Ophthalmology最新文献

{"title":"Presumed Multifocal Orbital Recurrence of Pleomorphic Adenoma after Orbitotomy","authors":"April Lee, Katharine Dempsey","doi":"10.1016/j.ophtha.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.07.010","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":13.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754981","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":"Atypically Large Lobular Capillary Hemangioma (Pyogenic Granuloma) of the Eyelid","authors":"Jobanpreet Dhillon, Kianoosh Keyhanian, David Jordan","doi":"10.1016/j.ophtha.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.07.009","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"56 1","pages":""},"PeriodicalIF":13.7,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754987","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":"Efficacy of Dual-Sided Composite Defocus Spectacles for Myopia Control in Children: A Randomized Clinical Trial.","authors":"Yihan Guo, Kai Cao, Zhaocheng Zhang, Furong Ye, Ruijia Shi, Min Wu, Ping Tang, Yanyun Lv, Ying Jie, Lei Tian","doi":"10.1016/j.ophtha.2026.08.006","DOIUrl":"10.1016/j.ophtha.2026.08.006","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the efficacy and safety of a novel dual-sided composite defocus (DSCD) lens for pediatric myopia control.</p><p><strong>Design: </strong>Prospective, randomized, double-masked, 3-arm, parallel-controlled clinical trial with 1-year follow-up.</p><p><strong>Participants: </strong>A total of 225 children aged 6 to 14 years with myopia ranging from -0.50 to -6.00 diopters (D) were randomized 1:1:1 to DSCD, single-surface defocus (SSD), or single-vision spectacle (SVS) lenses. Overall, 194 participants (86.2%) completed the 1-year follow-up.</p><p><strong>Methods: </strong>Participants were randomly assigned to the DSCD, SSD, or SVS lens group. The DSCD lens incorporated a front-surface microlens array and a posterior freeform aspheric design intended to generate an asymmetric peripheral myopic defocus profile. Outcomes were measured at baseline and during the 12-month follow-up. Statistical analyses included analysis of covariance, Pearson correlation, and exploratory subgroup analyses.</p><p><strong>Main outcome measures: </strong>The primary outcomes were 12-month changes in axial length (AL) and spherical equivalent refraction (SER).</p><p><strong>Results: </strong>At 12 months, the DSCD group exhibited significantly less SER progression than the SVS group (-0.22 ± 0.37 D vs. -0.83 ± 0.47 D; P < 0.001) and the SSD group (-0.22 ± 0.37 D vs. -0.46 ± 0.43 D; P = 0.005). Axial elongation was also significantly slower with DSCD than with SVS lenses (0.19 ± 0.14 mm vs. 0.42 ± 0.18 mm; P < 0.001). No statistically significant difference in axial elongation was observed between the DSCD and SSD groups. The DSCD lens reduced SER progression by 73.6% and AL elongation by 55.2% relative to SVS lenses. Exploratory subgroup analyses suggested less progression in children aged 8 to 12 years, those with a baseline AL of 24 to 25 mm, and those with low myopia. No lens-related adverse events were observed, and all groups demonstrated high compliance and good adaptation.</p><p><strong>Conclusions: </strong>Over 12 months, DSCD lenses resulted in significantly less SER progression and axial elongation than SVS lenses. Compared with the SSD lenses tested in this study, DSCD lenses showed significantly less SER progression, whereas the difference in axial elongation was not statistically significant. Dual-sided composite defocus lenses were generally well tolerated and may represent a spectacle-based option for pediatric myopia control.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713242","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 Comparison of Machine Learning and Human Graders for Glaucoma Diagnosis from Fundus Images for Population Screening.","authors":"Thomas R P Taylor, Justin Khasentino, Robert N Luben, Laura A Meliante, Kelsey V Stuart, Dun Jack Fu, Michelle P Y Chan, David C Broadway, Farhad Hormozdiari, Andrew Carroll, Ruiqi Hu, Wessel Verburg, Mahantesh I Biradar, Pearse A Keane, Paul J Foster, Cory Y McLean, Anthony P Khawaja","doi":"10.1016/j.ophtha.2026.07.043","DOIUrl":"10.1016/j.ophtha.2026.07.043","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the accuracy of vertical cup-disc ratios (VCDRs), ascertained by machine learning (ML) versus human graders, from fundus images for glaucoma detection. This study uses population-based data, with a disease prevalence and case mix that is more reflective of an unselected patient population than conventional case-control studies, with the aim of developing improved glaucoma screening tests.