Ophthalmology最新文献

{"title":"Adolescent Malignant Uveal Melanoma with SMARCB1 Deficiency and Orbital Invasion.","authors":"Xiaotong Sha, Zhenguo Xiao, Lijun Shen","doi":"10.1016/j.ophtha.2025.08.029","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.08.029","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275262","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":"Rapidly Progressing Glaucoma: Clinical, Structural, and Socioeconomic Drivers of Treatment Escalation.","authors":"Lok Hin Lee, Yangyiran Xie, Annabelle Pan, Saeid Rasouli, Chris Bradley, Jithin Yohannan","doi":"10.1016/j.ophtha.2025.10.003","DOIUrl":"10.1016/j.ophtha.2025.10.003","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical and sociodemographic factors associated with selecting treatments in glaucoma patients with rapid visual field (VF) progression.</p><p><strong>Design: </strong>Retrospective cohort study PARTICIPANTS: 2,782 eyes from 1,812 adults with 5 or more 24-2 visual fields over five years and at least one optical coherence tomography (OCT) scan at baseline.</p><p><strong>Methods: </strong>Rapid progressors were defined by mean deviation (MD) slopes worse than -1 dB/year. Demographic (age, gender, race), clinical (intraocular pressure (IOP), VF metrics, OCT measures), and socioeconomic (social vulnerability index, or SVI) variables were collected. Patients were categorized based on the most intensive treatment received in the first seven years: medical management, minimally invasive procedures (e.g., minimally invasive glaucoma surgery or laser), or aggressive procedures (e.g., filtering surgery or external ciliodestruction). Multinomial regression was performed to identify demographic, clinical, and socioeconomic factors associated with treatment intensity.</p><p><strong>Main outcome measures: </strong>Odds of treatment selection based on rapid VF progression RESULTS: Rapid progressors had significantly higher odds of receiving aggressive procedures (odds ratio [OR] 6.96, 95% confidence interval [CI] 2.61-18.55, p < 0.001), yet only 23% of rapid progressors underwent aggressive procedures in the first seven years. In a sample of rapid progressors who were managed with medical treatment alone, we found that 85% were conservatively managed due to clinician decision-making rather than patient preference. Worse MD, smaller rim area, and higher initial IOP were associated with more aggressive intervention. Functional decline (MD slope) was not associated with treatment selection in rapid progressors. We also found that higher (worse) SVI was associated with a reduced likelihood of receiving minimally invasive procedures among rapid progressors (OR 0.06, 95% CI 0.00-0.78, p = 0.032).</p><p><strong>Conclusion: </strong>Although rapid progression was a strong predictor of aggressive procedures, fewer than one in four underwent aggressive IOP-lowering interventions in the first seven years. Rate of functional decline did not play a role in treatment selection within rapid progressors. Rapidly progressing patients in areas of higher socioeconomic vulnerability were also less likely to receive less invasive procedures. Better integrating rates of functional decline and addressing socioeconomic barriers may help optimize care for rapidly progressing glaucoma patients.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280813","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":"Adalimumab vs. Conventional Immunosuppression for Uveitis (ADVISE) Trial.","authors":"Douglas A Jabs, Elizabeth A Sugar, Alyce E Burke, Michael Altaweel, Jennifer E Thorne, Sheriza Baksh, Lyndell Lim, Akshay Thomas, Steven Yeh, Janet T Holbrook","doi":"10.1016/j.ophtha.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.10.004","url":null,"abstract":"<p><strong>Objective: </strong>Patients with non-infectious intermediate, posterior, or panuveitides typically are treated with oral corticosteroids and immunosuppressive agents, such as antimetabolites and calcineurin inhibitors. Goals of treatment include suppression of ocular inflammation (inactive disease) and reduction of oral corticosteroids to a prednisone dose <7.5 mg/day (corticosteroid sparing) or, if possible, discontinuation of prednisone. The anti-tumor necrosis factor monoclonal antibody, adalimumab, also is used in the treatment of these diseases, but its comparative effectiveness to conventional agents is unknown. The purpose of this trial was to compare adalimumab treatment to that with conventional immunosuppressive drugs for uveitis.