Survey of ophthalmology最新文献

{"title":"Altered ocular surface microbiome in nasolacrimal duct obstruction: Clinical Implications for intraocular surgery.","authors":"Bahram Eshraghi, Leila Babaei, Ali Aghajani","doi":"10.1016/j.survophthal.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.survophthal.2025.09.018","url":null,"abstract":"<p><p>Nasolacrimal duct obstruction (NLDO) significantly alters the ocular surface microbiome, increasing bacterial load, polymicrobial colonization, and the presence of drug-resistant organisms. This microbial shift poses a serious risk for postoperative endophthalmitis following intraocular surgery. Patients with NLDO have up to a 100% conjunctival culture positivity rate, compared to 40% in normal eyes, with increased prevalence of pathogenic species such as Pseudomonas aeruginosa and Streptococcus pneumoniae. Preoperative screening using the Regurgitation on Pressure over the Lacrimal Sac (ROPLAS) test is recommended for all patients undergoing intraocular surgery; however, its low sensitivity necessitates selective use of lacrimal irrigation in high-risk individuals. Definitive management with dacryocystorhinostomy (DCR) reduces microbial burden, with normalization of flora typically occurring around 4 weeks postoperatively. In cases where DCR cannot be performed, alternative strategies such as topical/systemic antibiotics or dacryocystectomy may help mitigate infection risk. Even after successful DCR, ocular surface microbiome may resemble nasal microbiota, requiring continued vigilance during the perioperative period. These findings highlight the importance of identifying and managing NLDO before intraocular procedures to reduce the risk of vision-threatening complications.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in ocular blood flow imaging: Clinical applications of laser speckle flowgraphy and optical coherence tomography angiography in retinal and choroidal vascular diseases.","authors":"Yi-Hsuan Tseng, Pei-Liang Wu, Eugene Yu-Chuan Kang, Kuan-Jen Chen, Po-Han Yeh, Ling Yeung, Ming-Hui Sun, Nan-Kai Wang, Yih-Shiou Hwang, Chi-Chun Lai, Wei-Chi Wu","doi":"10.1016/j.survophthal.2025.09.016","DOIUrl":"https://doi.org/10.1016/j.survophthal.2025.09.016","url":null,"abstract":"<p><p>Ocular blood flow imaging techniques have become indispensable in current clinical practice because retinal vascular disturbances have been implicated in the pathophysiology of numerous ocular diseases. In this review, we explore the applications of laser Doppler flowmetry, laser speckle flowgraphy (LSFG), and optical coherence tomography angiography (OCTA), focusing on LSFG and OCTA. Each modality is discussed in detail, including its principles, key parameters, advantages, limitations, and common artifacts. We further evaluated their roles in several ocular diseases, including age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, pathologic myopia, glaucoma, non-arteritic anterior ischemic optic neuropathy, and retinopathy of prematurity. Finally, we discuss emerging advancements such as neonatal imaging devices, ultrawide-field OCTA, and artificial intelligence integration in vascular analysis.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double layer sign in chorioretinal diseases: Clinical significance and implications from multimodal imaging.","authors":"Alberto Quarta, Alessandro Feo, Giulia Corradetti, Marko M Popovic, SriniVas R Sadda","doi":"10.1016/j.survophthal.2025.09.017","DOIUrl":"10.1016/j.survophthal.2025.09.017","url":null,"abstract":"<p><p>The double-layer sign (DLS) is an emerging optical coherence tomography (OCT) biomarker of growing diagnostic and prognostic relevance in retinal and chorioretinal diseases, including age-related macular degeneration, pachychoroid spectrum disorders. Multimodal imaging, particularly OCT angiography (OCTA), has enhanced our ability to characterize DLS and its role in disease progression and treatment response. DLS is identified as a separation between the retinal pigment epithelium (RPE) and Bruch's membrane, with overlapping phenotypic presentations including flat irregular pigment epithelial detachment (FIPED) and shallow irregular retinal pigment epithelial elevation. These signs are often associated with vascularized lesions that demonstrate increased DLS thickness, irregular contours, and heterogeneous reflectivity. OCTA offers superior sensitivity and specificity for detecting subclinical macular neovascularization compared to dye-based angiography, which may underestimate nonexudative neovascularization. Additionally, indocyanine green angiography remains crucial for identifying branching vascular networks and polypoidal lesions, especially in polypoidal choroidal vasculopathy. In pachychoroid diseases, such as chronic central serous chorioretinopathy, the presence of FIPED/DLS can indicate underlying neovascularization, which may benefit from combination therapy with anti-vascular endothelial growth factor agents. We discuss the multimodal imaging characteristics, prognostic significance, and clinical relevance of DLS across various retinal and chorioretinal disorders.