Survey of ophthalmology最新文献

{"title":"The role of adjunctive aqueous suppressants for anti-vascular endothelial growth factor therapy: A systematic review.","authors":"Kareem Sadek, Philip Yu, Salem Abu Al-Burak, Rahma Osman, Brendan K Tao, Abdullah Al-Ani, Farhad Ghaseminejad, Haaris Khan, Parnian Arjmand, Cindy Hutnik, Eduardo V Navajas","doi":"10.1016/j.survophthal.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.04.007","url":null,"abstract":"<p><p>Our goal is to determine whether adjunctive aqueous suppressants (topical β-blockers, carbonic anhydrase inhibitors, or oral acetazolamide) enhance outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME), retinal vein occlusion (RVO), and neovascular age-related macular degeneration (nAMD), focusing on retinal thickness, visual acuity, injection burden, intraocular pressure (IOP), and safety. DME, RVO, and nAMD are leading causes of vision loss treated with repeated intravitreal injections, yet many eyes show persistent fluid. Aqueous suppressants are inexpensive and widely available, with potential to prolong intravitreal drug residence and improve outcomes, but their clinical value remains uncertain. Following a registered protocol, we searched 4 databases (January, 2000 toMay, 2025) for randomized and comparative studies evaluating adjunct aqueous suppressants with anti-VEGF therapy. Primary outcome was change in retinal thickness; secondary outcomes included visual acuity, injection burden, IOP, and adverse events. Risk of bias was assessed and findings synthesized narratively. Twelve studies (7 randomized trials; 495 eyes) met inclusion criteria. In DME, 3 of 4 trials showed greater thickness reduction with adjunctive dorzolamide (±timolol), although visual gains were inconsistent. In RVO, 1 trial suggested transient anatomical benefit, whereas oral acetazolamide showed no added effect. In nAMD, adjunctive dorzolamide-timolol reduced residual fluid in refractory cases without visual or treatment-sparing benefit. Topical therapy produced modest IOP reductions without serious adverse events. Adjunct aqueous suppressants may provide limited short-term anatomical benefit, particularly in DME and refractory nAMD, but consistent functional or durability effects are not found in this study. Larger, longer-term randomized studies are needed.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857311","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":"Glaucoma Filtering Surgery Combined with Phacoemulsification in the Era of New Aqueous Humor Filtration Devices: A Systematic Review of the Literature.","authors":"Sieta Gassama, Paul Bastelica, Christophe Baudouin, Antoine Labbé","doi":"10.1016/j.survophthal.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.04.001","url":null,"abstract":"<p><p>We evaluate the efficacy and safety of filtering glaucoma surgeries combined with phacoemulsification (PCE)-including new aqueous humor drainage devices-compared to standalone procedures. We performed a systematic search up to March 23, 2025, including all comparative studies assessing trabeculectomy (TRAB), non-penetrating deep sclerectomy (NPDS), Xen® Gel Stent (XEN), or Preserflo® MicroShunt (PMS) combined with PCE, versus the same surgery alone. Key exclusion criteria include inadequate follow up (less than 12-month), absence of a defined success criterion, more than 50% of loss to follow-up at 12-month, and lens extraction performed without PCE. Main outcome was surgical success at ≥ 12 months. Secondary outcomes included intraocular pressure (IOP) reduction, decrease in hypotensive medications, and rates of complications. A total of 27 studies were included for analysis. Among studies comparing TRAB/PCE with standalone TRAB, half reported similar success rates, while others favored standalone TRAB, particularly using strict IOP thresholds. Safety profiles were comparable. For NPDS/PCE, data mostly showed equivalent outcomes versus standalone NPDS, with comparable safety. In studies on XEN/PCE and PMS/PCE, results suggested similar rates of surgical success, efficacy in IOP and medication reduction, and safety compared to their standalone procedures. Small differences occasionally favored standalone procedures under stricter success definitions. Current evidence suggests that combined filtering glaucoma surgery provides long-term efficacy and safety comparable to standalone, though some subgroups and outcome thresholds may slightly favor standalone approaches. The limited availability of high-quality prospective trials underscores the need for further large-scale robust studies.