International journal of ophthalmology最新文献

{"title":"One-year structural and functional outcomes of accelerated epithelium-off corneal cross-linking in keratoconus.","authors":"Iva Ćubela, Daliborka Miletić, Biljana Kuzmanović Elabjer, Senad Ramić, Ivan Pavlović, Dean Šarić, Mladen Bušić","doi":"10.18240/ijo.2026.10.10","DOIUrl":"10.18240/ijo.2026.10.10","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the structural and functional outcomes of accelerated epithelium-off corneal collagen cross-linking (CXL) in patients with keratoconus (KC) 1y after treatment.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent an accelerated epi-off CXL for progressive KC at the Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia, between January and December 2023. The protocol consisted of epithelial removal, riboflavin 0.1% instillation for 3min, and ultraviolet-A (UVA) irradiation at 9 mW/cm² for 10min. Pentacam HR was used to assess keratometric parameters (Kmax, Kmean), curvature-based indices [index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry (IHA), index of height decentration, minimum sagittal curvature (Rmin)], pachymetry-based indices [central corneal thickness (CCT), average pachymetric progression index, maximum Ambrósio relational thickness], Belin/Ambrósio deviation, and the ABCD progression system preoperatively and at 12mo.</p><p><strong>Results: </strong>A total of 45 eyes from 45 patients (mean age: 29.1±6.2y) were included in the study. One year after CXL treatment, only Kmax front (55.20 to 55.00 D) showed a statistically significant decrease among the keratometric parameters. A statistically significant reduction was observed in all curvature-based indices, except for IHA, which did not reach statistical significance, whereas Rmin (6.11 to 6.14 mm) showed a statistically significant increase. Additionally, CCT, anterior radius of curvature (ARC), and best-corrected distance visual acuity (BCVA) also demonstrated statistically significant increase.</p><p><strong>Conclusion: </strong>Accelerated epi-off CXL results in significant structural and functional improvements in KC at the 1-year follow-up. Decreased Kmax and curvature indices, increased Rmin, CCT, and ARC, and improved BCVA indicate better corneal regularity, biomechanical stability, and functional vision, with ABCD analysis confirming disease stabilization.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 10","pages":"1964-1970"},"PeriodicalIF":2.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How much vitrectomy is enough? A narrative review.","authors":"Fatih Ali Ceylan","doi":"10.18240/ijo.2026.10.20","DOIUrl":"10.18240/ijo.2026.10.20","url":null,"abstract":"<p><p>The optimal extent of vitreous removal in modern vitreoretinal surgery remains controversial. While extensive vitrectomy has traditionally been performed to minimize traction and reduce postoperative complications, emerging evidence challenges its routine use across all indications. This narrative review critically evaluates whether extensive vitreous removal provides superior outcomes compared to limited, vitreous-sparing approaches. Current data do not demonstrate a consistent or clinically meaningful advantage of extensive vitrectomy. Although broader vitreous removal may reduce residual traction, it is associated with increased intraoperative manipulation and a higher risk of iatrogenic retinal injury, particularly during peripheral vitreous shaving. In contrast, limited vitrectomy appears sufficient in macular surgery and selected cases of rhegmatogenous retinal detachment, especially with advances in microincisional techniques, high-speed cutters and improved visualization systems. In complex tractional diseases, however, more extensive dissection may still be required. Overall, the available evidence supports a selective, pathology-driven approach rather than routine extensive vitreous removal, reflecting a shift toward more precise and minimally invasive vitreoretinal surgery.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 10","pages":"2041-2046"},"PeriodicalIF":2.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of delayed reversible loss of light perception following vitreoretinal surgery and risk factors influencing time to recovery.","authors":"Mei-Qi Liu, Jia-Yi Wei, Ren-Wan Liu, Sai-Fei Zhang, Jun-Yi Chen, Zong-Duan Zhang, Qin-Tuo Pan","doi":"10.18240/ijo.2026.10.13","DOIUrl":"10.18240/ijo.2026.10.13","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the incidence and clinical features of delayed reversible loss of light perception (D-RLLP) following vitreoretinal surgery, including vitrectomy or silicone oil (SO) removal, and to identify risk factors influencing its recovery time.