary outcome was histological inflammatory reaction diameter around the suture assessed by a masked histopathologist. Secondary outcomes were clinical scarring assessed using a validated scar grading questionnaire completed by patients and masked assessors and clinical photographs assessed by two masked oculoplastic surgeons.RESULTSMean inflammatory reaction diameter was 0.39 mm for Prolene and 0.56 mm for Vicryl. Median histological grade sum was 32 (IQR 22-37) for Prolene and 40 (IQR 27-46) for Vicryl. The median number of foreign body giant cells around the suture was 1 (IQR 0-3) for Prolene and 4 (IQR 3-8) for Vicryl. Only this last result was statistically significant; the lack of significance for other results may be due to the small sample size. One patient developed a clinical granuloma following surgery with Vicryl. There was no significant difference between suture scarring assessed by questionnaire responses or clinical photography.CONCLUSIONProlene may cause less histological inflammation than Vicryl in eyelid skin but clinical scarring is similar.TRIAL REGISTRATION NUMBERNCT04724512.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"34 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732713","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}
BACKGROUND/AIMSTo assess binocular visual performance, visual acuity at different contrast levels and visual disturbances in patients with primary open-angle glaucoma (POAG) undergoing bilateral cataract surgery with the placement of wavefront-shaping partial-range of field-extend (PROF-Ex) intraocular lens (IOL).DESIGNProspective, descriptive, single-arm study with 3 months of follow-up.METHODSPatients diagnosed with bilateral early-to-moderate POAG were included and underwent cataract surgery with implantation of a PROF-Ex IOL (AcrySof IQ Vivity, Alcon Healthcare) bilaterally. Postoperative outcomes were measured in binocular conditions for visual acuity (uncorrected and corrected at varying distances and contrast levels), contrast sensitivity and visual disturbances assessed through light distortion analysis in terms of the light distortion index (LDI) and best-fit circle radius.RESULTS27 patients were included, with a mean age of 74.2±8.1 years. Three months after surgery, binocular corrected visual acuities at 100% contrast were -0.01±0.06, 0.11±0.08 and 0.26±0.13 LogMAR for far, intermediate and near distance vision, respectively. Those at 25% contrast were 0.57±0.11 and 0.65±0.12 LogMAR for intermediate and near distance vision, respectively. The mean binocular contrast sensitivity was 1.63±0.11, and the mean LDI was 13.28±7.06. No significant adverse events were recorded.CONCLUSIONSThe wavefront-shaping PROF-Ex IOL technology shows positive outcomes in terms of visual acuity, contrast sensitivity and visual disturbances for patients with bilateral early-to-moderate POAG. Thus, wavefront-shaping PROF-Ex technology lenses can be a viable and effective option for patients with POAG seeking spectacle independence.
{"title":"Visual outcomes in patients with bilateral early to moderate primary open-angle glaucoma following wavefront-shaping partial-range of field-extend intraocular lens implantation.","authors":"Mercè Guarro,Idoia Goñi Guarro,Elena López,Sergi Ruiz,Meritxell Vázquez,Laura Sararols,Sorcha Ní Dhubhghaill,Marc Biarnés","doi":"10.1136/bjo-2025-328047","DOIUrl":"https://doi.org/10.1136/bjo-2025-328047","url":null,"abstract":"BACKGROUND/AIMSTo assess binocular visual performance, visual acuity at different contrast levels and visual disturbances in patients with primary open-angle glaucoma (POAG) undergoing bilateral cataract surgery with the placement of wavefront-shaping partial-range of field-extend (PROF-Ex) intraocular lens (IOL).DESIGNProspective, descriptive, single-arm study with 3 months of follow-up.METHODSPatients diagnosed with bilateral early-to-moderate POAG were included and underwent cataract surgery with implantation of a PROF-Ex IOL (AcrySof IQ Vivity, Alcon Healthcare) bilaterally. Postoperative outcomes were measured in binocular conditions for visual acuity (uncorrected and corrected at varying distances and contrast levels), contrast sensitivity and visual disturbances assessed through