Seminars in Ophthalmology最新文献

{"title":"Clinical Spectrum and Insights from One Year of Ocular Genetics at a Single Tertiary Eye Care Centre.","authors":"Goura Chattannavar, Vyshnavika Mupparapu, Rachana Maragani, Pravalika Sadhu, Venkatesh Pochaboina, Ramesh Kekunnaya","doi":"10.1080/08820538.2026.2746532","DOIUrl":"https://doi.org/10.1080/08820538.2026.2746532","url":null,"abstract":"<p><strong>Introduction: </strong>Genetic testing benefits individuals and families with inherited eye diseases by facilitating accurate diagnosis, informing prognosis, enabling assessment for at-risk family members, and supporting targeted therapies. This study aimed to characterize the spectrum of inherited eye disorders and evaluate the diagnostic yield of genetic testing at a single tertiary eye care centre over a one-year period.</p><p><strong>Methods: </strong>A retrospective review of patients attending the ocular genetics service at a tertiary eye care centre in India from January 1 to December 31, 2024, was conducted.</p><p><strong>Results: </strong>Of 1325 patients evaluated, 862 (65%) underwent genetic testing. Inherited retinal disorders were the most common (<i>n</i> = 440, 51%), followed by cornea and anterior segment disorders (<i>n</i> = 107, 12.4%). Other conditions included hereditary optic nerve disorders (<i>n</i> = 75, 8.7%), glaucoma (<i>n</i> = 70, 8.1%), lenticular disorders (<i>n</i> = 54, 6.3%), phacomatoses (<i>n</i> = 25, 2.9%), ocular tumours (<i>n</i> = 20, 2.3%), strabismus and albinism (<i>n</i> = 19 and 18; ~2% each), MAC spectrum disorders (<i>n</i> = 10, 1.4%), and systemic syndromes (<i>n</i> = 22, 2.5%). Diagnostic yield was achieved in 605 (70%), while 257 (30%) remained inconclusive. Of the 463 untested families, the motivations were unascertained reasons (<i>n</i> = 156, 33%), financial constraints (<i>n</i> = 138, 30%), intent to test later (<i>n</i> = 90, 19%), and belief that no treatment was available (<i>n</i> = 79, 17%).</p><p><strong>Discussion: </strong>Inherited retinal and anterior segment disorders constitute the most frequent genetic eye diseases. Genetic testing has enabled genotype-phenotype correlation in over two-thirds of cases. Financial constraints and limited availability of disease-modifying treatments remain key barriers for uptake of genetic testing.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tofacitinib for Refractory Non-Infectious Ocular Inflammation: A Retrospective Observational Study.","authors":"Vidya S Mooss, Kalpana Babu, Haridas Mundot Puliappadamb","doi":"10.1080/08820538.2026.2746535","DOIUrl":"https://doi.org/10.1080/08820538.2026.2746535","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical indications, effectiveness, and cost implications of tofacitinib in refractory non-infectious ocular inflammation.</p><p><strong>Methods: </strong>This retrospective study included 60 patients treated with tofacitinib at a tertiary eye care centre in South India, between January 2020 and January 2026. Data collected included demographics, anatomical/etiological diagnoses, prior immunomodulation, indications, treatment regimen, adverse events of tofacitinib, and duration of follow-up. Ocular inflammatory flares before and after tofacitinib were quantified and expressed as incidence rates/1,000 person-months. Incidence-rate-ratios were estimated using Poisson regression with log person-months as an offset. A descriptive cost and exploratory cost-effectiveness analysis was performed.</p><p><strong>Results: </strong>Mean age: 43.5 ± 13.8 years; 61.7% were female. Tofacitinib was initiated for recurrent ocular inflammation in 91.7%. Median duration of tofacitinib therapy: 11 months (range: 6-24). Number of ocular inflammatory flares decreased from 263 before tofacitinib to 34 after tofacitinib. The incidence rate declined from 275.1 to 47.5 episodes/1,000 person-months, corresponding to a significant reduction in flare incidence (<i>p</i><0.001), representing approximately an 83% reduction. A greater proportion of patients achieved better visual acuity at final follow-up(<i>p</i> = .0001). Adverse events occurred in 13.8% of patients, commonly dyslipidaemia. A total of 229 flares were prevented, with an estimated cost-per-flare avoided of approximately ₹7,200 (76 USD). Among patients switched from mycophenolate-mofetil/adalimumab, tofacitinib therapy was associated with an average cost saving of ₹79,369/ patient and ₹9,458/ patient-month.