JAMA ophthalmology最新文献

{"title":"JC Virus-Related Retinopathy.","authors":"Fanny Varenne, Aurore Siegfried-Vergnon, Sébastien Lhomme, Emmanuel Treiner, Béatrice Pignolet, Marine Joly, Fabrice Bonneville, Peggy Gandia, Christophe Rodriguez, Irene Cortese, Vincent Soler, Guillaume Martin-Blondel","doi":"10.1001/jamaophthalmol.2025.2235","DOIUrl":"10.1001/jamaophthalmol.2025.2235","url":null,"abstract":"<p><strong>Importance: </strong>Reactivation of the JC polyomavirus in individuals with impaired immunity is most commonly associated with progressive multifocal leukoencephalopathy. We report a case of polyomavirus-related retinopathy, representing a potentially novel manifestation of JC polyomavirus infection.</p><p><strong>Objective: </strong>To describe a patient with common variable immunodeficiency who exhibited isolated unilateral retinopathy related to JC polyomavirus infection of the retinal ganglion cell layer.</p><p><strong>Design, setting, and participants: </strong>This case report describes a patient managed at a referral center in Toulouse, France, from June 2022 to March 2025 presenting with progressive decrease in visual acuity related to a right-sided unilateral retinopathy.</p><p><strong>Interventions: </strong>Anterior eye chamber paracentesis was performed for polymerase chain reaction (PCR) and shotgun metagenome sequencing, and a retinal biopsy was taken for diagnostic purposes. An intravitreal injection of cidofovir was administered as a therapeutic procedure.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was identification of a potentially novel manifestation of JC polyomavirus infection.</p><p><strong>Results: </strong>A 52-year-old White male presented with isolated, right-sided unilateral progressive retinopathy. Shotgun metagenome sequencing and specific PCR on anterior chamber paracentesis identified JC polyomavirus DNA. A biopsy of the retina demonstrated JC polyomavirus infection of retinal ganglion cells in the ganglion cell layer. A diagnosis of late-onset common variable immunodeficiency complicated by JC polyomavirus-related retinopathy was made. The single intravitreal injection of cidofovir administered was associated with transient negativation of the JC polyomavirus DNA PCR, but resulted in severe cidofovir-related adverse events.</p><p><strong>Conclusions and relevance: </strong>This case report extends the spectrum of clinical phenotypes associated with polyomavirus infection and raises the possibility that retinopathy may be an underappreciated complication in this setting. Testing for JC polyomavirus should be considered in immunocompromised patients presenting with retinopathy of unexplained etiology.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"785-789"},"PeriodicalIF":9.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Receptor Agonists and Risk of Uveitis","authors":"Nitesh Mohan, Sunil K. Srivastava, Matthew J. Schulgit, Amy S. Nowacki, David C. Kaelber, Sumit Sharma","doi":"10.1001/jamaophthalmol.2025.2822","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2822","url":null,"abstract":"ImportanceEmerging evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1RAs), commonly used for glycemic control in diabetes, may possess anti-inflammatory properties. Understanding their potential protective role against uveitis could provide insights into novel therapeutic strategies.ObjectiveTo evaluate whether being prescribed a GLP-1RA is associated with a reduced risk of developing uveitis.Design, Setting, and ParticipantsThis was a retrospective cohort study using electronic health record (EHR) network data from 2006 to 2025. Propensity score matching was applied to control for demographics, smoking status, hypertension, body mass index, hemoglobin A<jats:sub>1c</jats:sub>, and diabetic retinopathy stage. Data from the US Collaborative Network of TriNetX, a large multicenter EHR platform, were used in this analysis. Included were patients with and without diabetes with prescriptions for GLP-1RAs, metformin, insulin, or sodium-glucose cotransporter 2 inhibitors (SGLT2is). The control groups consisted of patients without prescriptions for each medication.ExposureUse of GLP-1RAs, metformin, insulin, or SGLT2is, identified through prescription records.Main Outcomes and MeasuresThe primary outcome was the incidence of noninfectious uveitis, identified using <jats:italic>International Classification of Diseases </jats:italic>(<jats:italic>ICD</jats:italic>) encounter diagnosis codes. Risk ratios (RRs) with 95% CIs were calculated to assess the association between GLP-1RA use and uveitis risk. Analyses included risk of overall uveitis and subtypes such as chorioretinal inflammation, anterior uveitis, panuveitis, and retinal vasculitis.ResultsA total of 516 052 patients were included in this study, 258 026 (mean [SD] age, 56.4 [13.7] years; 159 025 female [61.6%]) in the GLP-1RA group and 258 026 (mean [SD] age, 56.4 [14.0] years; 159 374 female [61.8%]) in the control group. The GLP-1RA cohort had a reduced risk of uveitis compared with controls (RR, 0.48; 95% CI, 0.46-0.51). This was consistent among those with type 2 diabetes (RR, 0.54; 95% CI, 0.51-0.58) and