Graefe’s Archive for Clinical and Experimental Ophthalmology最新文献

{"title":"Changes in lower eyelid positions after Müller's muscle-conjunctival resection with tarsectomy for the correction of upper eyelid ptosis.","authors":"Le-Yu Chen, Shu-Lang Liao, Yi-Hsuan Wei","doi":"10.1007/s00417-025-06829-2","DOIUrl":"10.1007/s00417-025-06829-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the effect of Müller's muscle-conjunctival resection (MMCR) with tarsectomy on lower eyelid position in patients with unilateral aponeurotic ptosis in the East Asian population.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients undergoing unilateral MMCR surgery. Margin reflex distance (MRD) 1 and 2 were measured preoperatively and three months postoperatively. The primary outcome was the change in MRD2 following surgery. Additionally, we investigated the relationship between the relative change of MRD1 and that of MRD2. The secondary outcome was the influence of factors including age, sex, and preoperative MRD on the change in MRD2.</p><p><strong>Results: </strong>Sixty-one patients were included. In the ptotic eye, postoperative MRD1 increased from 1.47 ± 0.88 mm to 3.57 ± 1.00 mm (p < 0.001), while MRD2 decreased from 5.53 ± 0.97 mm to 5.31 ± 0.96 mm (p = 0.007). A negative correlation was observed between the relative change of MRD1 and MRD2 in the ptotic eye (r = -0.335, unstandardized coefficient [B] = -0.016, 95% confidence interval [CI] -0.028 to -0.004, p = 0.009). Additionally, a positive correlation was found between the relative change in MRD2 in the ptotic and normal eyes (r = 0.818, B = 0.760, 95% CI 0.621 to 0.899, p < 0.001). Preoperative MRD2 in the ptotic eye was a predictor of postoperative MRD2 reduction (B = -0.189, 95% CI -0.327 to -0.051, p = 0.008).</p><p><strong>Conclusion: </strong>This study demonstrates that MMCR alters lower eyelid position, with reductions in MRD2 correlating with the degree of upper eyelid correction. It is important to inform patients of this potential alteration preoperatively.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2341-2347"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ahmed and baerveldt in glaucoma surgery: what is the safest choice? - a systematic review and meta-analysis.","authors":"Francesco Matarazzo, Maria Laura Passaro, Michele Rinaldi, Gabriele Gallo Afflitto, Francesco Aiello, Fabio Claudio Avolio, Alessandro Aurilia, Diego Strianese, Carlo Nucci, Ciro Costagliola","doi":"10.1007/s00417-025-06794-w","DOIUrl":"10.1007/s00417-025-06794-w","url":null,"abstract":"<p><strong>Background/aims: </strong>Glaucoma drainage devices (GDDs) are essential in managing complex glaucoma cases. This review focuses on the Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI), the most commonly used GDDs. We aim to evaluate complications associated with AGV and BGI, particularly post-operative hypotony.</p><p><strong>Methods: </strong>We systematically reviewed randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing AGV and BGI. The primary outcome was persistent hypotony (IOP < 5 mmHg). Secondary outcomes included hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, vision loss, cystoid macular edema, diplopia, corneal decompensation, endophthalmitis, hyphema, further surgery for IOP control, tube interventions, exposure, and occlusion.</p><p><strong>Results: </strong>Thirteen studies (4 RCTs, 9 NRSs) with 2,513 eyes were analyzed. AGV was associated with a lower incidence of persistent hypotony in RCTs (0.6% vs. 4.4%, p = 0.006), choroidal effusion (4.95% vs. 15.8%, p < 0.0001), vision loss (9% vs. 18.9%, p = 0.01), and cystoid macular edema (2.5% vs. 9.6%, p = 0.009). BGI showed a lower need for further surgery to control IOP in RCTs (14.5% vs. 7.5%, p = 0.01). No significant differences were found for other outcomes, including suprachoroidal hemorrhage, corneal decompensation, and tube-related complications.</p><p><strong>Conclusion: </strong>AGV seems to offers a safer profile with fewer hypotony-related complications compared to BGI. Personalized device selection is crucial for optimizing glaucoma surgery outcomes. Further high-quality, well-designed studies are needed to validate those results.