</p><p><strong>Conclusions: </strong>Tofacitinib was associated with a significant reduction in ocular flares and improvement in visual outcomes in patients with refractory non-infectious ocular inflammation. These findings suggest that JAK inhibition may represent an effective and economically viable therapeutic option for selected patients with difficult-to-treat ocular inflammatory disease.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"1-7"},"PeriodicalIF":3.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Corneal Higher-Order Aberrations and Quantitative Macular OCT Angiography Metrics in Healthy Eyes: A Cross-Sectional Study.","authors":"Burhan Başkan, Yusuf Evcimen","doi":"10.1080/08820538.2026.2747762","DOIUrl":"https://doi.org/10.1080/08820538.2026.2747762","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether anterior corneal higher‑order aberrations (HOA) influence the measurement of macular optical coherence tomography angiography (OCTA) features, including foveal avascular zone (FAZ) parameters and macular vessel density (VD) across different retinal layers.</p><p><strong>Methods: </strong>We conducted a single‑center, retrospective, cross-sectional study of 110 healthy eyes of 110 patients. Anterior corneal HOA were measured over a fixed 6-mm zone by Scheimpflug-Placido corneal topography. Macular OCTA (6 × 6 mm) provided VD in the superficial (SCP) and deep (DCP) capillary plexuses, and FAZ area, perimeter, and circularity on the full inner retinal slab. Signal strength index (SSI), axial length, tear‑break‑up time, scotopic pupil diameter, age, and sex were also recorded. Each OCTA parameter was then regressed on total HOA by multivariable linear regression with adjustment for these covariates, and an exploratory mediation analysis partitioned the association into signal‑strength‑mediated and non‑mediated components.</p><p><strong>Results: </strong>Corneal total HOA was inversely associated with SCP whole‑image VD (standardized β = ‑0.41, partial <i>r</i> = ‑0.56) and, more strongly, with DCP whole‑image VD (β = ‑0.50, partial <i>r</i> = ‑0.62; both <i>p</i> < .001). Only 35% of the association was mediated by SSI. Absolute VD differences between the lowest and highest HOA tertiles were 3.60% for SCP and 3.94% for DCP. FAZ area, perimeter, and circularity showed no association with corneal HOA (all |β| <0.07; <i>p</i> > .50).</p><p><strong>Conclusions: </strong>Higher anterior corneal HOA were associated with lower measured macular VD, and the device SSI explained only part of this. FAZ metrics were unaffected. No independent reference measurement of retinal perfusion was available, so whether this reflects a measurement effect or a true perfusion difference remains undetermined.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"1-13"},"PeriodicalIF":3.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Significance of Polypoidal Lesion Regression in Polypoidal Choroidal Vasculopathy - A Review.","authors":"Jun-Wei Chen, De-Kuang Hwang, Yi-Ting Hsieh, Wei-Chi Wu, Shih-Jen Chen","doi":"10.1080/08820538.2026.2745913","DOIUrl":"https://doi.org/10.1080/08820538.2026.2745913","url":null,"abstract":"<p><strong>Importance: </strong>Polypoidal choroidal vasculopathy (PCV) is a distinct pachychoroid disease in which persistent polypoidal lesions represent an important structural substrate for recurrence and hemorrhage. While standard anti-vascular endothelial growth factor (anti-VEGF) monotherapy effectively manages exudation, it often fails to achieve complete anatomical closure - a phenomenon termed the \"PCV paradox.\" This review evaluates the prognostic significance of complete polypoidal lesion regression and synthesizes evidence on the efficacy of various therapeutic strategies in achieving durable anatomical clearance.</p><p><strong>Observations: </strong>Multimodal imaging, led by indocyanine green angiography (ICGA) as the reference standard, has refined PCV diagnostic criteria and nomenclature. Evidence from landmark trials demonstrates that combination therapy (anti-VEGF plus photodynamic therapy) achieves significantly higher complete polypoidal lesion regression rates (up to 77.8%) and lower injection burdens compared to monotherapy. Although newer agents such as faricimab and high-dose aflibercept show improved anatomical outcomes, complete regression can now be meaningful even with monotherapy, though it remains one of several key treatment endpoints. Persistent lesions may nonetheless act as a structural reservoir associated with recurrence and severe hemorrhagic complications.