those without diabetes (RR, 0.52; 95% CI, 0.46-0.59). Compared with the cohorts taking metformin (RR, 0.58; 95% CI, 0.54-0.62) and insulin (RR, 0.57; 95% CI, 0.54-0.61), GLP-1RA prescriptions were associated with greater protection against uveitis. However, GLP-1RAs were associated with a slightly increased uveitis risk vs SGLT2is (RR, 1.17; 95% CI, 1.04-1.32). SGLT2i prescriptions were also associated with reduced uveitis risk compared with controls (RR, 0.52; 95% CI, 0.48-0.56).Conclusions and RelevanceThis cohort study found that GLP-1RA prescriptions were associated with a lower risk of uveitis compared with controls. These findings suggest potential anti-inflammatory benefits beyond glycemic control, warranting further investigation into their role in ocular inflammatory diseases.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"21 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Nerve Atrophy Conditions Associated With 3D Unsegmented Optical Coherence Tomography Volumes Using Deep Learning","authors":"David Szanto, Jui-Kai Wang, Brian Woods, Asala Erekat, Mona Garvin, Randy Kardon, Mark J. Kupersmith","doi":"10.1001/jamaophthalmol.2025.2766","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2766","url":null,"abstract":"ImportanceAccurate differentiation of optic nerve head (ONH) atrophy is vital for guiding diagnosis and treatment of conditions such as glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), and optic neuritis. Traditional 2-dimensional assessments may overlook subtle, volumetric changes.ObjectiveTo determine whether a 3-dimensional (3D) deep learning model trained on unsegmented ONH optical coherence tomography (OCT) scans can reliably distinguish optic atrophy in glaucoma, NAION, optic neuritis, and healthy eyes.Design, Setting, and ParticipantsThis cross-sectional study used data from multiple clinical trials and referral centers (2008-2025), including randomized trials, longitudinal studies, and referral clinics. Participants included patients with glaucoma, NAION, or optic neuritis and healthy control patients.ExposuresThree ResNet-3D-18 models were trained using 5-fold stratified cross-validation. One assessed the full OCT volume, another focused only on the peripapillary region (PPR), and the third considered only the ONH. Identical data splits were used to allow direct performance comparison.Main Outcomes and MeasuresClassification accuracy, macro area under the receiver operating characteristic curve (AUC-ROC), precision, recall, and F1 scores, aggregated across all validation folds. Confusion matrices were generated to characterize misclassifications.ResultsA total of 7014 Cirrus ONH OCT scans from 1382 eyes of glaucoma (n = 113), NAION (n = 311), optic neuritis (n = 163), and healthy controls (n = 715) were analyzed. The mean (SD) age was 54.2 (16.9) years; there were 733 (65%) male patients and 402 (35%) female patients. The entire-volume model achieved 88.9% accuracy (macro AUC-ROC, 0.977; 95% CI, 0.974-0.979) and F1 scores of 0.94, 0.87, 0.78, and 0.91 for glaucoma, NAION, optic neuritis, and healthy eyes, respectively. The PPR-only model reached 85.9% accuracy (AUC-ROC, 0.970; 95% CI, 0.967-0.972), while the ONH-only model attained 87.0% accuracy (AUC-ROC, 0.972; 95% CI, 0.970-0.975). Both achieved F1 scores from 0.71 to 0.94. Optic neuritis presented the greatest classification challenge, misclassified as NAION or healthy when axonal loss was severe or minimal. Activation maps revealed disease-specific regions of interest in the retina, including the retinal nerve fiber layer, ganglion cell layer, and retinal pigment epithelium.Conclusions and RelevanceDeep learning–based analysis of unsegmented OCT scans reliably distinguished between different forms of optic nerve atrophy, suggesting subtle, disease-specific structural patterns. This automated approach may support diagnostic efforts, guide clinical management of optic neuropathies, and complement less standardized imaging modalities and subjective clinical impressions.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D Deep Learning Analysis of OCT to Classify Optic Atrophy.","authors":"Sabrina Poonja,Dan Milea,John J Chen","doi":"10.1001/jamaophthalmol.2025.2829","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2829","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Intravitreal Injection of Methylprednisolone","authors":"Ting Zhang, Xin Huang","doi":"10.1001/jamaophthalmol.2025.1848","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1848","url":null,"abstract":"This case report discusses surgical management of retinal necrosis after unintentional injection of methylprednisolone into the vitreous cavity of a patient with nonarteritic anterior ischemic optic neuropathy.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"26 1","pages":"e251848"},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyphema and Yellow Floaters in a Patient With Hyperlipidemia","authors":"Yu Yang, Nan Luo, Jingjing Huang","doi":"10.1001/jamaophthalmol.2025.1869","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1869","url":null,"abstract":"This case report discusses the management of pain and elevated intraocular pressure in patient with persistent hypercholesterolemia who experienced penetrating ocular trauma 20 years prior.