International Journal of Retina and Vitreous最新文献

{"title":"Complications of silicone oil in vitreoretinal surgery: a narrative review of clinical and experimental evidence.","authors":"Rosa Lomelino Pinheiro, Filipe Henriques, Mun Faria, Elisa Julião Campos, Carlos Marques-Neves","doi":"10.1186/s40942-026-00847-w","DOIUrl":"10.1186/s40942-026-00847-w","url":null,"abstract":"<p><p>Our purpose was to review the existing literature on the clinical and immunopathologic adverse effects of silicone oil (SO). A review was performed of studies published from 1993 to October 2025 in PubMed/MEDLINE, Web of Science, ClinicalTrials.gov, and Cochrane Library. Heavy SO agents were excluded. For silicone oil-related visual loss (SORVL), only rhegmatogenous retinal detachment studies reporting macular status were included. The review is organized into subthemes, including SORVL, emulsification, SO-related corneal and lens changes, retinal layer abnormalities, vascular changes, glaucoma, electrolyte balance, globe deposits, and optic neuropathy. Currently, there is no consensus explanation for SORVL, either due to the different surgical methodologies, the complexity of cases, or the lack of routine multimodal testing. SORVL was frequently associated with inner macular thinning, papillomacular bundle damage, and reduced macular vessel density. Emulsification and globe deposits have been described as a possible cause for the irreversible nature of some adverse effects. Longer SO duration was frequently, but not always, related to structural ocular changes. Finally, cytokine and electrolyte profiles provide evidence of inflammatory and potentially toxic mechanisms. In this review, we compiled the most recent evidence on the structural and functional complications associated with SO (such as macular thinning, SORVL, and optic neuropathy). We then summarized the pathophysiological mechanisms that may lead to these complications, including inflammation, phototoxicity, emulsification, and globe deposits. Standardized definitions (particularly for SORVL and SO-related ocular hypertension), multimodal monitoring protocols, and consensus on safe tamponade duration are still lacking.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relaxing retinectomy and autologous retinal transplant for complex retinal detachment with macular hole: a case series.","authors":"Rami Madani, Armin Wolf, Jad Madani, Michael F Ward, Matthew Cohen, Ferris Bayasi, Tarek Alasil","doi":"10.1186/s40942-026-00843-0","DOIUrl":"10.1186/s40942-026-00843-0","url":null,"abstract":"<p><p>BACKGROUND: To describe the surgical techniques for transplantation of an autologous retinal graft in cases of chronic retinal detachment with proliferative vitreoretinopathy and full-thickness macular hole. METHODS: Descriptive case series of three consecutive patients (1 woman and 2 men; ages 60, 60, and 61) who underwent pars plana vitrectomy with peeling of proliferative vitreoretinopathy membranes, followed by relaxing retinectomy, where a notch was created to harvest a full-thickness neurosensory retinal graft. Perfluoro-n-octane was injected to flatten the retinectomy edges and stabilize the graft, which was then separated from the retinectomy edge and gently mobilized under Perfluoro-n-octane using a finesse loop to plug the macular hole. Endolaser was applied to the retinectomy edge under Perfluoro-n-octane, followed by a controlled Perfluoro-n-octane –air exchange and silicone oil (5000 cSt) infusion. RESULTS: Primary outcomes were anatomical macular hole closure and retinal reattachment; visual outcomes were assessed by postoperative visual acuity, exam and imaging. Initial visual acuity ranged from light perception to hand motion. Postoperatively, visual acuity improved from light perception and hand motion to 20/400 and 20/200; the retina remained attached, and the macular hole was successfully closed, with the autologous retinal transplant integrating into the surrounding retinal tissue. CONCLUSIONS: Autologous retinal transplant, coupled with a relaxing retinectomy, may present a promising strategy for closing macular holes and improving visual acuity in cases of complex retinal detachment with proliferative vitreoretinopathy. We show that this procedure can be performed unimanually, potentially reducing technical demands in such cases. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do we need to hold aspirin before vitreoretinal surgery? A systematic review and meta-analysis.","authors":"Hashem Abu Serhan, Abdullah Ahmed, Muhammad M Elsharkawy, Ameen Alkhateeb, Mutaz Al-Nawaflh, Husam Abu Dawood, Anant Pai","doi":"10.1186/s40942-026-00840-3","DOIUrl":"10.1186/s40942-026-00840-3","url":null,"abstract":"<p><p>PURPOSE: To evaluate the safety of aspirin continuation versus discontinuation in patients undergoing vitreoretinal surgery by assessing hemorrhagic complications and visual outcomes. METHODS: The review protocol was prospectively registered in PROSPERO (CRD420251270694). A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Scopus, Ovid, and Web of Science were searched from inception through August 31, 2025. Studies comparing aspirin continuation versus discontinuation or no aspirin use in adult patients undergoing vitreoretinal surgery were included. The primary outcome was vitreous hemorrhage. Secondary outcomes included hyphema, subconjunctival hemorrhage, subretinal hemorrhage, choroidal hemorrhage, retinal hemorrhage, and visual acuity changes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Quality assessment was performed using the Newcastle-Ottawa Scale, and certainty of evidence was rated using the GRADE framework. RESULTS: Seven studies comprising 2,889 surgical procedures (2,873 patients) were included. Aspirin continuation was not associated with significantly increased risk of vitreous hemorrhage (RR 1.55, 95% CI: 0.73–3.29, p = 0.253, I²=61.7%), hyphema (RR 1.52, 95% CI: 0.56–4.17, p = 0.415, I²=0.0%), subconjunctival hemorrhage (RR 1.20, 95% CI: 0.58–2.48, p = 0.622, I²=0.0%), subretinal hemorrhage (RR 1.06, 95% CI: 0.15–7.63, p = 0.956, I²=82.4%), choroidal hemorrhage (RR 2.07, 95% CI: 0.81–5.24, p = 0.127, I²=0.0%), retinal hemorrhage (RR 1.68, 95% CI: 0.33–8.52, p = 0.532, I²=73.6%), or postoperative visual acuity (MD = 0.26 logMAR, 95% CI: −0.005 to 0.52; p = 0.055). Included studies were rated as moderate to high quality on the Newcastle-Ottawa Scale. GRADE certainty of evidence was rated as low to very low across all outcomes. CONCLUSIONS: Aspirin continuation appears safe in vitreoretinal surgery, with low risk of hemorrhagic complications. Given aspirin’s thrombotic benefits, it can likely be continued in most patients. However, this conclusion, based on low-certainty evidence, should be interpreted with caution and requires confirmation from high-quality prospective randomized trials. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in retinal care: transforming the doctor-patient partnership.","authors":"Joel Hanhart, Leo Anthony Celi, Eytan Z Blumenthal, Ronit Almog, Joachim Behar","doi":"10.1186/s40942-026-00837-y","DOIUrl":"10.1186/s40942-026-00837-y","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence into retinal practice represents more than a technological advancement; it constitutes an anthropological shift fundamentally redefining the centuries-old therapeutic partnership between physician and patient.</p><p><strong>Objective: </strong>To examine how artificial intelligence integration into retinal care transforms the therapeutic partnership, revealing what this transformation illuminates about the nature of medical knowledge itself and identifying frameworks for conscious implementation.</p><p><strong>Methods: </strong>We conducted a structured narrative review examining AI-based diagnosis and monitoring of diabetic retinopathy and age-related macular degeneration (2018-2025), synthesizing clinical deployment evidence with qualitative implementation studies, adopting an anthropological interpretive stance to examine technology as a mediator of human relationships.</p><p><strong>Results: </strong>FDA-approved AI systems demonstrate robust diagnostic performance for diabetic retinopathy and age-related macular degeneration. AI integration shifts encounters from examination-based to screen-mediated, clinical reasoning from individual to algorithm-guided, and physicians from diagnosticians to interpreters. Three insights emerge. First, AI reveals that medical practice always combined mechanistic reasoning with pattern recognition, now separated algorithmically. Second, accountability operates asymmetrically: while all stakeholders derive benefits from algorithmic integration, authority over system selection and deployment remains concentrated among vendors and institutions rather than distributed to frontline clinicians or patients. Third, impact diverges along existing stratification: transformation may create access for excluded populations while potentially eroding relationships for those who had comprehensive care, raising fundamental questions about equitable distribution.</p><p><strong>Conclusions: </strong>The AI transformation of retinal care offers a revealing mirror of medicine's algorithmic future. Success demands epistemological rigor, robust evaluation competencies and establishing frameworks for shared accountability among the various stakeholders. Our framework maps six fundamental dimensions where synthesis supersedes substitution: expanding algorithmic capabilities while preserving healing relationships, creating access while maintaining continuity. Medicine can embrace algorithmic intelligence while preserving its humanistic core through conscious choices about epistemology, equity, and the character of practice we create.