light distortion analysis in terms of the light distortion index (LDI) and best-fit circle radius.RESULTS27 patients were included, with a mean age of 74.2±8.1 years. Three months after surgery, binocular corrected visual acuities at 100% contrast were -0.01±0.06, 0.11±0.08 and 0.26±0.13 LogMAR for far, intermediate and near distance vision, respectively. Those at 25% contrast were 0.57±0.11 and 0.65±0.12 LogMAR for intermediate and near distance vision, respectively. The mean binocular contrast sensitivity was 1.63±0.11, and the mean LDI was 13.28±7.06. No significant adverse events were recorded.CONCLUSIONSThe wavefront-shaping PROF-Ex IOL technology shows positive outcomes in terms of visual acuity, contrast sensitivity and visual disturbances for patients with bilateral early-to-moderate POAG. Thus, wavefront-shaping PROF-Ex technology lenses can be a viable and effective option for patients with POAG seeking spectacle independence.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"150 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728511","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}
AIMSTo investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), Descemet's membrane endothelial keratoplasty (DMEK) and cataract surgery and the association with visual function.METHODSThis predefined secondary analysis of a randomised trial included 72 patients with Fuchs' endothelial dystrophy (FED) and cataract for UT-DSAEK or DMEK combined with cataract surgery. Thirty-seven patients with cataract and healthy corneas served as controls and underwent cataract surgery alone.RESULTSTotal posterior HOAs were significantly higher 12 months after UT-DSAEK than DMEK (p<0.001) and higher after DMEK than in the control group (p<0.01).Total densitometry for the central (0-2 mm) and peripheral (2-6 mm) annular corneal zones was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01 for both comparisons).Objective scatter index (OSI) was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01) and higher after DMEK than in the control group (p<0.001). For patients treated with endothelial keratoplasty, visual acuity and OSI were significantly correlated (r2=0.55, p<0.001), as were contrast sensitivity and OSI (r2=0.37, p<0.001).CONCLUSIONSTotal posterior HOAs and OSI were higher 12 months after UT-DSAEK than after DMEK and higher after DMEK than after cataract surgery alone. Visual acuity and contrast sensitivity were correlated with OSI. Although DMEK surgery for FED provides excellent visual rehabilitation, the corneal optical quality remains suboptimal.TRIAL REGISTRATION NUMBERNCT04417959.
{"title":"Optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty: a randomised controlled clinical trial.","authors":"Morten Brok Molbech Madsen,Anders Ivarsen,Jesper Hjortdal","doi":"10.1136/bjo-2025-328970","DOIUrl":"https://doi.org/10.1136/bjo-2025-328970","url":null,"abstract":"AIMSTo investigate corneal higher order aberrations (HOAs), densitometry and whole-eye optical quality after ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK), Descemet's membrane endothelial keratoplasty (DMEK) and cataract surgery and the association with visual function.METHODSThis predefined secondary analysis of a randomised trial included 72 patients with Fuchs' endothelial dystrophy (FED) and cataract for UT-DSAEK or DMEK combined with cataract surgery. Thirty-seven patients with cataract and healthy corneas served as controls and underwent cataract surgery alone.RESULTSTotal posterior HOAs were significantly higher 12 months after UT-DSAEK than DMEK (p<0.001) and higher after DMEK than in the control group (p<0.01).Total densitometry for the central (0-2 mm) and peripheral (2-6 mm) annular corneal zones was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01 for both comparisons).Objective scatter index (OSI) was significantly higher 12 months after UT-DSAEK than DMEK (p<0.01) and higher after DMEK than in the control group (p<0.001). For patients treated with endothelial keratoplasty, visual acuity and OSI were significantly correlated (r2=0.55, p<0.001), as were contrast sensitivity and OSI (r2=0.37, p<0.001).CONCLUSIONSTotal posterior HOAs and OSI were higher 12 months after UT-DSAEK than after DMEK and higher after DMEK than after cataract surgery alone. Visual acuity and contrast sensitivity were correlated with OSI. Although DMEK surgery for FED provides excellent visual rehabilitation, the corneal optical quality remains suboptimal.TRIAL REGISTRATION NUMBERNCT04417959.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"146 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728482","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}