</p><p><strong>Design: </strong>Randomized, unmasked, comparative effectiveness trial conducted at uveitis clinics at academic medical centers and private practices in the United States and internationally PARTICIPANTS: Patients with active or recently active non-infectious intermediate, posterior, or panuveitides needing immunosuppression INTERVENTIONS: Adalimumab vs. conventional immunosuppressive drugs (antimetabolites and/or calcineurin inhibitors) MAIN OUTCOME MEASURES: The primary outcome was successful corticosteroid sparing, defined as inactive uveitis at a prednisone dose <7.5 mg/day (or its equivalent) for 2 consecutive study visits >28 days apart, at 6 months. Other outcomes included successful corticosteroid sparing at 1 year and successful corticosteroid discontinuation, defined as inactive uveitis and no oral corticosteroid therapy for 2 consecutive study visits >28 days apart RESULTS: 227 participants were randomized to either adalimumab (N=114) or conventional immunosuppression (N=113). By 6 months of follow-up successful corticosteroid sparing occurred in 69% of participants assigned to adalimumab vs. 54% assigned to conventional immunosuppression (odds ratio [OR] 1.86; 95% confidence interval [CI] 1.06, 3.25; P=0.029) and by 12 months in 86% of participants assigned to adalimumab vs. 77% assigned to conventional immunosuppression (OR 1.89; 95% CI 0.93, 3.83; P=0.077). By 12 months successful corticosteroid discontinuation occurred in 55% of participants assigned to adalimumab vs. 40% assigned to conventional immunosuppression (OR 1.85; 95% CI 1.06, 3.19: P=0.028).</p><p><strong>Conclusions: </strong>For patients with non-infectious intermediate, posterior, or panuveitides requiring immunosuppression, adalimumab treatment resulted in a greater proportion of participants with successful corticosteroid sparing at 6 months and successful corticosteroid discontinuation at 12 months compared to treatment with antimetabolites or calcineurin inhibitors.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280819","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":"Quantifying Effects Of Lifestyle Changes On Progression To Advanced Age-Related Macular Degeneration In High Genetic Risk Individuals.","authors":"Johanna M Seddon, Dikha De, Bernard Rosner","doi":"10.1016/j.ophtha.2025.09.030","DOIUrl":"10.1016/j.ophtha.2025.09.030","url":null,"abstract":"<p><strong>Purpose: </strong>We examined the extent to which adopting healthy lifestyle behaviors could offset high genetic risk for progression to advanced age-related macular degeneration (AMD), to address concerns of family members of affected patients.</p><p><strong>Design: </strong>Prospective longitudinal analysis PARTICIPANTS: Eyes with early/intermediate AMD at baseline were defined based on the Age-Related Eye Disease Study severity scale. High genetic risk was defined as the third tertile of a genetic risk score (GRS) for progression, adjusted for age, race and sex.</p><p><strong>Methods: </strong>Information on lifestyle behaviors was obtained from baseline risk and food frequency questionnaires. Risk-inducing and health-promoting lifestyle profiles were defined based on dichotomous categorizations of smoking, body-mass index (BMI), and dietary caloric intake, green leafy vegetables and fish, in never and ever smokers. Cox proportional hazard ratios (HRs), relative risks and population attributable risks (PARs) were calculated, adjusting for inter-eye correlation, demographic factors, macular status and family history.</p><p><strong>Main outcome: </strong>Progression to advanced AMD (AAMD) and subtypes geographic atrophy (GA) and neovascular (NV), confirmed at 2 consecutive visits over 5 years follow-up.