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857408","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":"Schlaegel lines: History, etiology, multimodal imaging, and differential diagnosis of curvilinear streaks in chorioretinal disorders.","authors":"Paolo Forte, Alessandro Feo, Giovanni Forte, Lorenzo Bianco, Giacomo Boscia, Meira Miri Fogel Levin, Alessio Antropoli, Pierluigi Scandale, Jennifer Cattaneo, Alberto Quarta, Lorenzo Ferro Desideri, Chiara Maria Eandi, Mariacristina Parravano, Alessandro Marchese, Hiok Hong Chan, Marko M Popovic, Elisabetta Miserocchi, David Sarraf, Edmund Tsui","doi":"10.1016/j.survophthal.2026.05.001","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.05.001","url":null,"abstract":"<p><p>Schlaegel lines (SL) represent distinctive curvilinear patterns of chorioretinal atrophy that have emerged as a distinctive, yet non-pathognomonic, funduscopic sign across diverse ocular disorders. First described as related to presumed ocular histoplasmosis syndrome in the early 1980s in Histoplasma-endemic regions, these peripheral fundus lesions have since been documented across numerous other etiologies. The majority of SL arise in the context of inflammatory chorioretinal disorders, with idiopathic multifocal choroiditis and punctate inner choroiditis constituting the most frequent underlying causes. SL can also occur in a subset of inherited retinal diseases, where they may represent a secondary acquired sign of outer retinal damage. SL demonstrate a predilection for young to middle-aged myopic women. On fundus examination, SL appear as linear atrophic spots or streaks with variable pigmentation. Optical coherence tomography demonstrates retinal pigment epithelium-Bruch membrane-choriocapillaris complex disruption or, when SL are detected during the active inflammatory phase, hump-like hyperreflective RPE elevations. The differential diagnosis of SL requires recognition of the characteristic multimodal imaging patterns to distinguish them from mimicking conditions, such as Verhoeff lines and West Nile chorioretinitis. A comprehensive understanding of the diverse etiologies of SL is essential for accurate diagnosis and appropriate clinical management.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857405","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":"The clinical and genetic profiles, management, and treatment outcomes of familial exudative vitreoretinopathy.","authors":"Le-Ran Tao, Wen-Fei Zhang, Ya-Ning Chen, Zi-Cheng Wang, Xin-Yu Zhao, Sheng-Zhi Liu","doi":"10.1016/j.survophthal.2026.05.004","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.05.004","url":null,"abstract":"<p><p>Our meta-analysis of 99 studies (463 patients) clarifies key controversies in familial exudative vitreoretinopathy. We found that nearly half of patients are asymptomatic at diagnosis, underscoring the need for early screening in at-risk individuals. Pathogenic mutations (most commonly in FZD4, LRP5, NDP) were identified in 43% of cases. Critically, treatment analysis suggests that combination therapy (laser + anti-vascular endothelial growth factor) was associated with a reduced incidence of retinal detachment in early-stage disease, and vitrectomy was associated with improved anatomical outcomes in advanced stages. These findings provide evidence for genotype-aware, stage-based management.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842976","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":"Dynamic regulation mechanisms of macrophages and advances in targeted therapy for corneal injury repair.","authors":"Yuan Li, Yanxin Tao, Jingyi Wu, Yuan He, Jianye Li, Yue Li, Lingdan Wu, Fen Xiong, Hongfei Liao, Qihua Xu, Anan Wang","doi":"10.1016/j.survophthal.