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"26 1","pages":"e251869"},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Trabeculectomy With Mitomycin C in Patients of Hispanic vs European Descent","authors":"Sajad Besharati, Vahid Mohammadzadeh, Maryam Ashrafkhorasani, Golnoush Mahmoudinezhad, Ziyue Hu, Mahshad Rafiei, Alaiza Guerrero, Judy Figueroa, Anne L. Coleman, JoAnn Giaconi, Simon K. Law, Zhe Fei, Joseph Caprioli, Kouros Nouri-Mahdavi","doi":"10.1001/jamaophthalmol.2025.2815","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2815","url":null,"abstract":"ImportancePrevious studies suggest that race or ethnicity may influence glaucoma surgical outcomes.ObjectiveTo compare outcomes of initial trabeculectomy with mitomycin C (MMC) in patients of Hispanic descent with those in patients of European descent and identify prognostic factors for failure.Design, Setting, and ParticipantsThis retrospective matched-cohort study was conducted at a single-tertiary academic center. The study included 111 eyes from 96 patients of Hispanic descent that were matched to 111 eyes from 108 patients of European descent, based on age (±5 years), surgeon, lens status, and surgery date (±1 year). Ethnicity was self-determined by patients.ExposureInitial trabeculectomy with MMC.Main Outcome MeasuresCriteria A, B, and C defined qualified success as final intraocular pressure (IOP) of 18 mm Hg or less, 15 mm Hg or less, and 12 mm Hg or less, respectively, with corresponding IOP reduction of 20% or more, 25% or more, and 30% or more, or a decrease of 2 or more medications. Complete success required meeting the above criteria without medication use. Kaplan-Meier survival curves compared patients of Hispanic descent and patients of European descent success rates with log-rank tests. Cox proportional hazard models estimated the influence of ethnicity on surgical success adjusting for confounders.ResultsThe Hispanic descent cohort included 59 females (61.5%) and 37 males (38.5%) with a mean (SD) age of 69.1 (9.9) years. The European descent cohort included 53 females (49.1%) and 55 males (50.9%) with a mean (SD) age of 69.2 (9.4) years. Qualified success rates at 5 years in Hispanic descent and European descent patients were 52% and 68% based on criteria A (difference, 16.7%; 95% CI, 4.0%-29.4%; <jats:italic>P</jats:italic> &amp;amp;lt; .001), 45% and 61% according to criteria B (difference, 16.2%; 95% CI, 3.2%-29.1%; <jats:italic>P</jats:italic> = .01), and 31% and 51% based on criteria C (difference, 20.0%; 95% CI, 7.3%-32.6%; <jats:italic>P</jats:italic> = .002). On multivariable analyses, Hispanic descent was associated with higher failure rates with all complete and qualified success criteria (hazard ratio range, 2.07-3.03; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Early bleb leaks were more frequent in patients of Hispanic descent (14 eyes vs 6 eyes; <jats:italic>P</jats:italic> = .10).Conclusion and RelevanceIn this study, Hispanic descent was associated with higher failure rate after initial trabeculectomy with adjunctive MMC compared with European descent. These findings need to be considered when glaucoma surgery is contemplated in patients of Hispanic descent, especially if these findings are confirmed in future studies that address some of the limitations of this single-center retrospective investigation.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leopard Spots in Antiglomerular Basement Membrane Disease","authors":"Yanping Zhou, Shi Jin","doi":"10.1001/jamaophthalmol.2025.1865","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1865","url":null,"abstract":"This case report discusses a diagnosis of Goodpasture syndrome in a patient aged 56 years who presented with 4 months of blurred vision and bilateral leopard spots on fundus examination.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"146 1","pages":"e251865"},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Arteriolar Emboli From Facial Triamcinolone Injection","authors":"Xiaowei Sun, Jiao Wang, Yuanbin Li","doi":"10.1001/jamaophthalmol.2025.1934","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1934","url":null,"abstract":"This case report describes a diagnosis of retinal arteriolar emboli secondary to a facial triamcinolone injection for allergic dermatitis in a male patient aged 45 years.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"21 1","pages":"e251934"},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural OCT Changes Following Repeated Low-Level Red-Light Therapy for Myopia Prevention","authors":"Zhehuan Zhang, Di Hu, Wenwen Xu, Tianchen Wu, Lu Gao, Chenhao Yang","doi":"10.1001/jamaophthalmol.2025.2767","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2767","url":null,"abstract":"This randomized clinical trial examines optical coherence tomography (OCT) changes following repeated low-level red-light therapy for myopia prevention to assess the treatment’s efficacy and safety.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"27 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}