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trials and quasi-experimental studies in the treatment of noninfectious retinal vasculitis: A Systematic Review from the International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) - Report 4.","authors":"Paola Saboya-Galindo, Carlos Cifuentes-González, William Rojas-Carabali, Germán Mejía-Salgado, Yong Le Tong, Ikhwanuliman Putera, Xin Ying Rachel Song, Cheong Fu Yuan Walter, Zhang Shengjuan, Reo Chan, Rina La Distia Nora, Jyotirmay Biswas, Sapna Gangaputra, Jose S Pulido, John H Kempen, Quan Dong Nguyen, Alejandra de-la-Torre, Vishali Gupta, James T Rosenbaum, Rupesh Agrawal","doi":"10.1016/j.survophthal.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.survophthal.2025.09.013","url":null,"abstract":"<p><p>This systematic review evaluates clinical trials and quasi-experimental studies reporting diagnostic criteria, disease activity scoring systems (including Disease Activity Index (DAI), Total Inflammatory Activity Index (TIAI), and Total Adjusted Disease Activity Index (TADAI), and others), and therapeutic strategies used in noninfectious retinal vasculitis (RV), aiming to consolidate current evidence on treatment response and effectiveness measures. Of 5,533 articles screened (PROSPERO: CRD42023489232), 15 studies met the inclusion criteria. Most were conducted in Asia (73.3%) and focused on Behçet disease (60%) or Eales disease (27%). RV was diagnosed clinically in all studies, while half incorporated fluorescein angiography to confirm vascular inflammation through leakage, staining, or occlusion; however, definitions of RV were highly variable, often inferred rather than explicitly stated, and lacked standardization. This diagnostic inconsistency, combined with limited imaging data, undermines comparability across studies. Disease activity was assessed using outdated composite indices such as the DAI, TIAI, and TADAI, which lack external validation and fail to capture key clinical features such as macular ischemia or capillary non-perfusion. Best corrected visual acuity, although frequently reported, was confounded by unrelated factors such as cataracts or macular scarring. Therapeutic strategies included systemic corticosteroids, immunosuppressants (e.g., methotrexate, azathioprine), and biologics (e.g., infliximab, interferon-alpha). Treatment selection was heterogeneous, and several regimens-such as cyclophosphamide-azathioprine combinations-do not align with current standards of care. Due to variability in study design and outcome reporting, no pooled effect estimates, or statistical comparisons were conducted. Treatment outcomes were synthesized descriptively based on individual study findings. Current evidence in RV clinical trials is outdated and lacks diagnostic and therapeutic standardization. There is a particular need for RV-specific definitions, validated disease activity and response indices, and contemporary therapeutic trials to guide clinical management and improve outcome comparability.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in age-related macular degeneration: Advancing diagnosis, prognosis, and treatment.","authors":"Euna Lee, David Hunt, Yavuz Cakir, David Kuo, Ziqi Zhou, Miroslav Pajic, Majda Hadziahmetovic","doi":"10.1016/j.survophthal.2025.09.007","DOIUrl":"10.1016/j.survophthal.2025.09.007","url":null,"abstract":"<p><p>Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in older adults. While anti-vascular endothelial growth factor (anti-VEGF) therapy and novel treatments for geographic atrophy have improved management, timely diagnosis and personalized intervention remain a challenge. Artificial intelligence (AI), such as machine learning and deep learning models, shows promise in AMD diagnosis, classification, and treatment planning. This review summarizes AI's recent advancements, highlights its clinical utility, and addresses key limitations for wider real-world implementation in AMD. We conducted systematic search of PubMed from its conception up to August 1, 2024. Studies utilizing AI-based algorithms for AMD management were identified and categorized into early detection/classification and prediction of disease progression/treatment response. Data extraction focused on AI model performance, imaging modalities, and clinical applicability. Of 193 records screened, 47 studies were included, in which 19 studies focused on early detection/classification and 28 on prediction of disease progression/treatment response. AI models demonstrated high accuracy in AMD classification and progression prediction, including in real-world settings. Prediction models for treatment response, particularly anti-VEGF therapy, could provide recommendations on optimizing injection timelines. Recent studies have also begun tackling previous challenges, such as algorithmic biases, limited generalizability, and AI's \"black-box\" nature. AI-based models offer significant potential to transform AMD care through timely detection and personalized treatment; however, clinical integration depends on improving model interpretability and validating tools across diverse populations. As AI continues to evolve, ongoing research is needed to refine AI models and support their translation into evidence-based, real-world applicability in AMD.