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2325-2340"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of intraocular pressure during phacoemulsification in patients with either diabetic retinopathy or glaucoma; a randomized controlled feasibility trial.","authors":"Raffaele Raimondi, Karmen Sow, Tunde Peto, Nicholas Wride, Maged S Habib, Alan Sproule, Alyson K Muldrew, Michael Quinn, David H Steel","doi":"10.1007/s00417-025-06839-0","DOIUrl":"10.1007/s00417-025-06839-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate whether performing phacoemulsification with a lower infusion pressure using the Centurion active sentry system affects surgical efficiency, complications and a range of clinical and imaging parameters compared to the higher pressures routinely used in patients with cataract and concomitant diabetic retinopathy and glaucoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Sunderland Eye Infirmary, Sunderland, United Kingdom.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Masked observer randomized controlled feasibility trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with cataracts undergoing routine phacoemulsification with either diabetic retinopathy or primary open-angle glaucoma of any severity were included and randomized to an infusion pressure of 30 ('LOW') or 60 ('HIGH') mmHg. All other fluidic settings were standardized. Surgical metrics and a range of imaging and clinical variables were measured pre- and postoperatively on days 1, 21 and 40.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy eyes from 70 patients underwent surgery and completed follow-up. Forty-one patients had diabetic retinopathy and 29 had glaucoma. There was no difference in any of the recorded surgical metrics including cumulative dissipated energy (CDE) between the two randomization groups (mean CDE 6.5 versus 6.1 percent seconds in the HIGH and LOW groups respectively, p = 0.68). There were no patients in either group with posterior capsule rupture or other intraoperative complications. There was no significant difference in the number of patients with raised intraocular pressure (IOP) on day 1. Seven (21.2%) patients in the LOW and 5 (13.3%) in the HIGH group had slit lamp detectable corneal oedema on day 1, which had all resolved by day 21. There were no between group differences for visual acuity, IOP, corneal thickness, and any of the optical coherence tomography (OCT) acquired measures at any of the time points. The foveal avascular zone perimeter and area were significantly smaller on day 21 than at baseline in the HIGH group as compared to the LOW group (P = 0.03 and 0.04 respectively), with a corresponding increase in the superficial vascular plexus density (p = 0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Using an infusion pressure of 30mmHg with standardized aspiration fluidic settings on the Centurion active sentry system did not decrease surgical efficiency or increase complication rates compared to a pressure of 60mmHg. The lower infusion pressure may cause fewer short-term changes in the retinal microvasculature, the long-term significance of which is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;What is known Traditionally, phacoemulsification has been carried out under relatively high intraocular pressure (IOP) to mitigate the effects of post occlusion aspiration surge during lens removal.  A new enhanced phacoemulsification fluidics system has reduced surge allowing surgeons to operate at considerably lower, and more physiological IOP levels. What i","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2277-2288"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of ocular surface microbiota in children with blepharoconjunctivitis.","authors":"Burçin Çakır, Büşra Güner Sönmezoğlu, Elif Özözen Şahin, Mehmet Köroğlu, Nilgün Özkan Aksoy","doi":"10.1007/s00417-025-06836-3","DOIUrl":"10.1007/s00417-025-06836-3","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the conjunctival and eyelid margin bacterial microbiota in children with blepharoconjunctivitis by using 16S rDNA amplicon sequencing.</p><p><strong>Methods: </strong>In this prospective cross-sectional study, 20 children aged between 3-15 years with blepharoconjunctivitis or blepharokeratokonjunctivitis formed Blepharitis Group and 21 children aged between 3-15 years without any ocular and sysemic diseases except mild refractive errors formed Control Group. Swap samples from all children were taken. The alpha diversity of the ocular surface microbiota within each group were evaluated by using Shannon's, Simpson, and Chao index. Beta diversity was evaluated by Bray Curtis index.</p><p><strong>Results: </strong>Microbiological diversity was higher in the patient group than in the control group. According to Shannon's, Simpson, and Chao index, there were statistically difference between groups (p: 0.000013, p:000003 p: 0.00235, respectively). According to the Bray Curtis index, the healthy eye microbiome in the control group is observed to be highly similar, consistent with other analyses, and the overlapping cluster with the blepharitis eye microbiome is quite low (pco1: 40.93%). Sphingoblump, Micrococus, Lacnospiracebacterium, Stenothermophilus, Aurelmonass, Micrococus, Blatiabeum, Delfiacdiovorans and Vellonella densities were found to be higher in the patient group.