Acta Ophthalmologica最新文献

{"title":"Long-term results after sutureless intrascleral fixation of the Carlevale intraocular lens: Changes in scleral pocket thickness over time.","authors":"Markus Schranz, Ioanna Dimakopoulou, Marcus Lisy, Victor Danzinger, Daniel Schartmüller, Claudette Abela-Formanek","doi":"10.1111/aos.17468","DOIUrl":"https://doi.org/10.1111/aos.17468","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the long-term effects and dynamic changes in scleral thickness above the T-haptic after sutureless scleral-fixated intraocular lens (sSFIOL) implantation using the FIL-SFF Carlevale lens.</p><p><strong>Setting: </strong>Single-centre, single-surgeon, prospective clinical trial, Department of Ophthalmology, Medical University of Vienna, Austria.</p><p><strong>Methods: </strong>Thirty-six eyes of 36 consecutive patients met the inclusion criteria for this post hoc analysis. Visual acuity, tilt and decentration of the IOL, as well as complications, were evaluated alongside imaging of the scleral pockets during multiple time points using the anterior optical coherence tomography (AS-OCT) system Tomey CASIA 2 in the bleb mode. The OCT scan pattern, oriented parallel to the T-shaped haptic of the IOL, facilitated manual analysis of images to measure scleral pocket thickness on both the temporal and nasal haptics. To compensate for distortions and non-perpendicular image acquisition, distal T-haptic thickness was also measured to calculate the relative scleral pocket thickness. For statistical evaluation, a linear mixed model was used, where we corrected for multiple measurements.</p><p><strong>Results: </strong>The mean follow-up period was 28 ± 11 months. Measured scleral thickness above the T-haptic exhibited a significant decrease on both temporal and nasal sides, translating to an estimated annual decrease of approximately 0.03 mm (p < 0.001). Postoperatively, best-corrected visual acuity (BCVA) significantly improved from 0.77 ± 0.74 logMAR preoperatively to 0.41 ± 0.60 (p < 0.001). IOL tilt increased slightly from 7.23° ± 3.43° to 7.71° ± 3.70° (p = 0.003), while decentration significantly decreased from 0.41 ± 0.21 to 0.39 ± 0.20 mm (p < 0.001) postoperatively.</p><p><strong>Conclusions: </strong>Long-term evaluation of Carlevale sSFIOL implantation demonstrated a significant improvement in postoperative BCVA. However, we observed a thinning of the scleral pocket thickness, raising questions about its clinical significance and the viability of subconjunctival placement of T-haptics in the long term. Further studies are necessary to evaluate the long-term patency of the scleral pocket.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract surgery in megalocornea: A qualitative and quantitative evaluation of published literature.","authors":"Sabrina Vaccaro, Mariacarmela Ventura, Maria Laura Passaro, Mariantonia Ferrara, Francesco Semeraro, Sorcha Ní Dhubhghaill, Vito Romano","doi":"10.1111/aos.17467","DOIUrl":"https://doi.org/10.1111/aos.17467","url":null,"abstract":"<p><p>Megalocornea is a rare condition characterized by an enlarged anterior chamber and an extended ciliary ring, often accompanied by early cataracts and zonular anomalies. This systematic review evaluates the outcomes of cataract surgery in patients with megalocornea, focusing on surgical techniques, intraocular lens (IOL) implantation, complications, and visual outcomes. A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus. Data regarding the included eyes, including preoperative best-corrected visual acuity (BCVA), primary surgery, sequential intraocular lens (IOL) implantation, type of implant, IOL formulae used, follow-up, final BCVA, reported complications, additional surgeries, and IOL-related drawbacks, were collected. A total of 30 studies involving 66 eyes meeting the inclusion criteria were identified. The most common surgical approaches were phacoemulsification (62.1%) and extracapsular cataract extraction (33.3%). IOL displacement occurred in 25% of cases, and further surgery was required in 21.5%. Overall, patients experienced significant improvement in visual acuity, with an average best-corrected visual acuity (BCVA) improvement of -1.05 logMAR. Individuals with megalocornea present unique challenges when undergoing cataract surgery, particularly the risk of IOL displacement due to zonular weakness and capsular enlargement. Despite these risks, appropriate IOL selection and surgical techniques can lead to favourable visual outcomes.