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual outcomes associated with optical coherence tomography biomarkers in diabetic macular edema: A systematic review.","authors":"Keean Nanji, Amin Hatamnejad, Justin Grad, Abdullah El-Sayes, Andrew Mihalache, Mohamed Gemae, Ryan Huang, Mark Phillips, Dena Zeraatkar, Rishi Singh, Marion R Munk, SriniVas R Sadda, David Sarraf, Peter Kaiser, Robyn Guymer, Sobha Sivaprasad, Samantha Fraser-Bell, Yih Chung Tham, Sunir J Garg, Tien Yin Wong, Charles C Wykoff, Varun Chaudhary","doi":"10.1016/j.survophthal.2025.09.009","DOIUrl":"10.1016/j.survophthal.2025.09.009","url":null,"abstract":"<p><p>We evaluated the value of baseline structural optical coherence tomography (OCT) biomarkers in determining functional treatment response at 6,12-, and 24-months following treatment initiation in patients undergoing anti-vascular endothelial growth factor, steroid, or laser treatment for diabetic macular edema (DME). Ovid MEDLINE, EMBASE, and Web of Science databases were searched from inception for studies evaluating the association between baseline OCT biomarkers and best-recorded central visual acuity (VA). A synthesis using vote counting based on the direction of effect in relation to a five-letter minimally important difference was used. GRADE guidelines informed the certainty of evidence. Ninety-six studies evaluating 29 biomarkers were included. No biomarker with at least 'Low' certainty was associated with improved VA. Greater baseline ellipsoid zone (EZ) disruption and hyperreflective foci were associated with decreased VA at 6 months with \"Low\" certainty of evidence. There was also \"Low\" certainty that increased baseline disorganization of the retinal inner layers, increased baseline disruption of the external limiting membrane or EZ were associated with decreased VA at 12 months. No biomarker was associated with a poor prognosis with at least 'Moderate' certainty. The certainty was downgraded due to inadequately controlling for confounders and a lack of standardization regarding how biomarkers were defined and outcomes were measured.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work-up in patients with retinal vasculitis: A systematic review and meta-analysis: International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) Report 2.","authors":"Carlos Cifuentes-González, Ikhwanuliman Putera, Cheong Fu Yuan Walter, Germán Mejía-Salgado, Yong Le Tong, Reo Chan, William Rojas-Carabali, Xin Ying Rachel Song, Azadeh Mobasserian, Rina La Distia Nora, Jyotirmay Biswas, Sapna Gangaputra, Jose S Pulido, John H Kempen, Quan Dong Nguyen, Alejandra de-la-Torre, Vishali Gupta, James T Rosenbaum, Rupesh Agrawal","doi":"10.1016/j.survophthal.2025.09.011","DOIUrl":"10.1016/j.survophthal.2025.09.011","url":null,"abstract":"<p><p>This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conducted in 5 databases and registered in PROSPERO (CRD42023489232). Studies included articles on at least 10 patients with RV without publication date or language restrictions. RV was categorized as secondary RV if they were associated with systemic disease, syndromic if they were associated with a syndromic ocular disease without systemic disease, idiopathic RV without association to systemic or syndromic ocular diseases. This report includes 84 studies analyzing 3480 patients with RV. Among infectious causes, tuberculosis tests were frequently reported, with TST/IGRA positivity observed in 31.4 % (95 % CI: 17.2-50.2 %) of de novo RV cases, increasing to 64.7 % (95 % CI: 47.8-78.9 %) in confirmed tubercular RV and 65.7 % (95 % CI: 39.0-85.1 %) in Eales disease. Chest radiograph abnormalities were present in 21.8 % (95 % CI: 12.9-33.8 %) of tubercular RV cases. Non-infectious causes showed notable regional variability. HLA-B51 positivity was 1 % (95 % CI: 0.03-3.1 %) in de novo RV, but rose to 61.4 % (95 % CI: 23.1-89.4 %) in Behçet's RV. Sarcoidosis RV revealed noncaseating granulomas in 80.5 % (95 % CI: 9.7-99.4 %), with angiotensin-converting enzyme elevation in 4.6 % (95 % CI: 2.3-9.1 %). This study highlights significant geographic variability in RV etiologies. Tuberculosis remains a key infectious cause, while non-infectious causes vary regionally. Region-specific diagnostics and Bayesian testing protocols are critical to improving diagnostic accuracy and patient outcomes.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unfolding the diagnostic pipeline of diabetic retinopathy with artificial intelligence: A systematic review.","authors":"K Suganya Devi, Hemanth Kumar Vasireddi, Gnv Raja Reddy, Satish Kumar Satti","doi":"10.1016/j.survophthal.