</p><p><strong>Conclusions and relevance: </strong>Achieving complete polypoidal lesion regression is a critical clinical endpoint for ensuring long-term disease stability and reducing the risk of catastrophic recurrence. It should nonetheless be regarded as one of several important endpoints - alongside visual acuity, exudative control, safety, and treatment accessibility. Rather than being universally superior, PDT-based combination therapy is best applied selectively in centers with access to ICGA and PDT, whereas optimized treat-and-extend anti-VEGF regimens and newer agents can also achieve meaningful regression and durable functional outcomes.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetric Choroidal Vascular Remodeling Following Temporal Inverted Internal Limiting Membrane Flap Surgery: A Retrospective Longitudinal Study.","authors":"Cemal Ozsaygili, Nurettin Bayram, Arzu Nur Şahin Şekerci, Muhammed Numan Işın, Gokcen Dinc","doi":"10.1080/08820538.2026.2746528","DOIUrl":"https://doi.org/10.1080/08820538.2026.2746528","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate regional changes in choroidal thickness (CT) and choroidal vascularity index (CVI) in the nasal and temporal macula following temporal inverted internal limiting membrane (ILM) flap surgery for macular hole (MH).</p><p><strong>Methods: </strong>In this retrospective longitudinal observational study, 29 eyes of 29 patients with idiopathic full-thickness MH undergoing temporal inverted ILM flap surgery were included, along with a control group of 29 age- and sex-matched healthy eyes. Spectral-domain optical coherence tomography with enhanced depth imaging (EDI-OCT) was performed preoperatively and at 2 weeks, 1, 3, 6, 9, and 12 months postoperatively. CT and CVI measurements were obtained at 1500 μm nasal and temporal to the foveal center. Nasal-temporal sectoral comparisons were performed using paired t-tests, and longitudinal changes were assessed using repeated-measures ANOVA with Bonferroni correction.</p><p><strong>Results: </strong>Twelve patients (41.4%) were female, and the mean age was 68.5 years. The mean follow-up duration was 13.6 months. Postoperative changes were not uniform and were significantly more pronounced in the temporal macula, corresponding to the area of ILM manipulation. At the 2-week postoperative visit, total choroidal area, luminal area, CT, and CVI were significantly increased compared with baseline values in both nasal and temporal sectors (all <i>p</i> < .0001), with more pronounced changes in the temporal sector. When comparing sectoral differences relative to baseline, temporal CVI showed a significant reduction at 2 weeks and 1 month postoperatively (<i>p</i> = .001 and <i>p</i> = .035, respectively), indicating a transient regional vascular alteration.</p><p><strong>Conclusion: </strong>Eyes with MH showed reduced CT and CVI preoperatively, followed by a significant postoperative increase after temporal inverted ILM flap surgery. These findings suggest that postoperative choroidal changes may not be uniformly distributed after temporal inverted ILM flap surgery. The more pronounced temporal changes in CVI may be related to surgical manipulation of the temporal ILM, although intrinsic nasal-temporal differences in choroidal structure may also contribute. These findings warrant further investigation in larger prospective studies.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"1-12"},"PeriodicalIF":3.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lacrimal History - Part 70: Doyens of Dacryology Series - Donald Stilwell Gunn (1862-1939) and His Concepts of Lacrimal Obstructions in the Young.","authors":"Mohammad Javed Ali","doi":"10.1080/08820538.2025.2576418","DOIUrl":"10.1080/08820538.2025.2576418","url":null,"abstract":"","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"765-768"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Ocular Complications Following Orbital Fractures: A Large-Scale Multivariate Analysis.","authors":"Hiroaki Oku, Akihide Watanabe, Tomomichi Nakayama, Akiko Yoneda, Chie Sotozono","doi":"10.1080/08820538.2026.2645622","DOIUrl":"10.1080/08820538.2026.2645622","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate the risk factors of ocular complications associated with orbital fractures in a large cohort of patients.