</p><p><strong>Design: </strong>Cross-sectional analysis of a population-based study.</p><p><strong>Participants: </strong>A total of 6304 participants of the European Prospective Investigation of Cancer (EPIC)-Norfolk Eye Study with color fundus images gradable by humans and ML in both eyes.</p><p><strong>Methods: </strong>Vertical cup-disc ratio was independently estimated from 2-dimensional fundus images of EPIC-Norfolk Eye Study participants by trained human graders (human-derived VCDR [H-VCDR]) and an externally trained, open-access ML model (ML-derived VCDR [ML-VCDR]). A neural network trained on 81 830 ophthalmologist-labeled images was used to generate pseudo-labels for over 100 000 UK Biobank images, on which ML-VCDR was subsequently trained. Glaucoma status was ascertained by tertiary-center specialist examination. Predictive performance of VCDR for glaucoma status was examined using logistic regression. Machine learning-derived VCDR estimates were additionally compared with a popular open-source ML model (AutoMorph) and scanning laser ophthalmoscopy (Heidelberg Retinal Tomography [HRT]).</p><p><strong>Main outcome measures: </strong>Area under the receiver operating characteristic curve (AUROC) explained variance (McFadden's pseudo-R²).</p><p><strong>Results: </strong>Of 6304 participants (mean age, 68 years; 57% women), 696 had glaucoma or suspect status in at least 1 eye. For left eyes, H-VCDR and ML-VCDR explained 17% (95% confidence interval [CI], 14.7-20.4) and 31% (95% CI, 27.9-33.9) of glaucoma status variance and had an AUROC of 79% (95% CI, 76.8-81.2) and 88% (95% CI, 86.3-89.1), respectively. Right eye H-VCDR and ML-VCDR explained 20% (95% CI, 16.9-22.6) and 35% (95% CI, 32.4-37.9) of the variance and had an AUROC of 81% (95% CI, 78.6-82.5) and 90% (95% CI, 88.7-91.0), respectively. Machine learning-derived VCDR also performed better than AutoMorph and HRT at predicting glaucoma status from VCDR estimations.</p><p><strong>Conclusions: </strong>In this population-based setting, ML far outperformed trained human graders at predicting specialist-ascertained glaucoma status from fundus images. This provides promise for ML-supported strategies for glaucoma population screening.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707250","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":"Assessment of Ellipsoid Zone Integrity and Other Quantitative OCT Biomarkers for Intermediate Age-Related Macular Degeneration Progression to Atrophy.","authors":"Karen Matar, Adrienne Delaney, Asmita Indurkar, Reem Amine, Jordan Budrevich, Amy Tang, Ming Hu, Hannah J Yu, Jamie Reese, Sunil K Srivastava, Charles C Wykoff, Justis P Ehlers","doi":"10.1016/j.ophtha.2026.08.005","DOIUrl":"10.1016/j.ophtha.2026.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between baseline OCT biomarkers and 2-year disease progression from intermediate age-related macular degeneration (iAMD) to advanced atrophic age-related macular degeneration (AMD), defined by OCT, with emphasis on ellipsoid zone (EZ) attenuation/loss and other quantitative structural features.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants: </strong>A total of 502 eyes with iAMD and no evidence of atrophy (i.e., retinal pigment epithelium [RPE] loss with associated outer retinal atrophy) or exudation at baseline, each with 2-year follow-up OCT imaging.</p><p><strong>Methods: </strong>Baseline and 2-year spectral-domain OCT scans were analyzed using a validated, machine learning-enhanced multilayer segmentation platform with subsequent certified reader review and correction. Quantitative OCT parameters included EZ-RPE thickness, partial and total EZ attenuation, drusen volume (DV), hyperreflective foci (HRF) count, total RPE loss, and outer nuclear layer (ONL)-RPE thickness. Fully automated deep-learning models quantified hypertransmission (HT) and EZ at-risk (i.e., a model developed to identify areas of abnormal EZ-RPE thinning in the absence of RPE loss). A random forest classifier was trained using baseline features, with performance assessed using fivefold stratified cross-validation.