</p><p><strong>Methods: </strong>This study retrospectively reviewed 19 029 cases (19 029 eyes) of vitreoretinal surgery performed between October 2016 and March 2024. Based on strict temporal criteria, postoperative loss of light perception was classified as immediate postoperative loss of light perception (IP-LLP), D-RLLP, and delayed permanent loss of light perception (D-PLLP). The incidence of reversible loss of light perception (RLLP) and its clinical features were evaluated. A multiple linear regression model was constructed to identify the independent predictors of the recovery time of D-RLLP.</p><p><strong>Results: </strong>Among 19 029 vitreoretinal surgeries, 113 eyes (0.59%) experienced postoperative loss of light perception (LLP), including 32 eyes (28.32%) with IP-LLP, 78 eyes (69.03%) with D-RLLP, and 3 eyes (2.65%) with D-PLLP. The overall incidence of D-RLLP was 0.41% (78/19 029). D-RLLP incidence was significantly higher following SO removal (0.89%, 33/3703) than general vitrectomy (0.29%, 45/15 326; <i>P</i><0.001). In 78 D-RLLP cases, the median recovery time was 47min (interquartile range: 28-71min), with 25.64% recovering in ≤30min, 64.10% in 30-60min, and 10.26% requiring >60min. Multivariate regression identified a history of hypertension (<i>B</i>=18.63, <i>P</i>=0.046) and intraocular pressure difference (<i>B</i>=1.77/min per mm Hg, <i>P</i>=0.011) as independent predictors of prolonged recovery time.</p><p><strong>Conclusion: </strong>D-RLLP is a rare clinical event following vitreoretinal surgery, with a median recovery time of 47min, and the vast majority of affected eyes recovered within 1h. SO removal displayed a significantly higher RLLP incidence than vitrectomy. Importantly, a history of hypertension and greater intraocular pressure difference correlated significantly with an extended recovery time.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 10","pages":"1985-1993"},"PeriodicalIF":2.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FLNA promotes the progression of diabetic retinopathy by increasing M1 macrophages.","authors":"Chun-Hua Li, Mao-Fei Feng, Xue Zhang, Lei Yu","doi":"10.18240/ijo.2026.09.04","DOIUrl":"10.18240/ijo.2026.09.04","url":null,"abstract":"<p><strong>Aim: </strong>To clarify the role of filamin A (FLNA) in promoting diabetic retinopathy (DR) progression and explore its underlying mechanism <i>via</i> modulating M1 macrophage inflammation and adenosine 5'-monophosphate activated protein kinase (AMPK) phosphorylation, as well as its potential as a diagnostic biomarker and therapeutic target.</p><p><strong>Methods: </strong>Gene Expression Omnibus (GEO) dataset and Weighted Gene Co-Expression Network Analysis (WGCNA) were used to identify differentially expressed genes across DR, diabetes mellitus (DM), and control groups. Gene Set Enrichment Analysis (GSEA), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) were employed to analyze the enrichment of intersecting genes. Machine learning models assessed the predictive performance of these genes, while single-cell sequencing and cell chat examined their expression in M1 macrophages and interactions with other cell types. Quantitative PCR (q-PCR) measured mRNA levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α), and Western blotting assessed protein levels of FLNA, AMPK, and phosphorylated-AMPK (p-AMPK).</p><p><strong>Results: </strong>Key findings revealed <i>FLNA</i>, plectin (<i>PLEC</i>), and Tweety family member 3 (<i>TTYH3</i>) as critical genes in DR, with <i>FLNA</i> showing the highest area under the curve (AUC) value and importance, and the random forest model performing best. The AMPK signaling pathway was enriched for FLNA, which was most significantly expressed in M1 macrophages. M1 macrophages promote IL-6, IL-1β, and TNF-α expression. FLNA increases the effect of M1 macrophages on DR progression and AMPK phosphorylation.</p><p><strong>Conclusion: </strong>Our study identifies FLNA as a key regulator in DR progression, primarily by enhancing M1 macrophage-mediated inflammation and AMPK phosphorylation. These findings highlight FLNA's critical role in DR pathogenesis and its potential as a biomarker for early diagnosis and a therapeutic target for intervening in macrophage-driven inflammatory responses.