Antonio Di Zazzo,Pier Luigi Surico,Uday Pratap Singh Parmar,Shilpa Tarini,Andrea De Luca,Bhagyasree Madduri,Nitin Mohan,Merle Fernandes
BACKGROUNDTo assess whether adjunctive topical voriconazole 1% offers additional benefit over natamycin 5% monotherapy in fungal keratitis, focusing on ulcer resolution, visual outcomes and safety.METHODSThis prospective, double-masked, randomised clinical trial was conducted at L.V. Prasad Eye Institute, India. A total of 108 adults with smear- or culture-positive fungal keratitis were randomised 1:1 to receive either natamycin 5% plus voriconazole 1% (combination therapy) or natamycin 5% plus placebo (monotherapy). Drops were instilled hourly for 72 hours, then tapered over 2 weeks. All patients also received oral ketoconazole and cycloplegics. The primary outcome was complete ulcer resolution with medical therapy alone, defined as epithelial closure with scarring without therapeutic penetrating keratoplasty. Secondary outcomes included time to epithelial healing, best-corrected visual acuity (BCVA) and adverse events.RESULTSOf 94 eyes completing follow-up (mean (SD) age, 50.4 (12.4) years; 66 (70%) male), complete healing occurred in 38 of 48 eyes (79.2%) in the combination group and 35 of 46 eyes (76.1%) in the monotherapy group (absolute difference, 3.1%; 95% CI -13.2% to 19.4%; p=0.70). Median time to epithelial healing was 38 days (IQR, 20-60) for combination therapy and 39 days (IQR, 21-61) for monotherapy (p=0.86). Final mean BCVA was 0.43 logMAR (logarithm of the minimum angle of resolution) versus 0.58 logMAR, respectively (p=0.07). In non-Aspergillus cases, natamycin monotherapy yielded better visual outcomes (p=0.048).CONCLUSIONSAdjunctive topical voriconazole did not significantly improve clinical outcomes compared with natamycin monotherapy. Natamycin 5% remains an effective first-line treatment, particularly in non-Aspergillus keratitis. Further studies are warranted to explore targeted roles for combination therapy.TRIAL REGISTRATION NUMBERNCT03230058.
{"title":"Efficacy of natamycin monotherapy versus combination therapy with voriconazole for fungal keratitis: a randomised clinical trial.","authors":"Antonio Di Zazzo,Pier Luigi Surico,Uday Pratap Singh Parmar,Shilpa Tarini,Andrea De Luca,Bhagyasree Madduri,Nitin Mohan,Merle Fernandes","doi":"10.1136/bjo-2025-328695","DOIUrl":"https://doi.org/10.1136/bjo-2025-328695","url":null,"abstract":"BACKGROUNDTo assess whether adjunctive topical voriconazole 1% offers additional benefit over natamycin 5% monotherapy in fungal keratitis, focusing on ulcer resolution, visual outcomes and safety.METHODSThis prospective, double-masked, randomised clinical trial was conducted at L.V. Prasad Eye Institute, India. A total of 108 adults with smear- or culture-positive fungal keratitis were randomised 1:1 to receive either natamycin 5% plus voriconazole 1% (combination therapy) or natamycin 5% plus placebo (monotherapy). Drops were instilled hourly for 72 hours, then tapered over 2 weeks. All patients also received oral ketoconazole and cycloplegics. The primary outcome was complete ulcer resolution with medical therapy alone, defined as epithelial closure with scarring without therapeutic penetrating keratoplasty. Secondary outcomes included time to epithelial healing, best-corrected visual acuity (BCVA) and adverse events.RESULTSOf 94 eyes completing follow-up (mean (SD) age, 50.4 (12.4) years; 66 (70%) male), complete healing occurred in 38 of 48 eyes (79.2%) in the combination group and 35 of 46 eyes (76.1%) in the monotherapy group (absolute difference, 3.1%; 95% CI -13.2% to 19.4%; p=0.70). Median time to epithelial healing was 38 days (IQR, 20-60) for combination therapy and 39 days (IQR, 21-61) for monotherapy (p=0.86). Final mean BCVA was 0.43 logMAR (logarithm of the minimum angle of resolution) versus 0.58 logMAR, respectively (p=0.07). In non-Aspergillus cases, natamycin monotherapy yielded better visual outcomes (p=0.048).CONCLUSIONSAdjunctive topical voriconazole did not significantly improve clinical outcomes compared with natamycin monotherapy. Natamycin 5% remains an effective first-line treatment, particularly in non-Aspergillus keratitis. Further studies are warranted to explore targeted roles for combination therapy.TRIAL REGISTRATION NUMBERNCT03230058.