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and surgical outcomes of combat blast-related full-thickness traumatic macular holes: insights from war eye trauma in Ukraine.","authors":"Andrii Ruban, Vitalyi Prudyus, Anna Zolnikova, Beáta Éva Petrovski, Goran Petrovski, Susanne Binder, Andrzej Grzybowski, Lyubomyr M Lytvynchuk","doi":"10.1186/s40942-026-00816-3","DOIUrl":"10.1186/s40942-026-00816-3","url":null,"abstract":"<p><strong>Background: </strong>This study analyzes the clinical features and surgical outcomes of combat blast-related traumatic full-thickness macular holes (BRTMH) secondary to war-related ocular trauma in Ukraine, managed at a single civilian center.</p><p><strong>Methods: </strong>Thirteen patients (14 eyes) with diagnosis of BRTMH treated with pars plana vitrectomy (PPV) were recruited for this retrospective, consecutive case, interventional study. Surgery outcome-related factors including face-down positioning were assessed and statistically analyzed.</p><p><strong>Results: </strong>Blast trauma was the cause of injury in all (100%) of the MH cases, wearing no eye protection. Four eyes (28.6%) with MH were secondary to an open-globe, whereas ten eyes (71.4) were related to a closed-globe injury. MH closure was achieved in all cases (100%) after the primary surgery. The median (IQR) ocular trauma score (OTS) was 68 (56-75), while the time interval from injury to surgery was 41 (19 to 71) days. The median (IQR, interquartile range 25-75%) Minimum Linear Diameters of the MHs (µm) was 682 μm (532-889), while nine out of fourteen eyes (64.3%) had BRTMH > 600 μm. There was a direct correlation of postoperative visual acuity at 1 month with the OTS score (ρ = 0.51, p = 0.03) and preoperative visual acuity (LogMar) (ρ = 0.72, p = 0.002), and an inverse correlation with the size of the MH (ρ = -0.63 p = 0.008).</p><p><strong>Conclusion: </strong>Combination of different surgical approaches with minimization of postoperative face-down position time allows to achieve high anatomical and functional results being safe and highly acceptable for wounded patients with BRTMH.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147573829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye-tracking-derived foveal biomarkers and functional alterations in dry AMD: findings from a controlled clinical study.","authors":"Bjørn André Helland-Hansen, Alexander Sverstad, Goran Petrovski, Stig Einride Larsen","doi":"10.1186/s40942-026-00838-x","DOIUrl":"10.1186/s40942-026-00838-x","url":null,"abstract":"<p><p>PURPOSE: Age-related macular degeneration (AMD) is the leading cause of vision loss in the elderly, and early detection is essential for timely intervention and slowing disease progression. This study validated novel foveal function tests using the Bulbicam (BCAM) device for differentiating early and intermediate dry AMD from healthy controls (HCs) and to identify functional variables that may serve as candidate biomarkers. METHODS: In a controlled clinical study, 17 patients with early and intermediate dry AMD and 17 age-matched HCs were assessed using the proprietary Bulbitech “ACOLAPT” (Acuity, Contrast, Light Adaptation) test. Each eye was classified as either the “Worst eye” or “Best eye” for AMD patients based on predefined clinical criteria. Foveal function metrics were derived from the five main variables: Pursuit acuity (PuAc), Pursuit contrast sensitivity (PuCS), Strobe Pursuit Contrast Sensitivity(StCS), (PuCS − StCS) / PuCS (ΔCS), and Variable Strobe Pursuit Object Detection(VaSt). Test validity, reliability, repeatability, and stability were assessed. Validation of ACOLAPT included Analysis of Variance (ANOVA) and Receiver Operating Characteristic (ROC) analyses to assess discriminative capacity, intraclass correlation coefficients (ICC) and Bland-Altman plots with Agreement Index (AI) to evaluate reliability and Stability Index (SI) for estimation of stability. RESULTS: All five BCAM tests showed significant differences between AMD patients and HCs in the worst eye (p ≤ 0.05). PuAc and PuCS showed good reliability (ICC ≥ 0.77), good repeatability (AI ≥ 0.75), and excellent stability (SI ≥ 0.59). The novel StCS test demonstrated excellent reliability (ICC = 0.96), excellent repeatability (AI = 0.88), and excellent stability (SI = 0.58). Despite good ICC values, VaSt and ΔCS had lower repeatability (AI ≤ 0.25), highlighting the importance of AI and SI metrics. CONCLUSION: PuAc, PuCS, and StCS fulfilled the predefined criteria for reliability, repeatability, and stability, supporting their use as candidate biomarkers at both population and individual patient levels. VaSt also met the predefined biomarker criteria through preserved cross-session stability despite lower single-trial agreement. ACOLAPT’s ability to assess multiple aspects of foveal function, along with enhanced stability and repeatability metrics, suggests that it could be valuable in clinical settings for early AMD detection and monitoring. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147520994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of retinal artery occlusion in patients with primary open-angle glaucoma: a retrospective cohort study.","authors":"Nadav Shemesh, Itay Nitzan, Shoham Kubovsky, Tehila Shalmov, Yossi Eshel, Nir Erdinest, Itay Lavy, Jaime Levy","doi":"10.1186/s40942-026-00836-z","DOIUrl":"10.1186/s40942-026-00836-z","url":null,"abstract":"<p><p>BACKGROUND: To evaluate the risk of Retinal Artery Occlusion (RAO) in individuals with Primary-Open Angle Glaucoma (POAG) using a large-scale real-world database. METHODS: This retrospective cohort study used the TriNetX Global Collaborative Network to analyze electronic health records from 145 healthcare organizations. Adults aged 18 years or older with POAG were compared with non-POAG controls. Propensity score matching (PSM) was performed 1:1 on 10 baseline characteristics. The primary outcome was incident RAO occurring from one day after the index POAG diagnosis up to 5 years of follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazard models. Kaplan-Meier analysis was conducted to compare RAO-free survival using log-rank tests. RESULTS: After PSM, there were 260,677 patients in each cohort (50.9% female; mean age 68.2 years). POAG patients had a significantly increased risk of RAO compared with controls (3.46 vs. 1.94 per 10,000; HR 2.16; 95% CI, 1.94–2.42; p < .001). The association persisted in sex-stratified and extended follow-up analyses. Anti-glaucoma medications did not significantly alter risk. CONCLUSIONS: This large-scale cohort study identifies POAG as an independently associated risk marker for RAO. These findings highlight the importance of vascular risk assessment in POAG management and highlight the need for increased vigilance for retinal ischemic events in this population. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of syringe design and cannula dimensions on time-force curve in intravitreal injection across different drug viscosities: area under the curve and peak injection force.","authors":"Bryan Calder Ackermann, Niklas Junker, Maximilian Friedrich, Øystein Kalsnes Jørstad, Morten C Moe, Victor Aristide Augustin, Gerd Uwe Auffarth, Maximilian Hammer","doi":"10.1186/s40942-026-00833-2","DOIUrl":"10.1186/s40942-026-00833-2","url":null,"abstract":"<p><p>BACKGROUND: New intravitreal medications can offer longer treatment duration by using higher drug concentrations, which, in turn, increase viscosity. There is also a trend toward having smaller-gauge cannulas, which require a higher injection force. While the ophthalmologist cannot control viscosity, the choice of syringe may affect the force needed to administer the drug. This study compared two standard 1-ml syringes (BD Plastipak™ and Braun Injekt®-F) with a syringe featuring a reduced plunger diameter (Zero Residual™ 0·2 mL silicone oil-free syringe) for injecting a variety of fluids with viscosity that mimics commonly used intravitreal formulations. METHODS: Injection force over time was measured for each combination of the three syringes, four fluids, and two cannulas (30 G and 33 G), and the results were compared using a two-way ANOVA, followed by Tukey’s post-hoc test. Plungers of the 1ml syringes had a diameter of approximately 4.70mm, while the smaller syringe had a plunger diameter of 2.48mm. Of the 1ml syringes, one was silicone oil lubricated (BD Plastipak™). The tested fluids were chosen to simulate bevacizumab (Balanced Salt Solution), pegcetacoplan (13.8 mg/0.1 ml of PEG-40,000), a high-viscosity solution (40 mg/0.1 ml of PEG-400), and a very high-viscosity solution (Tween 80 diluted with BSS). RESULTS: The Zero Residual syringe required significantly lower injection forces, as quantified by both the area under the curve (AUC) and peak force. These effects became more pronounced when using smaller-diameter cannulas and increasingly viscous fluids. The BD Plastipak needed lower forces than the Braun Injekt-F. CONCLUSIONS: While silicone-oil lubrication reduced injection force, its effect was modest compared with that of plunger diameter, which was the primary determinant of the injection force required for a given viscosity and cannula diameter. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13063457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiogenesis and inflammation in the retinopathy risk of insulin and semaglutide - a review.","authors":"Ming Lu","doi":"10.1186/s40942-026-00811-8","DOIUrl":"10.1186/s40942-026-00811-8","url":null,"abstract":"<p><p>PURPOSE: To critically evaluate evidence supporting the angiogenesis-inflammation hypothesis in diabetic retinopathy (DR); to examine the roles of angiogenic growth factors and inflammatory cytokines in the biphasic effects of insulin on DR - early worsening followed by long-term risk reduction; and to explore broader implications of this hypothesis, including potential biphasic effects of semaglutide due to its insulinotropic action and strategies to mitigate the transient DR exacerbation associated with insulin and insulin secretagogues. METHODS: Literature review. RESULTS: Hyperglycemia and the accumulation of advanced glycation end products upregulate angiogenic growth factors and inflammatory cytokines, notably vascular endothelial growth factor (VEGF) and angiopoietin-2. These mediators compromise the retinal neurovascular unit and disrupt the blood-retinal barrier, while promoting endothelial adhesion molecule expression. The resulting leukostasis triggers hypoxia, leukocyte activation, and self-perpetuating ischemic-inflammatory loops. Insulin-like growth factor-1 further enhances retinal VEGF and angiopoietin-2 expression, potentially driving DR to the proliferative stage. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has paradoxically been linked to DR deterioration like insulin therapy. In contrast, insulin-independent antidiabetic agents such as empagliflozin and metformin are not associated with DR worsening and may even slow its progression. GLP-1 augments glucose-induced insulin secretion, whereas insulin itself upregulates retinal VEGF and angiopoietin-2 and exerts pro-inflammatory effects in insulin-resistant states. Despite early worsening, long-term insulin therapy reduces DR risk through sustained glycemic control, with benefits outweighing initial harm. Semaglutide addresses a broader spectrum of systemic risk factors for DR than insulin, including hypertension, dyslipidemia, chronic kidney disease, and obesity. In addition, experimental evidence suggests that semaglutide may provide direct neurovascular protection through activation of the retinal GLP-1 receptor. CONCLUSIONS: The early worsening of DR associated with insulin therapy may be more accurately attributed to insulin’s pro-angiogenic effects rather than solely to rapid glycemic correction. As an insulin secretagogue, semaglutide may similarly cause early DR progression. However, long-term semaglutide therapy is anticipated to reduce DR risk by improving glycemic control, addressing a broader range of systemic risk factors compared with insulin, and offering direct neurovascular protection in the retina. Combination therapy with insulin-independent glucose-lowering agents may help mitigate the transient DR deterioration linked to insulin and insulin secretagogues. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13113116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed reality headset in vitreoretinal surgical teaching: a newly defined tele-mentoring model.","authors":"Rodolfo Mastropasqua, Maria Ludovica Ruggeri, Alberto Quarta, Ruggero Tartaro, Luca Vecchiarino, Lorenza Brescia, Corina Valentina de Sanctis Ciacci, Raffaella Aloia, Matteo Gironi, Ilaria Palladinetti, Matteo Orione, Andrea Russo, Teresio Avitabile, Leonardo Mastropasqua","doi":"10.1186/s40942-026-00829-y","DOIUrl":"10.1186/s40942-026-00829-y","url":null,"abstract":"<p><p>PURPOSE: To report the benefits of a newly defined tele-mentoring surgical model in vitreoretinal surgery based on a mixed reality headset (MRH) to enhance ophthalmic surgical education. METHODS: A two-step approach was used to define and test the efficacy of the tele-mentoring model designed for surgical teaching. First, the application of the innovative MRH in intraocular surgery was validated for safety and efficacy by an expert surgeon. Secondly, a board of vitreoretinal surgeons designed the tele-mentoring model for surgical teaching, entailing a pre-operative training and the execution of vitreoretinal procedures by a fellow supervised by the mentor through the connection offered by the device. Intraoperative parameters and a satisfaction questionnaire were used to assess surgical safety, efficacy and level of satisfaction for the tele-mentoring teaching method. Outcomes in the model validation were: Surgical safety, defined by (i) the absence of intraoperative complications (ii) the absence of early and (iii) late post-operative complications and surgical efficacy. In addition, in the model application MRH wearability and practicability, the all in one system, impact in the procedure and safety and confidence were investigated. In all cases, time lag and surgery duration were measured. RESULTS: A total of 40 vitreoretinal surgical procedures were performed by an experienced vitreoretinal surgeon with the aid of the MRH. No intraoperative nor early or late postoperative complications were recorded, and time lag and surgical duration were acceptable. A total of 40 surgical procedures were successfully performed by a fellow with the MRH, with no recorded complications and acceptable time-lag and intraoperative time. The tele-mentoring experience was found to be safe and effective, with overall fellows satisfaction in the surgical teaching method. CONCLUSIONS: Reshaping the mentor-fellow relation in a tele-mentoring dimension boosts the fellow self-confidence and training, preserving patient safety and surgical efficacy and representing a promising tool for surgical education in ophthalmology. </p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147457364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}