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.survophthal.2025.09.008","url":null,"abstract":"<p><p>Diabetic retinopathy (DR) is a leading cause of vision impairment globally, necessitating early and accurate detection through effective screening methods. We focus on the integration of artificial intelligence (AI) techniques in automating and enhancing DR diagnosis. Timely detection and classification of DR severity are critical for patient management and intervention. AI-driven DR classification frameworks typically consist of sequential stages: image preprocessing, optic disc (OD) localization and removal, blood vessel segmentation, feature extraction, and classification of DR severity. In the proposed and implemented model, each of these phases was systematically addressed to ensure improved performance. The implementation demonstrated superior accuracy, achieving 98.02 % on the widely used MESSIDOR dataset. The pipeline incorporated effective preprocessing to enhance image quality, accurate OD localization and exclusion to avoid false detections, followed by precise vessel segmentation. Extracted features were then used to train deep learning models for DR severity classification. Comparative analysis with existing methods executed on the same dataset revealed that proposed model outperformed other state-of-the-art techniques in terms of classification accuracy and robustness. Ww outline the recent progress in AI-based DR screening, highlighting the significance of each diagnostic phase and their role in improving overall performance. By evaluating multiple approaches and benchmarking them against established dataset, the study emphasizes the transformative role of AI in DR diagnosis. Despite current challenges, AI holds substantial promise in clinical application, offering scalable, accurate, and efficient DR screening solutions that may significantly reduce the risk of blindness in diabetic patients.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angioid streaks-related choroidal neovascularization: Clinical features, multimodal imaging-based differential diagnosis, and optimized treatment strategies.","authors":"Antonio La Rosa, Alessandro Feo, Elodie Bousquet, Diogo Cabral, Yousef Fouad, Mariacristina Parravano, Mario R Romano","doi":"10.1016/j.survophthal.2025.09.012","DOIUrl":"10.1016/j.survophthal.2025.09.012","url":null,"abstract":"<p><p>Angioid streaks-related choroidal neovascularization (AS-CNV) is a vision-threatening complication arising from breaks in a calcified Bruch membrane, commonly associated with systemic conditions such as pseudoxanthoma elasticum (PXE). This review comprehensively addresses the clinical features of AS-CNV, emphasizing its distinct pathophysiology and systemic implications. We highlight the critical role of multimodal imaging-including color fundus photography, fundus autofluorescence, fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography-in accurately diagnosing and differentiating AS-CNV from other choroidal neovascular pathologies. The integration of imaging biomarkers and vascular pattern analysis facilitates early detection of subclinical and quiescent CNV, allowing for timely, individualized anti- vascular endothelial growth facgtor therapy. Additionally, the systemic management of PXE and its cardiovascular, renal, and gastrointestinal manifestations is underscored to optimize overall patient outcomes. We provide an up-to-date synthesis of diagnostic advances and treatment strategies aimed at improving visual prognosis in patients with AS-CNV.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of methotrexate in preventing retinal detachment after proliferative vitreoretinopathy surgery: A systematic review and meta-analysis.","authors":"Ibrahim Kocak, Nihat Sayin, Sadik Etka Bayramoglu, Lukman Thalib","doi":"10.1016/j.survophthal.2025.09.015","DOIUrl":"10.1016/j.survophthal.2025.09.015","url":null,"abstract":"<p><p>Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with the aim of preventing recurrent PVR and subsequent retinal detachment; however, its efficacy remains uncertain. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to December, 2024, for studies evaluating intravitreal MTX as an adjuvant therapy in PVR surgery. The primary analysis included randomized controlled trials (RCTs), while supplementary analyses incorporated non-randomized studies. All meta- analyses were conducted using random-effect models. Study quality was assessed using the Cochrane Risk of Bias (ROB2) tool, and the certainty of evidence was evaluated using the GRADE approach. Three RCTs with 145 eyes met the eligibility criteria. The meta-analysis showed a pooled RR estimate of 0.64 (95 % CI 0.30-1.38), indicating a 36 % reduction in the risk of recurrent RD in MTX-treated eyes, although this was not statistically significant. No significant differences were observed in visual acuity improvement (SMD = 0.04; 95 % CI -0.53-0.60). Additionally, our meta-analysis of 5 non-randomized studies involving 277 eyes found no evidence to suggest that MTX reduces the incidence of recurrent retinal detachment in eyes undergoing surgery for PVR (RR = 0.90; 95 % CI 0.49-1.64). The RCTs were rated as having moderate risk of bias, while most non-randomized studies were assessed as having high risk of bias. Funnel plots indicated potential publication bias, and the certainty of evidence was rated as moderate according to GRADE. Although MTX was associated with a clinically relevant 36 % reduction in recurrent RD risk, the effect was not statistically significant. Larger, high-quality RCTs with adequate power are needed to confirm these findings.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}