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710771","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}
AIMTo compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at different stages of severity.METHODSCross-sectional study including patients who underwent visual field (VF) testing, completed three dry eye disease (DED) questionnaires and had ocular surface examination. Glaucoma severity was staged by averaging the severity grade of both eyes using mean deviation (MD) thresholds as mild (MD≥-6 dB), moderate (-6>MD≥-12 dB) and advanced (MD<-12 dB). Questionnaire results, pairwise correlations and predictors for each questionnaire result were assessed.RESULTS147 patients with a mean age of 65.8±12.5 years were included. OSDI showed moderate-to-high correlations with DEQ-5 and SANDE in patients without glaucoma (n=43) and with mild-to-moderate (n=32 and n=56) VF damage (always ρ≥0.55; p<0.01 with DEQ-5 and ρ≥0.5; p<0.01 with SANDE); while correlations became low and non-significant in advanced glaucoma (n=16) (ρ:0.38; p=0.60 and ρ:0.41; p=0.464 with DEQ-5 and SANDE, respectively). Conversely, DEQ-5 and SANDE always showed significant correlations (ρ≥0.66; p<0.01). Linear regression showed the OSDI to be the only questionnaire affected by mean MD (p=0.002). Additionally, glaucoma patients were more frequently defined as symptomatic for DED using the OSDI compared with the DEQ-5 (65.4% vs 51.9%; p=0.0082).CONCLUSIONDED questionnaires showed different behaviours in patients with glaucoma. The OSDI failed to maintain its correlation with both the DEQ-5 and SANDE in advanced glaucoma stages and was the only questionnaire influenced by VF damage. Questionnaire choice may influence how DED symptoms are captured in glaucoma patients, particularly in advanced stages.
{"title":"Assessment of dry eye questionnaires in patients with and without glaucoma.","authors":"Giulia Coco,Giulia Piccotti,Leopoldo Rossi,Pasquale Fucci,Gianluca Manni","doi":"10.1136/bjo-2025-327695","DOIUrl":"https://doi.org/10.1136/bjo-2025-327695","url":null,"abstract":"AIMTo compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at different stages of severity.METHODSCross-sectional study including patients who underwent visual field (VF) testing, completed three dry eye disease (DED) questionnaires and had ocular surface examination. Glaucoma severity was staged by averaging the severity grade of both eyes using mean deviation (MD) thresholds as mild (MD≥-6 dB), moderate (-6>MD≥-12 dB) and advanced (MD<-12 dB). Questionnaire results, pairwise correlations and predictors for each questionnaire result were assessed.RESULTS147 patients with a mean age of 65.8±12.5 years were included. OSDI showed moderate-to-high correlations with DEQ-5 and SANDE in patients without glaucoma (n=43) and with mild-to-moderate (n=32 and n=56) VF damage (always ρ≥0.55; p<0.01 with DEQ-5 and ρ≥0.5; p<0.01 with SANDE); while correlations became low and non-significant in advanced glaucoma (n=16) (ρ:0.38; p=0.60 and ρ:0.41; p=0.464 with DEQ-5 and SANDE, respectively). Conversely, DEQ-5 and SANDE always showed significant correlations (ρ≥0.66; p<0.01). Linear regression showed the OSDI to be the only questionnaire affected by mean MD (p=0.002). Additionally, glaucoma patients were more frequently defined as symptomatic for DED using the OSDI compared with the DEQ-5 (65.4% vs 51.9%; p=0.0082).CONCLUSIONDED questionnaires showed different behaviours in patients with glaucoma. The OSDI failed to maintain its correlation with both the DEQ-5 and SANDE in advanced glaucoma stages and was the only questionnaire influenced by VF damage. Questionnaire choice may influence how DED symptoms are captured in glaucoma patients, particularly in advanced stages.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"5 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710775","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}