</p><p><strong>Main outcome measures: </strong>Development of OCT-defined advanced atrophic AMD defined by total RPE loss with associated outer retinal atrophy with an area of ≥0.05 mm² (i.e., complete RPE and outer retinal atrophy equivalent) at 2 years and baseline OCT biomarkers associated with progression.</p><p><strong>Results: </strong>Eyes that developed advanced atrophic AMD showed significantly greater partial and total EZ attenuation, reduced EZ-RPE and ONL-RPE thickness, higher DV, and greater HRF counts than nonconverters (all P < 0.05). Deep learning-derived EZ at-risk and HT metrics were also significantly higher in converters. The cross-validated predictive model incorporating all baseline features achieved a mean area under the receiver operating characteristic curve of 0.853. Ellipsoid zone integrity metrics and HRF count ranked as the most influential predictors of progression.</p><p><strong>Conclusions: </strong>Quantitative OCT biomarkers, particularly EZ integrity measures and HRF count, are strongly associated with 2-year progression to advanced atrophic AMD in iAMD. These findings support the role of quantitative EZ integrity metrics and HRF features for early disease risk stratification and may inform the design of prevention-focused or early intervention clinical trials aimed at delaying the onset of atrophic changes.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707224","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":"Image-Based Artificial Intelligence for Automated Diagnosis and Clinical Activity Grading in Thyroid Eye Disease: A Systematic Review and Meta-Analysis.","authors":"Rui Hu, Junzhe Zhao, Guang-Yu Li","doi":"10.1016/j.ophtha.2026.07.038","DOIUrl":"10.1016/j.ophtha.2026.07.038","url":null,"abstract":"<p><strong>Topic: </strong>To evaluate image-based artificial intelligence (AI) accuracy for thyroid eye disease (TED) diagnosis and clinical activity grading (Clinical Activity Score [CAS] ≥ 3 vs. <3) and compare AI with ophthalmologists.</p><p><strong>Clinical relevance: </strong>TED diagnosis and activity grading are challenging because of overlapping signs and subjective CAS (interrater variability up to 30%). Its consolidated accuracy is unquantified.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and Cochrane Library through November 13, 2025, for studies of TED diagnosis or activity grading using image-based AI. Risk of bias was assessed with PROBAST+AI and certainty with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Bivariate random-effects models pooled sensitivity, specificity, and area under the curve (AUC).</p><p><strong>Results: </strong>Nineteen studies (n = 8744) were included: 8 evaluated diagnosis (11 validation sets; n = 4662) and 11 activity grading (11 validation sets; n = 4082). For diagnosis, sensitivity was 0.93 (95% confidence interval [CI], 0.86-0.96), specificity 0.84 (95% CI, 0.78-0.88), and AUC 0.93 (95% CI, 0.90-0.95); after outlier exclusion, 0.90, 0.82, and 0.92, respectively. For activity grading, sensitivity was 0.82 (95% CI, 0.77-0.85), specificity 0.87 (95% CI, 0.82-0.91), and AUC 0.90 (95% CI, 0.88-0.91); after outlier exclusion, 0.80, 0.84, and 0.89, respectively. AI showed higher sensitivity than available ophthalmologist comparators for diagnosis (P = 0.01) and activity grading (P = 0.003), but comparisons involved selected readers and limited clinical context. Negative likelihood ratio was 0.09 for diagnosis and 0.21 for activity grading. PROBAST+AI rated 12.5% of diagnosis studies and 36.4% to 54.5% of activity-grading studies at high risk of bias; GRADE certainty was low.</p><p><strong>Conclusion: </strong>Image-based AI showed promising accuracy for TED diagnosis and CAS-based activity grading. Evidence supports cautious use as a diagnosis rule-out aid under clinical supervision when negative results are interpreted with symptoms and clinical context; however, CAS-based activity grading should not rule out low-CAS active TED. Low certainty, substantial heterogeneity, and limitations of image-based comparisons preclude immediate autonomous clinical deployment. Patients with suspected TED should still be referred for ophthalmologic assessment. Prospective, multicenter, multiethnic validation is required.