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.04.005","url":null,"abstract":"<p><p>Corneal injury is a major cause of visual impairment worldwide and involves a tightly regulated cascade of inflammation, tissue repair, and remodeling. This process typically progresses from an early inflammatory phase to proliferative repair and ultimately to stromal remodeling, with potential outcomes including corneal neovascularization and fibrosis that compromise transparency and vision. Accumulating evidence highlights macrophages as central regulators across these stages. In the early phase, pro-inflammatory (M1-like) macrophages mediate pathogen clearance and immune activation through cytokines such as IL-1β and TNF-α. During the reparative phase, a transition toward anti-inflammatory (M2-like) phenotypes facilitates epithelial regeneration, extracellular matrix remodeling, and resolution of inflammation. Dysregulation of this dynamic balance, however, contributes to chronic inflammation, pathological angiogenesis driven by hypoxia-inducible factor-VEGF signaling, and TGF-β-mediated fibrotic remodeling. This review summarizes current understanding of macrophage-associated signaling networks in corneal injury, including pathways governing inflammation, angiogenesis, and fibrosis, and highlights emerging macrophage-targeted therapeutic strategies such as cytokine modulation, nanocarrier-based delivery, and gene editing approaches. Despite promising preclinical results, challenges including macrophage heterogeneity, temporal specificity, and translational safety remain. A deeper mechanistic understanding may enable the development of more precise immunomodulatory therapies to improve corneal repair and visual outcomes.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842969","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":"Multi-omics panorama of glaucoma: Pathogenesis, biomarkers, and novel therapeutic strategies.","authors":"Jia Gao, Miao Liu, Xue Liu, Mengdi Zhang, Wenjia Qu, Wei Wang, Ping Cao, Ya Mo","doi":"10.1016/j.survophthal.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.04.008","url":null,"abstract":"<p><p>Glaucoma is a group of irreversible, blinding eye diseases characterized by progressive loss of retinal ganglion cells, leading to gradual visual field defects that severely impact patients' quality of life. Its complex pathophysiological mechanisms remain incompletely understood, limiting the development of early diagnostic and effective therapeutic strategies. Advances in omics technologies have provided new insights into elucidating the pathophysiology of glaucoma. We summarize specific alterations in genomics, transcriptomics, proteomics, metabolomics, epigenomics, and microbiomics associated with glaucoma. We emphasize the systematic analysis of disease mechanisms, identification of clinically applicable biomarkers, and discovery of novel therapeutic targets through the integration of these data. This approach paves new pathways for glaucoma subtype diagnosis and personalized treatment, while also outlining future research directions and challenges.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843022","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":"Quantitative imaging for assessing uveitis activity: A comprehensive review.","authors":"Amin Nabavi, Mohammad Zarei, Avik Shome, Ilva D Rupenthal, Rachel R Caspi, Janet Davis, Siamak Yousefi","doi":"10.1016/j.survophthal.2026.04.003","DOIUrl":"https://doi.org/10.1016/j.survophthal.2026.04.003","url":null,"abstract":"<p><p>Assessment of uveitis activity is critical for guiding treatment and monitoring outcomes. Conventional measures, however, are largely subjective and heterogeneous. Advances in ocular imaging have increasingly enabled a shift from qualitative clinical grading to quantitative approaches. In the anterior chamber and vitreous, optical coherence tomography (OCT)-based signatures offer repeatable and potentially reproducible surrogates for inflammatory cell count and haze quantification. Similarly, quantitative fundus fluorescein angiography offers leakage and non-perfusion measures beyond traditional semi-quantitative scores, while OCT angiography (OCTA) provides noninvasive assessment of retinal vascular density. At the retinal tissue level, OCT signatures have been expanded beyond central subfield thickness to include perivascular mapping and ultrastructural parameters such as ellipsoid zone integrity and disorganization of the retinal inner layers. Choroidal biomarkers, including thickness, vascularity index, and OCTA-derived