</p><p><strong>Results: </strong>Among 898 high genetic risk eyes, 207 eyes progressed to AAMD (23%). Among never smokers, a high risk-inducing lifestyle profile conferred a 3-fold increased incidence of AAMD, compared to an ideal health-promoting profile [HR = 3.3 (CI 1.8, 6.4), P <0.001]. In ever smokers, a high risk-inducing profile was independently associated with a 5-fold increased incidence of AAMD [HR = 5.3 (CI 2.3,11.9), P <0.001]. Stronger effects of lifestyle behaviors were seen for GA compared to NV. Estimated PARs suggested adopting an ideal health-promoting profile could prevent 56% of incident AAMD in never smokers and 60% in ever smokers.</p><p><strong>Conclusion: </strong>Unhealthy behaviors increased incidence of AAMD by 3 to 5-fold among a highly genetically susceptible population, and 56-60% of AAMD incidence was attributed to modifiable factors: smoking, high BMI, high caloric intake and low intake of foods rich in lutein-zeaxanthin and omega-3 fatty acids. Results underscore the importance of lifestyle interventions in high genetic risk populations, such as relatives of affected patients and/or patients with a high GRS, to reduce progression from early/intermediate AMD to advanced vision-threatening stages.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275341","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":"Non-Mydriatic Ocular Fundus Imaging on Consecutive Patients Presenting to a General Emergency Department with Vision Complaints.","authors":"Jessica G McHenry, Mung Yan Lin, Andrew M Pendley, Kevin Y Yan, George Alencastro Landim, Nithya Shanmugam, Stuart Duffield, Daniel V Adamkiewicz, Duyen T Vo, Jordan Prosky, Matthew T Keadey, David W Wright, Andrew F Fischer, Michael Dattilo, Nancy J Newman, Valérie Biousse","doi":"10.1016/j.ophtha.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.029","url":null,"abstract":"<p><strong>Purpose: </strong>Visits to emergency departments (ED) for vision complaints are common, especially where access to eye-care may be limited. However, ophthalmologists are rarely available in EDs, resulting in costly/often unnecessary transfers to centers with ophthalmic coverage. Implementation of non-mydriatic color fundus photographs with optical coherence tomography (NMFP-OCT) in general EDs has the potential to facilitate on-site ophthalmologic diagnoses and opens the door to tele-ophthalmology for remote triage and rapid treatment. Our goal was to evaluate which ocular complaints/pathologies would benefit most from NMFP-OCT in a general ED.</p><p><strong>Design: </strong>Prospective quality improvement study.</p><p><strong>Subjects: </strong>Adult patients presenting to our general ED with any vision complaint who had NMFP-OCT obtained in our ED from 08/24/2024 to 09/08/2024.</p><p><strong>Methods: </strong>In this prospective quality improvement project over 16 consecutive days/nights, NMFP-OCT (table-top Maestro2, Topcon-Japan) was ordered for all patients presenting to our ED with any vision complaint. Demographic information, final diagnosis and NMFP-OCT findings were collected.</p><p><strong>Main outcome measures: </strong>Number of patients with vision complaints who received NMFP-OCT, number of in-person ophthalmology consultations, number of papilledema complaints ruled-out remotely.</p><p><strong>Results: </strong>Of 1838 ED visits over 16 days/nights, 182 (9.9%) patients had vision complaints; 162 (89%) underwent NMFP-OCT in the ED. 82/162 patients (50.6%) also had an in-person ED examination by an ophthalmologist. NMFP-OCT was ordered for: vision loss (51; 31.5%); other visual changes (13; 8.0%); papilledema/papilledema rule-out (60; 37.0%); painless red eye (7; 4.3%); eye/orbital pain (28; 17.3%); diplopia (3; 1.9%). 104/162 patients (64.2%) had relevant findings on NMFP-OCT; 31/162 (19.1%) had non-relevant incidental findings. NMFP-OCT was most useful in patients with posterior segment pathology (45; 27.8%) and neurologic disorders (72; 44.4%), by either demonstrating pathology such as acute retinal ischemia (5; 3.1%), optic disc edema (14; 8.6%), retinal detachment/vitreous hemorrhage (3; 1.9%), posterior uveitis/retinitis/vasculitis (3; 1.9%), retinopathy/maculopathy (9; 5.6%), or by ruling out papilledema (52; 32.1%).