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1687-1699"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How retinal artery occlusion reveals moyamoya disease-a case series and descriptive study.","authors":"Zi-Yue Li, Ying Li, Ya-Qi Wang, Ting Chen, Xuan Xiao","doi":"10.18240/ijo.2026.09.12","DOIUrl":"10.18240/ijo.2026.09.12","url":null,"abstract":"<p><strong>Aim: </strong>To systematically characterize the clinical features, correlations, and therapeutic implications of participants with moyamoya disease (MMD)-related retinal artery occlusion (RAO) through a case series and pooled descriptive analysis.</p><p><strong>Methods: </strong>A total of 9 participants with MMD-RAO (2020-2025) and 9 cases retrieved from published literature (1981-2025) were retrospectively reviewed to descriptively explore the association between MMD and RAO. Mean difference (MD) was adopted as the effect size for continuous variables, while odds ratio (OR) was used for categorical variables. Heterogeneity was evaluated using the <i>Q</i> statistic and <i>I</i> ² index. Publication bias was assessed <i>via</i> funnel plots, and sensitivity analysis was performed using the leave-one-out method.</p><p><strong>Results: </strong>Eighteen participants were enrolled in the final analysis, with a male predominance (male:female=1.25:1). Limited improvement in best-corrected visual acuity (BCVA) was observed after treatment (logMAR range: 0.22-3.0). Central retinal artery occlusion (CRAO) was the predominant subtype (83.3%), followed by branch retinal artery occlusion (BRAO, 11.1%) and cilioretinal artery occlusion (CLRAO, 5.6%). Participants in our institutional cohort were significantly older than those reported in literature (52.89±9.53 <i>vs</i> 25.56±12.58y, <i>P</i><0.001). Our cohort presented slightly worse initial BCVA (2.04±0.9 <i>vs</i> 1.90±0.68; MD=0.14, 95%CI: -0.60-0.88, <i>P</i>=0.711, <i>I</i> ²=78.3%) and inferior visual recovery (1.99±0.9 <i>vs</i> 1.22±1.14; MD=0.77, 95%CI: -0.19-1.73, <i>P</i>=0.132, <i>I</i> ²=82.5%), whereas complete visual recovery (logMAR=0.1) was documented in one BRAO case from published reports. The efficacy of intra-arterial thrombolysis (IAT) reached 60% (3/5) in our cohort, and the overall rate of visual improvement was 41.2%. Mild publication bias was detected; however, sensitivity analysis verified the robustness of primary results.</p><p><strong>Conclusion: </strong>Participants with MMD-related RAO exhibit unique clinical characteristics differing from those with isolated RAO or uncomplicated MMD. This study identifies an \"older MMD phenotype\" complicated by RAO, and highlights the necessity of comprehensive vascular screening in elderly participants presenting with RAO to facilitate timely combined ophthalmological and neurological intervention.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1766-1776"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormalities in retinal vascularity and blood perfusion associated with early syphilis revealed by optical coherence tomography angiography.","authors":"Xiao-Liu Wang, Yan-Qiong Zhu, Hui-Yin Zheng, Xin-Yi Luo, Jie-Hui Li, Hou-Jian Zhang, Zu-Guo Liu, Qiu-Ping Liu","doi":"10.18240/ijo.2026.09.13","DOIUrl":"10.18240/ijo.2026.09.13","url":null,"abstract":"<p><strong>Aim: </strong>To explore the feasibility of optical coherence tomography angiography (OCTA) in the early detection of syphilis and syphilitic chorioretinopathy.</p><p><strong>Methods: </strong>Patients with newly diagnosed syphilis were enrolled from September 2022 to November 2023. All the participants underwent serological examinations including rapid plasma reagin (RPR) test and treponema pallidum particle agglutination (TPPA) test, as well as macular OCTA scanning. Quantitative indicators including macular vessel flow density (VFD), vessel length density (VLD), and foveal avascular zone (FAZ) were measured and analyzed.</p><p><strong>Results: </strong>A total of 44 participants were recruited in this study, including 24 patients in the syphilis group (14 males, mean age: 30.83±9.59y) and 20 healthy individuals in the control group (6 males, mean age: 29.6±11.86y). Compared with the control group, the syphilis group presented significantly higher macular VLD and VFD (<i>P</i><0.05), as well as an increased FAZ perimeter. Subgroup analysis was performed based on RPR titers, with patients divided into the low-titer subgroup (1:2-1:4) and high-titer subgroup (1:8-1:128). Both subgroups showed elevated VLD and VFD (excluding inner VFD) relative to controls (all <i>P</i><0.05). Moreover, significant elevation of VFD was only observed in the high-titer subgroup. Receiver operating characteristic analysis identified outer VLD as the optimal indicator for distinguishing syphilis patients from controls, with an area under the curve of 0.802 (95%CI: 0.667-0.937).