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between red blood cell transfusion timing and the development of retinopathy of prematurity: Application of the two-phase theory.","authors":"Salma El Emrani, Lizanne A Derks, Angela M Tjiam, Michaela van Bohemen, Jacqueline U M Termote, Lotte E van der Meeren, Irwin K M Reiss, H Rob Taal, Enrico Lopriore, Nicoline E Schalij-Delfos","doi":"10.1111/aos.17471","DOIUrl":"https://doi.org/10.1111/aos.17471","url":null,"abstract":"<p><strong>Purpose: </strong>Red blood cell (RBC) transfusions are believed to be associated with retinopathy of prematurity (ROP), but the underlying mechanism is not fully understood, partly due to the lack of information on RBC transfusion timing. The aim was to determine the association between the timing and amount of RBC transfusions and the development and severity of ROP.</p><p><strong>Methods: </strong>This retrospective dual-center cohort study included 1177 neonates born in 2004-2022 with a gestational age at birth ≤28 weeks. Primary outcomes were any stage ROP and severe ROP based on maximum staging. Phase I of ROP was defined as ≤32.0 weeks postmenstrual age and phase II as >32.0 weeks postmenstrual age. Logistic regression analyses were adjusted for gestational age at birth, small for gestational age, mechanical ventilation duration, postnatal corticosteroids, sepsis, and necrotizing enterocolitis.</p><p><strong>Results: </strong>Multivariate analysis showed independent associations with severe ROP for RBC transfusion (OR 5.1; 95% CI 1.8-14.3), number of RBC transfusions (OR 1.2; 95% CI 1.1-1.3), RBC transfusion in phase I (OR 2.5; 95% CI 1.2-5.3), number of RBC transfusions in phase I (OR 1.2; 95% CI 1.0-1.3), RBC transfusion in phase II (OR 4.1; 95% CI 2.7-6.3) and number of RBC transfusions in phase II (OR 1.9; 95% CI 1.5-2.4).</p><p><strong>Conclusion: </strong>Based on maximum ROP staging, RBC transfusions in phases I and II are both associated with a high risk of severe ROP. A randomized controlled trial is urgently needed to determine the potential effect of RBC transfusions in phase II on ROP progression.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified penetrating deep sclerectomy versus conventional trabeculectomy for the treatment of glaucoma: A 12-month randomized prospective study.","authors":"Zhike Xu, Lixiang Wang, Xin Wei","doi":"10.1111/aos.17465","DOIUrl":"https://doi.org/10.1111/aos.17465","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the surgical outcomes and adverse events of modified penetrating deep sclerectomy with conventional trabeculectomy.</p><p><strong>Methods: </strong>A prospective randomized clinical study that successively recruited patients with moderate and advanced primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in West China Hospital. The modified penetrating deep sclerectomy creates a small triangular intrascleral lake, which aims to reduce the risk of flap adhesion in conventional trabeculectomy and sudden hypotony associated with the dissection of a larger rectangular deep scleral flap. The primary effectiveness endpoint was the IOP by non-contact tonometer with or without medication use at each follow-up visit. The primary safety endpoint was the incidence of all complications during the study.