</p><p><strong>Conclusion: </strong>Both alpha and beta diversity analyses were significantly higher in pediatric age group patients with blepharitis. In addition, Lacnospiracebacterium, Stenothermophilus, Aurelmonass, Micrococus, Blatiabeum, Delfiacdiovorans and Vellonella densities were found to be higher, which may lead to future studies focused on diagnosis and treatment.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2359-2367"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of different eyelid speculums compared to manual eyelid opening on intraocular pressure in children under general anesthesia.","authors":"Oren Iny, Achia Nemet, Erez Tsumi, Asim Ali, Chiya Robert Barrett, Ahed Imtirat","doi":"10.1007/s00417-025-06808-7","DOIUrl":"10.1007/s00417-025-06808-7","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of 4 commonly used eyelid speculums on intraocular pressure (IOP) among children undergoing examination under anesthesia.</p><p><strong>Methods: </strong>In this comparative cross-sectional study, IOP of children undergoing EUA at Soroka Medical Center was measured by manually opening the eyelids and the result was compared to measurements taken with 4 commonly-used speculums. Barraquer and Alfonso speculums were used in patients of all ages, whereas V- and U-shaped speculums were used in patients older than 6 months of age only. All measurements were taken using a Tono-Pen tonometer.</p><p><strong>Results: </strong>Data were collected from 41 eyes of 21 patients (8 eyes ≤ 6 months of age). Mean age was 3.6 years (range 10 days-14 years), and 52% were male. Mean IOP without an eyelid speculum was 14.3 ± 4.7 mmHg. In comparison to manual eyelid opening, the mean IOP measurement with the Barraquer speculum did not differ significantly (14.7 vs. 14.3 mmHg, respectively, p = 0.139). However, all other types of speculums significantly increased IOP measurements (14.3 vs. 18.9 mmHg, p < 0.001) for Alfonso speculum, (15.0 vs. 19.0 mmHg, p < 0.001) for V-shape speculum, and (15.0 vs. 18.8 mmHg, p < 0.001) for the U-shape speculum. The results were the same when the data from each eye were analyzed separately.</p><p><strong>Conclusions: </strong>The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to age 14 years. IOP measurements obtained with other types of speculums are expected to be overestimated.</p><p><strong>Key messages: </strong>What is known: • Obtaining accurate IOP measurements in children with glaucoma is important to assess disease progression and guide treatment decisions.</p><p><strong>What is new: </strong>• The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to 14 years. • IOP measurements obtained with other types of speculums are usually overestimated.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2315-2323"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal diastolic hypotension is associated with central visual field defect in early and moderate normal tension glaucoma.","authors":"Sung Il Im, Changmin Cha, Sangjoon Lee, Seunguk Lee","doi":"10.1007/s00417-025-06813-w","DOIUrl":"10.1007/s00417-025-06813-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between systemic blood pressure-related hemodynamic indices and central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma (NTG).</p><p><strong>Methods: </strong>This cross-sectional study examined 36 eyes of 36 early and moderate NTG patients with CMVFD from 295 consecutive NTG patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Hemodynamic variables and ocular examination results were compared between two groups. CMVFD was defined as a glaucomatous defect with at least one abnormal point at P < 1% within the central 5 degrees on two consecutive 24-2 or 30-2 visual field tests.</p><p><strong>Results: </strong>There were no significant differences in baseline demographics except for body weight (P = .009). The cup-to-disc ratio, pattern standard deviation in visual field test, and inferotemporal segmental thickness of retinal nerve fiber layer in OCT showed significant differences in the ophthalmic examinations. Univariate logistic regression analysis revealed significant association between CMVFD and 24-h average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure, and body weight. In multivariate logistic regression analysis, only the nighttime average diastolic blood pressure (odds ratio [OR] 0.877; P = .037) was independently associated with CMVFD in early and moderate NTG.