flow parameters, have improved understanding of choroidal involvement in specific uveitic entities and show promise as potential endpoints. Peripapillary OCT and OCTA extend activity assessment to the optic nerve, introducing additional structural and microvascular metrics. Composite indices, including clinician-derived scales, imaging-based scores, and end-to-end artificial intelligence-based grading systems, have also been recently proposed. Across these modalities, methods have evolved from manual to semi-automated and now fully automated pipelines; however, clinical translation requires rigorous validation, including assessment of construct validity, responsiveness to change, and reproducibility across devices. We summarize current strategies for quantifying uveitis activity, their applications, limitations, and future directions toward standardized, objective endpoints.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842985","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":"The downside of tamponade: Silicone oil emulsification and its ocular impact","authors":"Chaitra Jayadev,&nbsp;Karishma Tendulkar,&nbsp;Shruthi Vidyasagar,&nbsp;Vedant Gambhir,&nbsp;Vishma Prabhu,&nbsp;Prathibha Hande,&nbsp;Ramesh Venkatesh","doi":"10.1016/j.survophthal.2025.12.001","DOIUrl":"10.1016/j.survophthal.2025.12.001","url":null,"abstract":"<div><div>Silicone oil (SO) remains an essential intraocular tamponade in vitreoretinal surgery, particularly for complex retinal detachments; however, its long-term use is associated with significant complications, of which emulsification is the most clinically impactful. We offer a comprehensive synthesis of the pathophysiology, clinical presentation, imaging features, and management of SO emulsification. We begin by outlining the chemical structure and biophysical properties of SO, emphasizing the role of viscosity, interfacial tension, and molecular purity in emulsification resistance. The manufacturing process and its relevance to residual impurities, including surfactant-like components, are highlighted as critical contributors to emulsification risk. Clinical risk factors spanning preoperative inflammation, intraoperative techniques, and postoperative dynamics are detailed. Multimodal imaging including optical coherence tomography, ultrasound biomicroscopy, and fundus autofluorescence provides diagnostic insight into emulsified SO, while standardized grading systems offer a framework for clinical assessment. We also address pharmacokinetic alterations in SO-filled and emulsified eyes, impacting drug distribution and efficacy of anti-vascular endothelial growth factor agents, steroids, and antimicrobials. Management strategies include individualized algorithmic decision-making approach regarding the timing and technique of SO removal, acknowledging the challenges in achieving complete elimination of microdroplets. Emerging innovations in SO formulations, surface modifications, fluorinated oils, and AI-driven imaging tools are discussed as future solutions. Ultimately, our review underscores the need for an integrative approach combining material science, surgical expertise, and personalized care to mitigate the complications of SO emulsification and optimize long-term outcomes in retinal surgery.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 3","pages":"Pages 803-816"},"PeriodicalIF":5.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679048","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":"Prospective validation of deep-learning algorithms for diabetic retinopathy screening: A systematic review and meta-analysis","authors":"Ting-Wei Wang ,&nbsp;Wei-Ting Luo ,&nbsp;Yu-Kang Tu ,&nbsp;Yu-Bai Chou ,&nbsp;Yu-Te Wu","doi":"10.1016/j.survophthal.2025.11.012","DOIUrl":"10.1016/j.survophthal.2025.11.012","url":null,"abstract":"<div><div>Deep-learning (DL) algorithms are widely promoted for diabetic-retinopathy (DR) screening, yet their prospective diagnostic accuracy is not well defined. PubMed, EMBASE and ClinicalTrials.gov were searched to April, 2025, for prospective evaluations of DL systems using color-fundus images. Two reviewers screened records, extracted data, and applied QUADAS-2. Hierarchical bivariate random-effects models produced pooled sensitivity and specificity for referable and