</p><p><strong>Financial disclosure(s): </strong>The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679627","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":"Risk of Pediatric Eye Disease in Children with Neurodevelopmental and Behavioral Disorders in the United States.","authors":"Jainam Shah, Sachin Pathuri, Joshua Ong, James Plotnik, Mark Salevitz, Kourosh Shahraki, Donny W Suh, Anne Merrylees Dersch","doi":"10.1016/j.ophtha.2026.07.037","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.07.037","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association of neurodevelopmental disorders (NDDs) and behavioral disorders with amblyopia, myopia, strabismus, and strabismus surgery rates.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>Children aged ≤18 years with and without NDDs or behavioral disorders identified in a nationwide multicenter federated electronic health record network.</p><p><strong>Methods: </strong>Children diagnosed with attention-deficit/hyperactivity disorder, autism spectrum disorder, learning disorders, conduct disorder, or oppositional defiant disorder between 2013 and 2025 were compared with children without NDDs or behavioral disorders. Propensity score matching (1:1) was performed using demographics, medical comorbidities, laboratory values, and healthcare utilization metrics. After matching, time-to-event analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards models, with prespecified sensitivity and negative control analyses. Disorder-specific analyses and exploratory analyses of strabismus surgery rates among children with strabismus or strabismic amblyopia were also performed.</p><p><strong>Main outcome measures: </strong>Hazard ratios (HRs) with 95% confidence intervals (CIs) for amblyopia, myopia, and strabismus derived from propensity score-matched cohorts.</p><p><strong>Results: </strong>The primary analysis included 1,429,440 children with NDDs or behavioral disorders and 3,522,241 controls, yielding 1,156,503 matched pairs. Baseline characteristics were well-balanced after matching. Children with NDDs or behavioral disorders had an increased risk of amblyopia (HR: 1.60; 95% CI: 1.45-1.79), strabismus (HR: 1.66; 95% CI: 1.57-1.71), and myopia (HR: 1.55; 95% CI: 1.45-1.70) compared with controls following the initial diagnosis of an NDD or behavioral disorder (all P < 0.001). Increased risk was also observed across clinically relevant disease subtypes, individual disorders, and multiple follow-up intervals (all P < 0.001). Children with NDDs or behavioral disorders underwent strabismus surgery less frequently than controls (19.2% vs. 28.4%; P < 0.001).</p><p><strong>Conclusions: </strong>NDDs and behavioral disorders were associated with increased risk of amblyopia, myopia, and strabismus across multiple follow-up intervals, disease subtypes, and individual disorders. Pediatric eye disease may represent an important component of the overall health burden in this population. These findings support heightened clinical awareness and developmentally appropriate vision screening strategies in children with NDDs or behavioral disorders. Lower rates of strabismus surgery in this population warrant further investigation.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679694","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":"Systemic Interleukin-6 Inhibition and Risk of Diabetic Retinopathy Development and Progression.","authors":"Ahmed Abdi, Ahmed Alshaikhsalama, Zuhair Zaidi, Amer F Alsoudi, Melissa Yuan, Lisa J Faia, Prithvi Mruthyunjaya, Ehsan Rahimy","doi":"10.1016/j.ophtha.2026.07.029","DOIUrl":"10.1016/j.ophtha.2026.07.029","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether systemic interleukin-6 (IL-6) inhibitor use is associated with reduced risk of incident diabetic retinopathy (DR), DR progression, vision-threatening complications, and retinal interventions in adults with diabetes.</p><p><strong>Design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Participants: </strong>Adults with type 1 or type 2 diabetes were identified using the US TriNetX network from January 1, 2004, through May 30, 2026. After 1:1 propensity score matching, the primary analysis included 2605 IL-6 inhibitor users and 2605 matched controls. The secondary analysis included 1057 matched patients per group with known nonproliferative DR (NPDR).