</p><p><strong>Conclusion: </strong>Syphilis patients with either low or high RPR titers show increased macular VLD and VFD in the absence of obvious visual impairment, indicating the potential of OCTA microvascular parameters for early auxiliary diagnosis of syphilitic ocular lesions.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1777-1784"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desferrioxamine attenuating high glucose-induced ferroptosis and inflammatory responses in Müller glial cells <i>via</i> Nrf2/TXNRD1 pathway.","authors":"Min Luo, Yi Zhang, Na Li, Wen-Fang Zhan","doi":"10.18240/ijo.2026.09.05","DOIUrl":"10.18240/ijo.2026.09.05","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the protective effects of deferoxamine (DFO) on high glucose (HG)-induced ferroptosis and inflammatory responses in retinal Müller glial cells (MGCs) and offer potential therapeutic targets for early intervention in diabetic retinopathy (DR).</p><p><strong>Methods: </strong>Primary MGCs were cultured from C57BL/6J mouse retinas and exposed to normal glucose (NG, 5 mmol/L) or HG (25 mmol/L) conditions for various durations. Ferroptosis-related markers, including intracellular Fe²⁺ levels, glutathione (GSH), reactive oxygen species (ROS), malondialdehyde (MDA), and key proteins glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), ferritin heavy chain 1 (FTH1), were examined using multiple assays such as immunoblotting, enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF), and fluorometric detection. The role of DFO was evaluated through cell viability assessment and analysis of inflammatory cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α).</p><p><strong>Results: </strong>HG exposure significantly increased intracellular Fe²⁺ content, decreased GSH levels, elevated ROS and MDA concentrations, and altered expression profiles of ferroptosis regulators GPX4 and SLC7A11. Immunoblot and IF analyses confirmed downregulation of GPX4 and SLC7A11 alongside accumulation of FTH1 under prolonged HG treatment. DFO administration markedly attenuated these ferroptotic changes while reducing inflammatory cytokine secretion, demonstrating its protective effect against HG-induced damage in MGCs by modulating the nuclear factor erythroid 2-related factor 2 (Nrf2)/thioredoxin reductase 1 (TXNRD1) pathway.</p><p><strong>Conclusion: </strong>Low-dose DFO effectively mitigates HG-induced ferroptosis and inflammatory responses in MGCs through the Nrf2/TXNRD1 signaling axis, providing a theoretical framework for developing novel therapeutic strategies in DR management.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1700-1710"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoid-induced RPE injury in ARPE-19 cells: association with excessive autophagy and AMPK/mTOR signaling.","authors":"Wen-Xue Guan, Yue Guo, Si-Tong Chen, Zhi-Ming Liu, Yao-Yao Sun, Ming-Wei Zhao","doi":"10.18240/ijo.2026.09.01","DOIUrl":"10.18240/ijo.2026.09.01","url":null,"abstract":"<p><strong>Aim: </strong>To investigate whether excessive glucocorticoid (GC) exposure disrupts retinal pigment epithelial (RPE) homeostasis through glucocorticoid receptor (GR)-dependent autophagy hyperactivation.</p><p><strong>Methods: </strong>Human retinal pigment epithelial cell line (ARPE-19 cells) were exposed to GC (0-100 µmol/L, 48h). GR subcellular localization was analyzed <i>via</i> mitochondrial fractionation and immunofluorescence. Functional assessments included barrier integrity [zonula occludens-1 (ZO-1) immunostaining], phagocytic capacity (FluoSpheres™-labeled photoreceptor outer segment uptake), and ultrastructural analysis (transmission electron microscopy, TEM). Autophagic flux was quantified using mCherry-green fluorescent protein-microtubule-associated protein 1A/1B-light chain 3 (LC3) B reporters. Molecular mechanisms were probed through AMP-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway activity and autophagic flux assessed by LC3-II levels. GR dependency was confirmed using the antagonist RU486, and cell-type specificity was assessed using mouse photoreceptor (661W) cells.