</p><p><strong>Conclusion: </strong>Given that 10% of all ED visits were for vision complaints, having NMFP-OCT obtained in our general ED allowed for rapid/reliable diagnosis of ocular emergencies mostly involving the posterior segment, including acute retinal arterial ischemia and papilledema/rule-out papilledema, thereby facilitating rapid remote triage and treatment.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275308","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":"A Novel Staging Model for Uveal Melanoma: Combining Tumor Volume, Clinical Factors, and Genetic Alterations in a Danish Cohort.","authors":"Kristoffer Nissen, Tine Gadegaard Hindso, Carsten Faber, Karin Anna Wallentin Wadt, Mette Klarskov Andersen, Steffen Heegaard, Mette Bagger, Jens Folke Kiilgaard","doi":"10.1016/j.ophtha.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.028","url":null,"abstract":"<p><strong>Importance: </strong>Uveal melanoma classification systems based on anatomical location show limitations in risk stratification and create ambiguities when tumors span multiple uveal regions.</p><p><strong>Objective: </strong>To develop a comprehensive staging system for uveal melanoma integrating tumor volume, clinical factors, and genetic alterations that resolves classification challenges while improving risk stratification.</p><p><strong>Design, setting, and participants: </strong>Nationwide retrospective cohort study of 3,696 patients diagnosed with uveal melanoma in Denmark from 1943 to 2022, including 3,062 choroidal melanomas, 245 ciliary body melanomas, and 389 iris melanomas.</p><p><strong>Main outcomes and measures: </strong>Disease-specific survival was analyzed using volume-based tumor categories (T0-T5), clinical risk factors (ciliary body involvement and extraocular extension), and genetic alterations (chromosome 3 and 8q status) to develop an integrated staging system (S0-S6) with genetic enhancement (GS1-GS6).</p><p><strong>Results: </strong>Tumor volume demonstrated strong risk stratification, with T0 tumors (<12 mm³) showing 0% mortality throughout follow-up while 20-year mortality progressively increased from T1 (23%) to T5 (63%). The integrated staging system (S0-S6) showed excellent discrimination with 5-year mortality ranging from 0% (S0) to 54% (S6). Iris melanomas demonstrated distinct survival patterns, with non-ring configurations showing minimal mortality (0.5% at 20 years) compared to ring melanomas (21%). Genetic analysis revealed that chromosome aberrations, particularly combined monosomy 3 and 8q-gain (HR 12.6, 95% CI 5.5-29.4), carried stronger prognostic weight than conventional staging parameters, with genetic-enhanced staging providing superior risk stratification (10-year mortality: 0% for GS1 to 77% for GS6).</p><p><strong>Conclusions and relevance: </strong>Tumor volume represents a powerful risk stratifier for uveal melanoma that can be effectively integrated with clinical risk factors and genetic markers to create a refined staging system. The proposed unified approach incorporating volume-based categorization, clinical factors, and genetic status addresses current classification ambiguities and reflects the distinct natural histories of uveal melanoma subtypes. A practical scoring sheet is provided for clinical implementation of this staging system.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275203","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":"\"Stepwise Extension Treatment (SET) Protocol\" Versus \"Pro Re Nata Regimen\" of Intense Pulsed Light for Meibomian Gland Dysfunction.","authors":"Hyunmin Ahn, Jae Lim Chung, Ikhyun Jun, Tae-Im Kim, Kyoung Yul Seo","doi":"10.1016/j.ophtha.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.032","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the efficacy of a Stepwise Extension Treatment (SET) protocol and a Pro Re Nata (PRN) regimen of intense pulsed light (IPL) therapy with warm compresses for meibomian gland dysfunction (MGD).