</p><p><strong>Methods: </strong>Cohorts were matched on baseline characteristics, medication exposure, inflammatory disease burden, and ophthalmic history. The primary analysis assessed incident DR among patients without baseline retinopathy. Secondary analyses evaluated progression from NPDR to proliferative DR (PDR) and compared IL-6 inhibitors with alternative immunosuppressants. Sensitivity analyses compared IL-6 inhibitors with intravitreal steroid injections among patients with severe NPDR or PDR and evaluated outcomes at IL-6 inhibitor occurrence frequency.</p><p><strong>Main outcome measures: </strong>Risk ratios for incident NPDR, PDR, vitreous hemorrhage (VH), diabetic macular edema (DME), neovascular glaucoma (NVG), and receipt of anti-VEGF injections, panretinal photocoagulation (PRP), and pars plana vitrectomy (PPV) at 1, 3, and 5 years.</p><p><strong>Results: </strong>In the primary analysis, IL-6 inhibitor use was associated with significantly lower 5-year risks of NPDR [risk ratio (RR): 0.50; 95% confidence interval (CI): 0.42-0.60], PDR (RR: 0.47; 95% CI: 0.35-0.61), DME (RR: 0.37; 95% CI: 0.27-0.51), and VH (RR: 0.41; 95% CI: 0.28-0.61), with no significant difference in NVG. Use of anti-VEGF therapy, PRP, and PPV was also significantly lower at 5 years. Among patients with baseline NPDR, IL-6 inhibitor use was associated with lower 5-year risks of progression to PDR, DME, VH, NVG, and retinal interventions. Findings were consistent in active comparator analyses.</p><p><strong>Conclusions: </strong>Systemic IL-6 inhibitor use was associated with a lower risk of incident DR, DR progression, vision-threatening complications, and retinal interventions over 5 years. Prospective studies are needed to evaluate whether IL-6 pathway modulation may have a therapeutic role in diabetic eye disease.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670312","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":"Factors Associated with Endothelial Cell Density at 1 Year in the Diabetes Endothelial Keratoplasty Study.","authors":"Sanjay V Patel, Beth Ann Benetz, Marianne O Price, Zachariah W Reed, Robin L Gal, Loretta B Szczotka-Flynn, Brandon D Ayres, Michelle Boyce, Christopher R Croasdale, M Bowes Hamill, Mark S Hansen, Ahmed F Omar, Luke B Potts, Jesse M Vislisel, Roy W Beck, Jonathan H Lass","doi":"10.1016/j.ophtha.2026.07.027","DOIUrl":"10.1016/j.ophtha.2026.07.027","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate donor, recipient, and operative factors associated with endothelial cell density (ECD) at 1 year after Descemet membrane endothelial keratoplasty (DMEK) in the Diabetes Endothelial Keratoplasty Study.</p><p><strong>Design: </strong>This prospective cohort study was a predefined secondary analysis of the Diabetes Endothelial Keratoplasty Study multicenter, double-masked, randomized clinical trial.</p><p><strong>Participants: </strong>Subjects undergoing DMEK without graft failure and with analyzable endothelial images at 1 year.</p><p><strong>Methods: </strong>A central, masked image analysis reading center determined ECD from central endothelial images of corneal grafts from donors without or with diabetes preoperatively and 1 year after DMEK. Associations between ECD at 1 year and donor, recipient, and operative factors were assessed using multivariable linear mixed-effect models adjusting for surgeon (random effect) and accounting for correlation between fellow donor and recipient eyes.</p><p><strong>Main outcome measures: </strong>Post-DMEK ECD at 1 year.</p><p><strong>Results: </strong>Of 1421 eyes undergoing DMEK, 1274 eyes were included in this analysis; 724 (57%) were in women, 1215 (95%) were in White individuals, and 1229 (96%) had Fuchs endothelial corneal dystrophy (FECD). Lower ECD (estimated effect [99% confidence interval]) at 1 year was associated with lower donor preoperative ECD (-392 [-447 to -336] cells/mm² per 500 cells/mm² preoperatively), eye bank-reported donor endothelial cell damage (-161 [-281 to -40] cells/mm²) for 10% to 20% cell damage by trypan blue staining postlenticule preparation vs. <5% damage, intraoperative complications (-308 [-450 to -166] cells/mm²), and recipient indication other than FECD (-191 [-346 to -36] cells/mm²). One-year endothelial cell loss from preoperative was 26% to 30% across preoperative ECD groups (<2500, 2500 to <2750, 2750 to <3000, and ≥3000 cells/mm²), was 36% when there was 10% to 20% endothelial cell damage after lenticule preparation vs. 29% for <5% cell damage, was 28% when the preoperative indication was FECD vs. 40% when it was not, and was 42% when intraoperative complications occurred vs. 27% when they did not.