</p><p><strong>Results: </strong>A total of 19 patients (21 eyes) were randomized to modified deep sclerectomy and 21 patients (21 eyes) to conventional trabeculectomy. Age, sex ratio, pre-operative intraocular pressure (IOP) and the number of IOP-lowering medications used were comparable between the two groups. At the end of the follow-up period (12 months), IOPs were (15.52 ± 3.28) mmHg and (19.66 ± 4.01) mmHg in the modified deep sclerectomy and conventional trabeculectomy groups, respectively (p = 0.006). Deterioration of the visual field appeared in four eyes (19.0%) and seven eyes (33.3%) in the two groups (p = 0.33). At 12 months, the average areas of the aqueous outflow pathway were (0.67 ± 0.30) and (0.43 ± 0.26) mm², demonstrating a significant difference (p = 0.016). Using 18 and 15 mmHg as the IOP criteria for surgical success, the modified penetrating deep sclerectomy group showed a higher overall success rate than the conventional trabeculectomy group at 12 months (18 mmHg: 80.95% vs 52.38%, Log Rank p = 0.033; 15 mmHg: 52.38% vs 4.75%, Log Rank p = 0.001). Complication rates were similar between the two groups (23.8% vs 33.3%, p = 0.55), and no sight-threatening complications were reported.</p><p><strong>Conclusions: </strong>Modified deep sclerectomy shows superior efficacy in IOP control and maintenance of the outflow pathway opening, with comparable rates of adverse events, resulting in a higher overall success rate.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the phenotypical spectrum of the c.1876C>T p.(Leu626Phe) variant in IMPG1-associated disease.","authors":"Carlos Nogueira, Celso Costa, Vasil Kostin, Rufino Silva, Joaquim Murta, Ana Luísa Carvalho, João Pedro Marques","doi":"10.1111/aos.17470","DOIUrl":"https://doi.org/10.1111/aos.17470","url":null,"abstract":"","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking visual outcomes - Follow-up on patients born preterm with childhood-onset visual impairment.","authors":"Hajer A Al-Abaiji, Kamilla Rothe Nissen, Carina Slidsborg, Morten La Cour, Line Kessel","doi":"10.1111/aos.17461","DOIUrl":"https://doi.org/10.1111/aos.17461","url":null,"abstract":"<p><strong>Purpose: </strong>Preterm birth is associated with a risk of ocular complications. The primary aim of the study was to evaluate the main cause of visual impairment (VI) in a cohort of preterm born patients who had childhood-onset VI. The association between health-related quality of life (HRQoL) and age, cause-and severity of VI and impairment type was assessed.</p><p><strong>Methods: </strong>In Denmark, patients <18 years with VI are enrolled at the National Danish Registry of Children with Visual Impairment (NDRCVI). Patients born preterm and enrolled at NDRCVI at any time between 1988 and 2020 were invited for a follow-up regardless of current age. Examinations performed were visual acuity (VA), refraction, Goldmann visual fields, ocular biometry and posterior segment imaging. The three main outcomes were VA sorted by VI severity (mild, moderate, severe and blind), a score for HRQoL (HUI3) and the main cause of VI.</p><p><strong>Results: </strong>Thirty-two preterm-born patients participated in the study with a median age of 28 years at examination (range 8-43). ROP was the main cause of VI in 15 patients (47%) followed by CVI in eight patients (25%). Increasing age at assessment had a significantly negative impact on the HRQoL-score, when unadjusted for type of impairments. HRQoL was significantly lower in patients with combined impairments compared to isolated VI (p = 0.003).</p><p><strong>Conclusion: </strong>ROP and CVI were the most common causes of VI. The HRQoL was significantly lower when VI was combined with other impairments in contrast to isolated VI. Reducing cerebral damage in preterm born children is likely to enhance both HRQoL and visual function.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of AI-based retinal fluid monitoring in neovascular age-related macular degeneration with manual assessment by different eye care professionals under optimized conditions.","authors":"Martin Michl, Bianca S Gerendas, Anastasiia Gruber, Felix Goldbach, Georgios Mylonas, Oliver Leingang, Wolf Bühl, Stefan Sacu, Hrvoje Bogunovic, Amir Sadeghipour, Ursula Schmidt-Erfurth","doi":"10.1111/aos.17458","DOIUrl":"https://doi.org/10.1111/aos.17458","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether automated intra- and subretinal fluid (IRF/SRF) volume measurements are equivalent to manual evaluations by eye care professionals from different backgrounds on real-world optical coherence tomography (OCT) images in neovascular age-related macular degeneration (nAMD).