</p><p><strong>Design: </strong>A prospective, comparative study PARTICIPANTS: Participants with meibomian gland expressibility (MGE) or meibum quality (MQ) grade 2 or higher.</p><p><strong>Methods: </strong>All participants initially received four IPL sessions at 4-week intervals. In the SET group, intervals were extended or shortened by 2 weeks based on clinical response. In the PRN group, retreatment was performed only when predefined criteria were met. Retreatment was indicated if the Ocular Surface Disease Index (OSDI) was ≥ 23 or increased from the prior visit, along with MGE or MQ ≥ 2. A linear mixed model was used for analysis.</p><p><strong>Main outcome measures: </strong>The primary outcome measures were the longitudinal changes in the Ocular Surface Disease Index (OSDI), meibomian gland expressibility (MGE), and meibum quality (MQ). The total number of IPL sessions administered from baseline to 24 months was assessed as a secondary outcome.</p><p><strong>Results: </strong>Among 412 participants, 308 (74.8 %) completed the study. Mean changes in OSDI, MGE, and MQ from baseline to 24 months were -16.0, -0.8, and -0.9 in the SET group and -15.3, -0.7, and -0.8 in the PRN group, respectively (all P > 0.05). In patients with baseline MGE or MQ grade ≤ 2, both protocols effectively reduced scores to below 1.5. In patients with MGE grade 3, the SET group demonstrated greater improvement (P < 0.01), and episodic exacerbations were observed in the PRN group. The mean number of IPL sessions over 24 months was 14.8 ± 4.2 [median 13.0] in the SET group and 10.0 ± 6.4 [median 8.0] in the PRN group (P < 0.01).</p><p><strong>Conclusions: </strong>Both SET and PRN regimens led to symptomatic and functional improvement in MGD. Patients with mild-to-moderate MGD responded well to either regimen. In severe MGD, the SET protocol may provide more stable long-term control, suggesting the importance of individualized treatment approaches.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275242","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":"Long-term Ocular Safety in Children Treated with MAPK Pathway Inhibitor Therapy.","authors":"Robert A Avery, Andrea M Gross, Chantal Cousineau-Krieger, Tiarnán D L Keenan, Taylor McManus, Connor J Dallas, Christopher Hampton, Andrea Baldwin, Fangming Jin, Kara Heisey, Kristen Zeller, Grant T Liu, Chinwe Okeagu, Rachel Bishop, Michael J Fisher, Brigitte C Widemann, M Teresa Magone","doi":"10.1016/j.ophtha.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.031","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275295","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":"Ocular Hypertension and Glaucoma After Pars Plana Vitrectomy: A Systematic Review and Meta-analysis.","authors":"Gabriele Gallo Afflitto, Lorenzo Fabozzi, Filomena Palmieri, Marco Anastasi, Nayana Pant, Orkun Kaymaz, Pier Luigi Surico, Vincenzo Maurino, Francesco Aiello, Carlo Nucci","doi":"10.1016/j.ophtha.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.027","url":null,"abstract":"<p><strong>Topic: </strong>To evaluate whether pars plana vitrectomy (PPV) increases the risk of ocular hypertension (OHT) and glaucoma, with particular focus on lens status as a risk modifier.</p><p><strong>Clinical relevance: </strong>OHT and glaucoma are major complications that can threaten vision and require lifelong management. While PPV is a standard treatment for vitreoretinal disease, concerns exist about its long-term effects on intraocular pressure (IOP) and glaucoma, particularly in pseudophakic eyes, where the natural lens barrier is absent. No clear, quantitative synthesis currently informs risk stratification in this context.