vision-threatening DR), analyzed separately at patient and eye level. Twenty-one prespecified moderators were explored with uni- and multi-variate meta-regression; publication bias was assessed with Deeks’ test Seventy-three studies from 23 countries (255,330 examinations) met the criteria. Pooled patient-level sensitivity was 0.94 (95 % CI 0.92–0.95) and specificity 0.90 (95 % CI 0.87–0.93); eye-level values were 0.93 (95 % CI 0.91–0.95) and 0.94 (95 % CI 0.92–0.96). DR subtype, retinal-field strategy, camera form factor, and prevalence independently explained heterogeneity (p &lt; 0.05). Performance matched or exceeded pivotal FDA trials (IDx-DR, EyeArt). AI gradability was ≥ 95 % in 60 % of cohorts, including handheld and smartphone systems. DL-based DR screening achieves consistent, high accuracy across devices and care settings, enabling scalable deployment in primary care, pharmacies, and mobile clinics. Quality assurance and ongoing monitoring are essential to maximize population-level benefits.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 3","pages":"Pages 827-846"},"PeriodicalIF":5.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679043","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":"Comparative effectiveness and safety of intra-arterial chemotherapy and intravenous chemotherapy for retinoblastoma: A systematic review and meta-analysis","authors":"Kai-Yang Chen ,&nbsp;Hoi-Chun Chan ,&nbsp;Chi-Ming Chan MD, PhD","doi":"10.1016/j.survophthal.2025.12.009","DOIUrl":"10.1016/j.survophthal.2025.12.009","url":null,"abstract":"<div><div>Intra-arterial chemotherapy (IAC) has emerged as a targeted alternative to intravenous chemotherapy (IVC) for retinoblastoma; however, the comparative effectiveness and safety of these approaches remain incompletely defined. We performed a systematic review and meta-analysis to evaluate whether IAC-based regimens are associated with improved clinical outcomes compared with IVC in pediatric retinoblastoma. Twelve studies were included. Comparative studies contributed to the quantitative synthesis, whereas selected non comparative IAC series were summarized qualitatively to provide contextual evidence. Overall survival demonstrated a consistent association favoring IAC across both early and advanced disease categories, with a pooled effect estimate of OR 4.72 (95% CI 2.69–8.28). In early-stage disease, the pooled OR was 12.61 (95% CI 3.82–41.58), while advanced-stage disease showed a pooled OR of 3.56 (95% CI 1.88–6.74). Heterogeneity was negligible within subgroups (I² = 0%). Event-free survival favored IAC-based treatment overall with a pooled RR of 1.36 (95% CI 1.13–1.62). When stratified by treatment approach, IAC alone showed a pooled RR of 1.30 (95% CI 1.01–1.66) with moderate heterogeneity (I² = 61%), whereas IAC combined with IVC sequencing demonstrated a pooled RR of 1.43 (95% CI 1.10–1.86) with no heterogeneity (I² = 0%). Globe salvage outcomes were improved with IAC, with a pooled RR of 1.33 (95% CI 1.23–1.42; I² = 9%). Avoidance of enucleation also favored IAC overall, with a pooled RR of 1.69 (95% CI 1.34–2.12). Subgroup analyses indicated a modest and non-significant effect in early-stage disease (RR 1.27, 95% CI 0.89–1.80) and a clearer effect in advanced-stage disease (RR 2.08, 95% CI 1.54–2.80), with minimal heterogeneity (I² = 0%). Metastatic events were rare across studies; nevertheless, pooled analysis suggested lower odds of metastasis in IAC-based regimens compared with IVC (OR 0.42, 95% CI 0.19–0.91; I² = 0%), with no evidence of subgroup differences between IAC alone and IAC plus IVC sequencing. In conclusion, IAC-based strategies were associated with favorable outcomes in survival, disease control, globe salvage, and avoidance of enucleation compared with IVC, with consistently low heterogeneity across major endpoints and metastatic events remaining uncommon in both arms. These findings support the role of IAC as an important component of contemporary retinoblastoma management, particularly in settings with appropriate technical expertise and multidisciplinary resources.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 3","pages":"Pages 878-891"},"PeriodicalIF":5.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892908","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}