</p><p><strong>Conclusion: </strong>Central-most visual field defects were identified in some patients with early and moderate NTG. Particularly, low nocturnal diastolic blood pressure (nocturnal diastolic hypotension) was independently related to CMVFD, and should be considered when managing systemic care for NTG patients.</p><p><strong>Key messages: </strong>What is known: • The visual field defects are at greater risk in glaucoma patients with nocturnal hypotension.</p><p><strong>What is new: </strong>• The nocturnal diastolic hypotension is independently related to the presence of central-most visual field defect (CMVFD) in patients with early and moderate normal tension glaucoma. • If average nocturnal diastolic blood pressure is found to be low, it should be considered a modifiable risk factor for CMVFD.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2307-2314"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of ocular surface diseases: Deep learning for distinguishing ocular surface squamous neoplasia from pterygium.","authors":"Farshid Ramezani, Hossein Azimi, Behrouz Delfanian, Mobina Amanollahi, Jamshid Saeidian, Ahmad Masoumi, Hossein Farrokhpour, Elias Khalili Pour, Mehdi Khodaparast","doi":"10.1007/s00417-025-06804-x","DOIUrl":"10.1007/s00417-025-06804-x","url":null,"abstract":"<p><strong>Purpose: </strong>Given the significance and potential risks associated with Ocular Surface Squamous Neoplasia (OSSN) and the importance of its differentiation from other conditions, we aimed to develop a Deep Learning (DL) model differentiating OSSN from pterygium (PTG) using slit photographs.</p><p><strong>Methods: </strong>A dataset comprising slit photographs of 162 patients including 77 images of OSSN and 85 images of PTG was assembled. After manual segmentation of the images, a Python-based transfer learning approach utilizing the EfficientNet B7 network was employed for automated image segmentation. GoogleNet, a pre-trained neural network was used to categorize the images into OSSN or PTG. To evaluate the performance of our DL model, K-Fold 10 Cross Validation was implemented, and various performance metrics were measured.</p><p><strong>Results: </strong>There was a statistically significant difference in mean age between the OSSN (63.23 ± 13.74 years) and PTG groups (47.18 ± 11.53) (P-value =.000). Furthermore, 84.41% of patients in the OSSN group and 80.00% of the patients in the PTG group were male. Our classification model, trained on automatically segmented images, demonstrated reliable performance measures in distinguishing OSSN from PTG, with an Area Under Curve (AUC) of 98%, sensitivity, F1 score, and accuracy of 94%, and a Matthews Correlation Coefficient (MCC) of 88%.</p><p><strong>Conclusions: </strong>This study presents a novel DL model that effectively segments and classifies OSSN from PTG images with a relatively high accuracy. In addition to its clinical use, this model can be potentially used as a telemedicine application.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2289-2298"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent avascular retina in retinopathy of prematurity.","authors":"Ting Fang Tan, Su Ann Tay, Swati Agarwal-Sinha, Gavin Siew Wei Tan, Wei-Chi Wu, Andrew S H Tsai","doi":"10.1007/s00417-025-06820-x","DOIUrl":"10.1007/s00417-025-06820-x","url":null,"abstract":"<p><p>Persistent avascular retina (PAR) has been increasingly reported with the increased use of anti-vascular endothelial growth factor (VEGF) agents in treatment-requiring ROP. However, they have also been observed in ROP eyes that did not meet treatment requirement and spontaneously regressed. PAR is highlighted in the updated nomenclature under the International Classification of Retinopathy of Prematurity, 3rd edition (ICROP3) consensus statement, underscoring the increased emphasis in detecting PAR. PAR has been noted to persist beyond existing ROP screening guidelines, and were found to be associated with complications like retinal tear and detachment, especially in eyes with more posterior PAR. Thus, serial monitoring of retinal vascularization, facilitated by fluorescein angiography and wide-field imaging, for these associated complications have been encouraged. The current lack of consensus in the follow-up and management of PAR prompts further work in this area: understanding the natural course of retinal vascularization in both untreated and treated ROP, the modulation of anti-VEGF on retinal function, and the clinical significance of PAR-associated vascular patterns can help to guide management protocols for PAR in ROP eyes.