</p><p><strong>Methods: </strong>The protocol for this systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42024541683), and data reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies were randomized or nonrandomized comparative studies reporting OHT or glaucoma after PPV in adults. We last searched Ovid MEDLINE, Ovid EMBASE, and Web of Science on 25 May 2024. Two reviewers independently conducted screening, data extraction, and ROBINS-I risk of bias assessment. Meta-analyses were performed using generalized linear mixed-effects models. Publication bias and heterogeneity were assessed. The ROBINS-I tool was used to assess the risk of bias in nonrandomized studies, and the certainty of evidence was evaluated using GRADE. Numbers needed to treat for harm (NNTH) were calculated using standard formulas as recommended in the Cochrane Handbook to enhance the clinical interpretability of the results.</p><p><strong>Results: </strong>Forty-one observational studies (54,006 eyes) were included. The pooled absolute risk for post-PPV OHT was 5.6% (95%CI: 3.1-9.9; I² = 94.6%; low-certainty), and for glaucoma, 3.9% (95% CI, 2.0-7.2; I² = 94.4%; low-certainty). Pseudophakic eyes had threefold higher odds of OHT compared to phakic eyes (OR, 3.2; 95%CI: 1.0-9.9; I² = 75.1%; NNTH, 8; very low-certainty) and nearly twelvefold higher odds of glaucoma (OR, 11.81; 95%CI: 4.2-33.6; I² = 0%; NNTH, 10; moderate-certainty).</p><p><strong>Conclusions: </strong>PPV is associated with clinically meaningful risk of OHT and glaucoma, especially in pseudophakic eyes. Despite limitations from nonrandomized data and heterogeneity, these findings highlight lens status as a key modifier of post-PPV risk and support tailored surgical planning and postoperative monitoring.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275380","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":"Oral acetylcysteine and the risk of age-related macular degeneration: A retrospective cohort study.","authors":"Hou-Ren Tsai, Wei-Chuan Chang, Yuan-Chieh Lee","doi":"10.1016/j.ophtha.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.09.025","url":null,"abstract":"<p><strong>Purpose: </strong>N-acetylcysteine (NAC) functions as both a direct antioxidant agent and precursor for glutathione synthesis, both of which are implicated in the pathogenesis of age-related macular degeneration (AMD). However, whether NAC use confers protective effects against AMD remains unclear. This study aimed to investigate potential associations between NAC use and the risks of AMD development in a large cohort of the Taiwanese population.</p><p><strong>Design: </strong>Retrospective cohort study PARTICIPANTS AND CONTROLS: The study included 22,498 NAC users and 138,607 non-NAC users between 2003 and 2017 before propensity score matching (PSM).</p><p><strong>Methods: </strong>This nationwide, population-based study leveraged data from the Taiwan National Health Insurance Research Database. PSM was applied to ensure comparability of baseline demographics and comorbidities between NAC users and non-users. Stratified analyses by age and sex were conducted, and a cumulative defined daily dose was calculated to evaluate dose-response relationships among NAC users. Cox proportional hazards regression models were employed post-PSM to estimate the hazard ratio (HR) for each outcome.</p><p><strong>Main outcome measures: </strong>Outcome measures included the HR of overall, dry, and wet AMDs RESULTS: After PSM, 5234 patients were included in each cohort: NAC users and non-NAC users. NAC users exhibited a significantly lower risk of AMD than non-users did (HR 0.19; 95% CI: 0.14-0.26; p < 0.001). This protective effect was observed for both dry (HR 0.19; 95% CI: 0.14-0.26) and wet (HR 0.31; 95% CI: 0.12-0.81) AMDs. Stratified analyses demonstrated a reduced risk of AMD among NAC users, consistent across different age and sex groups. A dose-response relationship was identified, with higher cumulative doses of NAC associated with greater reductions in the risk of AMD and dry AMD. Sensitivity analyses for patients aged ≥ 60 and ≥ 70 years further supported the association between NAC use and reduced AMD risk, particularly for dry AMD.</p><p><strong>Conclusions: </strong>NAC use was associated with a significantly reduced risk of AMD, especially dry AMD. These findings support the need for further investigation into the effectiveness of NAC as a preventive treatment for AMD.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252235","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}