</p><p><strong>Results: </strong>GC induced GR upregulation and mitochondrial translocation in a dose- and time-dependent manner, correlating with pathological autophagy activation. Key findings included: 1) tight junction disruption, evidenced by ZO-1 fragmentation, 2) reduction in phagocytic uptake efficiency, 3) mitochondrial shrinkage and autolysosome accumulation (TEM), 4) altered AMPK/mTOR signaling (p-AMPK up, p-mTOR down) associated with autophagosome formation, 5) elevated LC3-II levels confirming excessive autophagic flux. Critically, all GC-induced effects, including GR upregulation, signaling changes, and increased autophagy, were abolished by GR antagonism with RU486.</p><p><strong>Conclusion: </strong>This study shows that GR-dependent GC exposure induces autophagic flux with ultrastructural evidence suggestive of mitochondria-targeted autophagy and alters AMPK/mTOR signaling, correlating with RPE barrier collapse and phagocytic failure, a possible link to steroid-associated central serous chorioretinopathy (CSC).</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1657-1666"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why aren't we using AI in eye clinics? A systematic review of barriers and solutions in AI-based fundus image diagnostics for ocular diseases.","authors":"Tehmina Shehryar, Zoha Zahid Fazal, Anum Abdul Salam, Santhoshi Varada, Fakhar Jabran, Muhammad Usman Akram","doi":"10.18240/ijo.2026.09.17","DOIUrl":"10.18240/ijo.2026.09.17","url":null,"abstract":"<p><p>Artificial intelligence (AI) has shown remarkable accuracy in the diagnosis of common ocular diseases such as diabetic retinopathy (DR), glaucoma, retinopathy of prematurity (ROP), and age-related macular degeneration (AMD), often matching or even outperforming expert clinicians. Despite these advancements, AI adoption in clinical settings remains limited due to key barriers. This systematic review evaluates 34 studies (2018-2025) highlighting AI's diagnostic performance (often >90% accuracy) while pointing out significant gaps in real-world deployment. We identify these persistent challenges through comprehensive analysis of current literature and propose actionable pathways to bridge the \"last-mile gap\" between research and clinical practice. This review pointed out three significant gaps in real-world deployment. These include 1) disjointed integration into clinical workflows, 2) lack of transparency in AI decision-making, and 3) poor generalizability across diverse populations. Our findings provide a framework for advancing AI implementation in ocular diagnostics to achieve equitable, scalable, and trustworthy solutions for global vision care.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1809-1825"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting ferroptosis in ocular diseases: mechanisms, clinical implications, and therapeutic horizons.","authors":"Nai-Yuan Zhang, Hui-Qian Kong, Yu-Qiao Liao, Yi-Ji Pan, Wei Sun, Lei Xi, Hong-Hua Yu, Yun-Hong Shi","doi":"10.18240/ijo.2026.09.21","DOIUrl":"10.18240/ijo.2026.09.21","url":null,"abstract":"<p><p>Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has been increasingly implicated in selected ocular diseases, although its causal relevance varies across disease entities. The retina and retinal pigment epithelium are biologically susceptible to ferroptosis-related injury because of their high oxygen demand, abundant polyunsaturated lipids, mitochondrial activity, light exposure, and tightly regulated iron handling. This review summarizes core mechanisms of ocular ferroptosis, including iron uptake and export, glutathione-glutathione peroxidase 4 (GPX4)-dependent antioxidant defense, lipid peroxidation, mitochondrial dysfunction, neuroinflammation, and blood-retina barrier disruption. We discuss evidence from major degenerative, vascular, ischemic, hereditary, infectious, and immune-mediated retinal diseases, with particular attention to glaucoma, age-related macular degeneration, diabetic retinopathy, ocular toxoplasmosis, uveitis, retinal vasculitis, and inflammatory chorioretinopathy. We also evaluate ferroptosis-targeted therapeutic strategies, proposed operational criteria for defining ferroptosis in retinal disease, and candidate structural, functional, biochemical, and imaging endpoints for future translational studies. Current evidence supports ferroptosis as a context-dependent contributor to retinal injury rather than a uniform pathogenic mechanism. Future studies should integrate cell-type-resolved biomarkers, lipidomic and imaging readouts, functional rescue experiments, and clinically meaningful visual outcomes to clarify when ferroptosis modulation may support vision preservation.</p>","PeriodicalId":14312,"journal":{"name":"International journal of ophthalmology","volume":"19 9","pages":"1858-1877"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}