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed the medical records of 1416 consecutive orbital fracture patients treated at Kyoto Prefectural University of Medicine, Kyoto, Japan between March 2009 and April 2025. Fracture characteristics, causes of injury, and the frequency of ocular complications were assessed via clinical records and associated computed tomography scan images. The factors associated with ocular complications were evaluated with multivariate logistic regression analysis.</p><p><strong>Results: </strong>Ocular complications occurred in 9.5% of the cases, with traumatic mydriasis, hyphema, and commotio retinae being the most common. Multivariate logistic regression identified sports-related injury (OR,2.19; 95% CI, 1.73-2.77, <i>p</i> < .01), male sex (OR,1.51; 95% CI, 1.12-2.03, <i>p</i> < .01), non-trapdoor fracture (OR,1.34; 95% CI, 1.01-1.80, <i>p</i> < .05), combined medial wall and orbital floor fractures (OR,1.32; 95% CI, 1.05-1.67, <i>p</i> = .02) and zygomatic or maxilla bone fracture (OR,1.34; 95% CI, 1.00-1.79, <i>p</i> < .05) as independent predictors of ocular complications. Sports-related injury, particularly those associated with golf and baseball, showed the highest rate of ocular complications, with golf-related orbital fractures resulting in a 100% complication rate and baseball-related orbital fractures resulting in a 38.1% complication rate.</p><p><strong>Conclusion: </strong>Sports-related injuries, male sex, non-trapdoor fractures, combined medial wall and orbital floor fractures and zygomatic or maxilla bone fracture are risk factors for ocular complications. Golf and baseball related orbital fractures are associated with a particularly high incidence of ocular complications, and urgent ophthalmologic examination is warranted in these cases.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"819-825"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uveitis Etiology in China: A Systematic Review and Meta-Analysis.","authors":"Tom Liba, Tal Elkobi, Alon Gorenshtein, Adir Sommer, David Carmon, Ron Eremenko, Gil Ben-David, Jacob Megreli, Raz Gepstein","doi":"10.1080/08820538.2026.2678956","DOIUrl":"10.1080/08820538.2026.2678956","url":null,"abstract":"<p><strong>Purpose: </strong>Define the etiologic profile of uveitis in China.</p><p><strong>Materials and methods: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of studies from PubMed, Scopus, PubMed Central, Web of Science, and the China National Knowledge Infrastructure (CNKI) (January 2005-January 2025). Eligible cross-sectional and cohort studies reporting etiologies were included. Proportions with 95% confidence intervals (CIs) were pooled, and heterogeneity was assessed with I².</p><p><strong>Results: </strong>Of 2,273 records, 10 studies met criteria (2005-2025; sample sizes 144-15373). Pooled proportions: idiopathic uveitis 41.75% (95% CI 36.88-46.78%); Vogt-Koyanagi-Harada (VKH) syndrome 14.12% (95% CI 10.56-18.63%); Behçet's disease 7.7% (95% CI 5.2-11.27%); and Ankylosing spondylitis 5.75% (95% CI 3.65-8.96%). Infectious causes were less frequent: herpetic uveitis 2.22% (95% CI 1.47-3.34%), acute retinal necrosis (ARN) 0.94% (95% CI 0.39-2.25%), and syphilis 1.03% (95% CI 0.59-1.79%), although rates varied significantly across centers.</p><p><strong>Conclusion: </strong>Uveitis in China is largely idiopathic (~41.75%), with a predominance of autoimmune etiologies, specifically Vogt-Koyanagi-Harada (VKH) syndrome and Behçet's disease. These findings reflect a distinct epidemiological profile.</p>","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"799-807"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lacrimal History - Part 60: Doyens of Dacryology Series - Emil Huschke (1797-1858) and His Concepts of the Lacrimal Drainage Anatomy.","authors":"Mohammad Javed Ali","doi":"10.1080/08820538.2025.2565077","DOIUrl":"10.1080/08820538.2025.2565077","url":null,"abstract":"","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"745-748"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lacrimal History - Part 65: Doyens of Dacryology Series - Peter Julian Dolman (1960-).","authors":"Mohammad Javed Ali, Bhupendra C K Patel","doi":"10.1080/08820538.2025.2569997","DOIUrl":"10.1080/08820538.2025.2569997","url":null,"abstract":"","PeriodicalId":21702,"journal":{"name":"Seminars in Ophthalmology","volume":" ","pages":"754-756"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}