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2177-2190"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous epiretinal membrane resolution: mechanisms, outcomes, and implications for clinical management.","authors":"Alberto Quarta, Maria Ludovica Ruggeri, Ruggero Tartaro, Lisa Toto, Rodolfo Mastropasqua","doi":"10.1007/s00417-025-06815-8","DOIUrl":"10.1007/s00417-025-06815-8","url":null,"abstract":"<p><strong>Purpose: </strong>To review the phenomenon of spontaneous epiretinal membrane (ERM) resolution focusing on the clinical settings, mechanisms of resolution, and implications for management.</p><p><strong>Methods: </strong>A comprehensive review of case reports and studies describing spontaneous ERM resolution was conducted. Data were extracted regarding ERM type, patient demographics, visual outcomes, and suspected mechanisms. Findings were analyzed to identify trends and to compare cases of spontaneous resolution across different ERM types.</p><p><strong>Results: </strong>Spontaneous ERM resolution was more frequently observed in younger patients or cases associated with posterior vitreous detachment (PVD). In idiopathic ERMs, spontaneous separation often involved PVD and extracellular matrix remodeling. Inflammatory ERMs demonstrated resolution due to reduced inflammation and traction, while secondary ERMs linked to vascular or traumatic events benefited from mechanisms such as photocoagulation-induced PVD or gliotic contraction. Visual outcomes varied, with improvements in best-corrected visual acuity (BCVA) and metamorphopsia in most cases, though persistent structural changes occasionally limited functional recovery.</p><p><strong>Conclusion: </strong>Spontaneous ERM resolution is a rare but clinically significant event influenced by vitreoretinal interface dynamics and patient-specific factors. Younger age, the presence of PVD, and underlying inflammatory or vascular conditions may contribute to natural resolution. Recognizing these cases allows for tailored management strategies supporting observation in selected patients while minimizing unnecessary surgical interventions. These insights may guide future research into therapeutic approaches that mimic natural resolution mechanisms.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2163-2175"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing pain management and pupil dilation in cataract surgery: a systematic review and meta-analysis of phenylephrine/ketorolac (OMIDRIA®).","authors":"Mohamed Abo Zeid, Amr Elrosasy, Kareem Khalefa, Mohamed Elhadary, Shrouk F Mohamed, Amr Elkelany, Hashem Abu Serhan","doi":"10.1007/s00417-025-06811-y","DOIUrl":"10.1007/s00417-025-06811-y","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review and meta-analysis aims to evaluate the efficacy and safety of the combination of phenylephrine 1% and ketorolac 0.3% (OMIDRIA®) for optimizing pain management and maintaining pupil dilation during cataract surgery. Comparisons were made against placebo/vehicle, phenylephrine alone, and epinephrine.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science was conducted. Eligible studies were randomized clinical trials and observational studies assessing intracameral phenylephrine/ketorolac against control groups. Key outcomes included pain management, pupil diameter, and adverse events. Data were synthesized using meta-analysis with fixed and random-effects models, and heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>Ten studies, including 220,061 patients, were analyzed. The combination of phenylephrine/ketorolac significantly reduced postoperative pain (RR = 0.72, 95% CI: 0.60-0.86) and opioid use (RR = 0.45, 95% CI: 0.23-0.89) compared to vehicle and epinephrine. PE/K also maintained a larger pupil diameter (MD = 0.54 mm, 95% CI: 0.32-0.75) with minimal heterogeneity (I² = 0%) and reduced the incidence of severe pain (RR = 0.41, 95% CI: 0.27-0.63). No significant differences in adverse events such as elevated intraocular pressure, inflammation, or headaches were observed.</p><p><strong>Conclusion: </strong>Phenylephrine/ketorolac (OMIDRIA®) demonstrates superior efficacy in maintaining intraoperative mydriasis, reducing postoperative pain, and minimizing opioid use without increasing adverse events. This combination offers a preferable alternative to traditional agents, potentially setting a new standard for pain management and pupil dilation in cataract surgery.</p>","PeriodicalId":12795,"journal":{"name":"Graefe’s Archive for Clinical and Experimental Ophthalmology","volume":" ","pages":"2265-2275"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}