</p><p><strong>Methods: </strong>Routine OCT images (Spectralis, Heidelberg Engineering) were obtained during standard-of-care anti-VEGF treatment for nAMD at a tertiary referral centre. IRF/SRF presence and change (increase/decrease/stability) were assessed without time constraints by five retinologists, three ophthalmology residents, three general ophthalmologists, three orthoptists and three certified readers. Fluid volumes were segmented and quantified using a regulatory-approved AI-based tool (Vienna Fluid Monitor, RetInSight, Vienna, Austria). Sensitivity/specificity (Sen/Spe) for grading fluid presence and kappa agreement were calculated for each group. Their performances in distinguishing between IRF/SRF increase and decrease were assessed using AUCs.</p><p><strong>Results: </strong>About 124 follow-up visit pairs of 59 eyes with active nAMD were included. Across all five groups, fluid volumes >5 nL were identified with values of 0.81-0.95 (Sen)/0.70-0.91 (Spe) for IRF and 0.89-0.98 (Sen)/0.74-0.90 (Spe) for SRF. Interpretations of IRF changes between -17 nL and +3 nL and SRF changes between -9.30 nL and +6.50 nL were associated with Sen > 0.80 and Spe > 0.87 among all groups. Agreements between the algorithm and groups in grading IRF/SRF presence ranged from κ = 0.69-0.82/0.73-0.79. The AUC for correctly classifying fluid change was >0.89 across all groups.</p><p><strong>Conclusion: </strong>Eye care professionals with different levels of clinical expertise assessed disease activity on standard OCT images with comparable accuracy. Despite optimizing the methodology and time resources, manual performance did not reach the high level of automated fluid monitoring.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of postoperative retinal detachment and bacterial endophthalmitis in the Swedish national paediatric cataract register and associated risk factors.","authors":"Arzu Seyhan Karatepe Hashas, Anna Linnarsson Wiklund, Jenny Gyllén, Birgitte Haargaard, Gunilla Magnusson, Alf Nyström, Kristina Tornqvist, Eric Trocmé, Ulrika Kjellström","doi":"10.1111/aos.17460","DOIUrl":"https://doi.org/10.1111/aos.17460","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the incidence and risk factors of retinal detachment (RD) and bacterial endophthalmitis in a cohort of children who underwent cataract surgery before the age of eight.</p><p><strong>Methods: </strong>Data was retrieved from the Swedish national paediatric cataract register. All eyes with congenital or infantile cataract that underwent surgery between January 1, 2007, and December 31, 2023 with at least one follow-up were included. Cases associated with trauma, uveitis or RD at surgery were excluded. Parameters that could be important for complications were analysed.</p><p><strong>Results: </strong>RD was found in seven of 1073 eyes reflecting an incidence of 0.65%. There were no statistically significant differences in age at surgery, presences of intellectual disability or general disease, cataract type, surgical technique, axial length, corneal diameter, previous glaucoma surgery or occurrence of persistent fetal vasculature (PFV), although the frequency of glaucoma surgery and PFV was higher in RD cases; 42.9% versus 13.2% and 57.1% versus 26.0%. Aphakia was significantly more common in RD patients; 71.4% versus 19.3% (p = 0.042), as well secondary glaucoma; 57.1% versus 19.5% (p = 0.032). No cases of endophthalmitis were observed.</p><p><strong>Conclusion: </strong>The incidence of RD was low compared to previous studies and no endophthalmitis was found. This might be a result of centralized paediatric cataract care with few but experienced surgeons. Aphakia and secondary glaucoma were associated with higher RD risk and those cases should be followed carefully. PFV and glaucoma surgery were found at a higher frequency in RD cases prompting comprehensive postoperative care also for these children.