Tasha Miller,Jim Shenchu Xie,Aljeena Rahat Qureshi,Brendan K Tao,Edward Margolin
BACKGROUND/AIMSTo evaluate short- and long-term cardiovascular risk following a first diagnosis of transient vision loss (TVL) compared with matched controls using the TriNetX research network.METHODSPatients with an incident diagnosis of TVL were retrospectively identified and 1:1 propensity score matched to controls with dry eye syndrome. Primary outcomes included major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), ventricular arrhythmias, venous thromboembolism (VTE), hospitalisation and all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) from 14 days to 10 years. Subgroup analyses evaluated patients free of events at 90 days and 1 year.RESULTSAfter matching, 37 750 patients were included in each cohort. Mean (SD) age was 56.8 (16.8) years in the TVL cohort (59.7% female) and 56.6 (16.3) years in the control cohort (58.9% female). Within 14 days, stroke risk increased over 21-fold (HR 21.7; 95% CI 13.4 to 37.4), MACE nearly 10-fold (HR 9.80; 95% CI 7.19 to 13.34), arrhythmia over fourfold (HR 4.01; 95% CI 2.72 to 5.90), MI fivefold (HR 5.00; 95% CI 1.92 to 12.06) and hospitalisation nearly fourfold (HR 3.83; 95% CI, 3.52 to 4.17) compared with controls. VTE risk was modest and transient, with no elevation beyond 5 years and all-cause mortality was not elevated at any time point. Among patients' event-free at 90 days or 1 year, elevated long-term risk persisted up to 10 years for MACE, stroke, arrhythmiaand hospitalisation.CONCLUSIONSTVL is associated with increased short- and long-term risks of MACE, stroke, MI, arrhythmia and hospitalisation, warranting prompt systemic evaluation and long-term monitoring.
背景/目的：利用TriNetX研究网络评估首次诊断为短暂性视力丧失（TVL）后与匹配对照组的短期和长期心血管风险。方法回顾性分析诊断为TVL的患者，并与干眼综合征对照组进行1:1倾向评分匹配。主要结局包括主要不良心血管事件（MACE）、中风、心肌梗死（MI）、室性心律失常、静脉血栓栓塞（VTE）、住院和全因死亡率。Cox比例风险模型估计了14天至10年的风险比（hr）。亚组分析评估患者在90天和1年内无事件发生。结果匹配后，每个队列共纳入37750例患者。TVL组（59.7%为女性）的平均（SD）年龄为56.8（16.8）岁，对照组（58.9%为女性）的平均（SD）年龄为56.6（16.3）岁。14天内，与对照组相比，卒中风险增加超过21倍（HR 21.7; 95% CI 13.4至37.4），MACE风险增加近10倍（HR 9.80; 95% CI 7.19至13.34），心律失常风险增加超过4倍（HR 4.01; 95% CI 2.72至5.90），MI风险增加5倍（HR 5.00; 95% CI 1.92至12.06），住院风险增加近4倍（HR 3.83; 95% CI 3.52至4.17）。静脉血栓栓塞的风险是适度和短暂的，5年后没有升高，全因死亡率在任何时间点都没有升高。在90天或1年内无事件的患者中，MACE、中风、心律失常和住院治疗的长期风险升高持续至10年。结论stvl与MACE、卒中、心肌梗死、心律失常和住院治疗的短期和长期风险增加相关，需要及时进行系统评估和长期监测。
{"title":"Cardiovascular risk following transient vision loss.","authors":"Tasha Miller,Jim Shenchu Xie,Aljeena Rahat Qureshi,Brendan K Tao,Edward Margolin","doi":"10.1136/bjo-2025-328605","DOIUrl":"https://doi.org/10.1136/bjo-2025-328605","url":null,"abstract":"BACKGROUND/AIMSTo evaluate short- and long-term cardiovascular risk following a first diagnosis of transient vision loss (TVL) compared with matched controls using the TriNetX research network.METHODSPatients with an incident diagnosis of TVL were retrospectively identified and 1:1 propensity score matched to controls with dry eye syndrome. Primary outcomes included major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), ventricular arrhythmias, venous thromboembolism (VTE), hospitalisation and all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) from 14 days to 10 years. Subgroup analyses evaluated patients free of events at 90 days and 1 year.RESULTSAfter matching, 37 750 patients were included in each cohort. Mean (SD) age was 56.8 (16.8) years in the TVL cohort (59.7% female) and 56.6 (16.3) years in the control cohort (58.9% female). Within 14 days, stroke risk increased over 21-fold (HR 21.7; 95% CI 13.4 to 37.4), MACE nearly 10-fold (HR 9.80; 95% CI 7.19 to 13.34), arrhythmia over fourfold (HR 4.01; 95% CI 2.72 to 5.90), MI fivefold (HR 5.00; 95% CI 1.92 to 12.06) and hospitalisation nearly fourfold (HR 3.83; 95% CI, 3.52 to 4.17) compared with controls. VTE risk was modest and transient, with no elevation beyond 5 years and all-cause mortality was not elevated at any time point. Among patients' event-free at 90 days or 1 year, elevated long-term risk persisted up to 10 years for MACE, stroke, arrhythmiaand hospitalisation.CONCLUSIONSTVL is associated with increased short- and long-term risks of MACE, stroke, MI, arrhythmia and hospitalisation, warranting prompt systemic evaluation and long-term monitoring.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710751","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}