</p><p><strong>Conclusions: </strong>Higher endothelial cell loss at 1 year after DMEK is associated with endothelial cell damage after lenticule preparation, recipient indication other than FECD, and intraoperative complications. Estimating donor endothelial cell damage by trypan blue staining was an independent assessment of donor endothelial health that complemented ECD.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631018","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":"Factors Associated with Successful Descemet Membrane Endothelial Keratoplasty in the Diabetes Endothelial Keratoplasty Study.","authors":"Marianne O Price, Loretta B Szczotka-Flynn, Zachariah W Reed, Robin L Gal, Ari M Brandsdorfer, Michael D Greenwood, Mark A Greiner, Ula V Jurkunas, Ellen H Koo, Parag A Majmudar, Paul M Phillips, Francis W Price, Divya Srikumaran, Peter B Veldman, David D Verdier, Roy W Beck, Jonathan H Lass","doi":"10.1016/j.ophtha.2026.07.022","DOIUrl":"10.1016/j.ophtha.2026.07.022","url":null,"abstract":"<p><strong>Objective: </strong>To identify donor, lenticule preparation, recipient, and operative factors associated with 1-year Descemet membrane endothelial keratoplasty (DMEK) success in the Diabetes Endothelial Keratoplasty Study (DEKS).</p><p><strong>Design: </strong>This prospective cohort study was a prespecified secondary analysis of the DEKS randomized, double-masked, multicenter clinical trial.</p><p><strong>Participants: </strong>Individuals undergoing DMEK to treat corneal endothelial dysfunction at 28 clinical sites.</p><p><strong>Methods: </strong>Recipient eyes were randomized to receive a cornea from a donor without or with diabetes in a 2:1 ratio. Details about donor, tissue preparation, recipient, and operative factors were recorded prospectively. The study excluded eyes with a prior penetrating keratoplasty or glaucoma tube shunt. Graft failures were classified as follows. If the recipient stroma was cloudy in the first postoperative week and did not clear or required a regraft within 8 weeks, it was classified as \"primary donor failure\" in the absence of operative complications or as \"early failure\" associated with operative complications. If the recipient stroma cleared in the first postoperative week or cleared after being cloudy in the first postoperative week and later required a regraft or became cloudy without clearing for 90 days, it was classified as \"late failure.\" Proportional hazards and logistic regression were used to estimate risk ratios.</p><p><strong>Main outcome measures: </strong>Graft success at 1 year.</p><p><strong>Results: </strong>Of 1421 DMEK grafts, 1374 (97%) were clear at 1 year, 32 were classified as primary donor failures, 12 as early failures, and 3 as late failures. In multivariate analysis, the 78 cases (5.5%) with operative complications had a lower success rate (89%; hazard ratio for graft failure 4.01; 95% confidence interval, 1.86-8.63; P < 0.001). Three additional factors were associated with slightly higher graft success rates without reaching the defined statistical significance threshold of P < 0.01: baseline donor endothelial cell density ≥2500 versus <2500 cells/mm² (97% vs. 95% success; P = 0.03); tissue peeled by surgeon versus eye bank (99% vs. 96% success; P = 0.02); and recipient diabetes status: no versus yes (97% vs. 94% success; P = 0.02).</p><p><strong>Conclusions: </strong>Descemet membrane endothelial keratoplasty was highly successful across a wide range of donor, recipient, and surgical technique variations. Not surprisingly, graft success was lower in cases with operative complications.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p><p><strong>Trial registration: </strong>NCT05134480, ClinicalTrials.gov.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606100","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}