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prototype master protocol for benchmarking of real-world follow-up data in glaucoma.","authors":"Pekko Hujanen, Anja Tuulonen, Sanna Leinonen, Kristian Vepsäläinen, Gauti Jóhannesson, Anu Vaajanen, Eemil Lehtonen, Hannele Uusitalo-Jarvinen","doi":"10.1111/aos.17453","DOIUrl":"https://doi.org/10.1111/aos.17453","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to create a prototype master protocol for benchmarking glaucoma real-world data (RWD). Benchmarking is part of the digital innovation strategy of the Finnish aces-rwm ecosystem (automation of care and evaluation of the system with real-world monitoring).</p><p><strong>Methods: </strong>We collected glaucoma RWD in 2012-17 at Tampere University Hospital (Tays) and compared them to six published RWD sets (one in Sweden and five in England). Visual field (VF) data at Tays were retrieved from the perimeter, and clinical RWD were collected manually. At baseline, VF data were available in 2511 of 4121 glaucoma patients (61%), of whom 1413 patients (56%) had 5 years of VF follow-up by 2017 (34% of all 4121 patients). Mean deviation (MD) data were analysed in multiple ways, considering also age and intraocular pressure (IOP).</p><p><strong>Results: </strong>In most data sets, higher age was related to faster progression. At Tays, the distributions of progression rates were similar in better and worse eyes. The proportions of eyes at Tays with the medium rate of MD progression (17% for 0.5-1.5 dB/year) and the fast rate (6% for >1.5 dB/year) were similar to the published RWD trial in England. The published datasets show significant variability in how their findings were reported.</p><p><strong>Conclusions: </strong>This study represents a first step toward the development of a master protocol for real-world benchmarking of glaucoma care. Further refinement of the protocol will encourage and require national and international collaboration in order to produce comprehensive and comparable real-world EHR data sets.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the choice of artificial tears harm patients? A narrative review with an overview of the Nordic market.","authors":"K N Mikha, C E Ø Rasmussen, S N G Ahrensberg, J Freiberg, R A Wozniak, U M K Alnoor, F Fineide, T P Utheim, S Heegaard, M Kolko","doi":"10.1111/aos.17455","DOIUrl":"https://doi.org/10.1111/aos.17455","url":null,"abstract":"<p><strong>Purpose: </strong>To provide an overview of artificial tears marketed in the following Nordic countries: Denmark, Finland, Norway, Iceland and Sweden. Furthermore, this review aimed to highlight the different preservatives and other constituents found in artificial tears in the Nordic market, focussing on adverse effects.</p><p><strong>Methods: </strong>Artificial tears appearing in online pharmacies in Denmark, Norway, Sweden, Finland and Iceland were included, and tables listing their components were created. Based on the preservatives and other constituents found in the artificial tears on the Nordic market, a literature search was conducted to investigate differences and potential adverse effects. This was achieved using PubMed with MeSH and free text search terms. Included articles were (i) studies performed on humans in vivo or in vitro human models, (ii) published between 2000 and 2023 and (iii) focussing on adverse effects, preservatives, toxicity, other constituents and preservative-free artificial tears.</p><p><strong>Results: </strong>A total of 88 artificial tears were found on the Nordic market. Approximately 32% (28 out of 88) of the artificial tears contain preservatives. Eleven of these are preserved with benzalkonium chloride (BAK) or cetrimide. After a thorough literature search, evidence has been found for the toxic effects of BAK and cetrimide. There is no evidence of toxic effects of lubricants, osmoprotectants and lipids.</p><p><strong>Conclusions: </strong>The findings of this review highlight the paradoxical fact that many treatments for ocular surface diseases contain toxic preservatives that may lead to worsening of the condition. In particular, long-time toxic effects of BAK may contribute to disease progression.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}