Teresa Sandinha,Jignasa Mehta,Kodchawan Doungsong,Rhiannon Tudor Edwards,David H W Steel,Deirdre A Lane,
BACKGROUND/AIMSIdiopathic epiretinal membrane (iERM) can affect vision in complex ways, requiring assessment beyond visual acuity. We developed a core outcome set (COS) for patients undergoing surgery for macular pucker secondary to iERMs for use in both clinical practice and clinical trials.METHODSAn online modified Delphi technique was used, incorporating literature review, stakeholder workshops and two-round Delphi survey, each followed by a hybrid consensus meeting. Stakeholders, including health professionals and patients rated the importance of each outcome on a 9-point Likert scale (1-3, not important; 4-6, important; 7-9, very important). Outcomes scored as 'very important' by ≥80% of stakeholders were included in the COS.RESULTSSixty-two outcomes were initially included. Only one outcome reached consensus after the first vote, a further 10 after the second vote and five in the final vote. After discussion and considering clinical relevance and patient importance, the initial list of 17 outcomes was reduced to 13 core outcomes, grouped into six overarching domains: measured visual function, symptoms, adverse events, functional ability, quality of life and other, including objective measurements of anatomical findings.CONCLUSIONA minimum COS for iERMS comprising 13 outcomes covering six domains was generated by the modified Delphi process. The COS is not yet ready for use as the methods of assessment and the time points remain to be determined before it can be used in practice. Future research will test the implementation of the COS in clinical practice and its' potential incorporation into future trials.
{"title":"Development of a core outcome set for patients with epiretinal membranes: a Delphi consensus study.","authors":"Teresa Sandinha,Jignasa Mehta,Kodchawan Doungsong,Rhiannon Tudor Edwards,David H W Steel,Deirdre A Lane, ","doi":"10.1136/bjo-2025-327811","DOIUrl":"https://doi.org/10.1136/bjo-2025-327811","url":null,"abstract":"BACKGROUND/AIMSIdiopathic epiretinal membrane (iERM) can affect vision in complex ways, requiring assessment beyond visual acuity. We developed a core outcome set (COS) for patients undergoing surgery for macular pucker secondary to iERMs for use in both clinical practice and clinical trials.METHODSAn online modified Delphi technique was used, incorporating literature review, stakeholder workshops and two-round Delphi survey, each followed by a hybrid consensus meeting. Stakeholders, including health professionals and patients rated the importance of each outcome on a 9-point Likert scale (1-3, not important; 4-6, important; 7-9, very important). Outcomes scored as 'very important' by ≥80% of stakeholders were included in the COS.RESULTSSixty-two outcomes were initially included. Only one outcome reached consensus after the first vote, a further 10 after the second vote and five in the final vote. After discussion and considering clinical relevance and patient importance, the initial list of 17 outcomes was reduced to 13 core outcomes, grouped into six overarching domains: measured visual function, symptoms, adverse events, functional ability, quality of life and other, including objective measurements of anatomical findings.CONCLUSIONA minimum COS for iERMS comprising 13 outcomes covering six domains was generated by the modified Delphi process. The COS is not yet ready for use as the methods of assessment and the time points remain to be determined before it can be used in practice. Future research will test the implementation of the COS in clinical practice and its' potential incorporation into future trials.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710866","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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