Frontiers in ophthalmology最新文献

{"title":"A 5-year retrospective review of post-Mohs reconstruction outcomes for periocular cutaneous malignancies at an academic medical center.","authors":"Amanda K Hertel, Aaron Veenis, Rachel Chu, Nathaniel Cameron, Nikki Gill, Irfan Ansari, Maggie Malmberg, Emilee Wells, Geethanjalee Mudunkotuwa, Isuru Ratnayake, Jason A Sokol","doi":"10.3389/fopht.2026.1777608","DOIUrl":"10.3389/fopht.2026.1777608","url":null,"abstract":"<p><strong>Purpose: </strong>This project examines outcomes of post-Mohs reconstruction for periocular cutaneous malignancies. These results highlight reconstructive surgery challenges and their solutions, a topic with limited peer-reviewed literature.</p><p><strong>Methods: </strong>A retrospective chart review on post-Mohs reconstruction outcomes for adults seen at a tertiary referral center between August 2018 and March 2023 was performed. Information on demographics, past medical history, and surgical outcomes was collected. Descriptive statistics and correlations where applied were applicable. The Institutional Review Board (IRB) approved this study.</p><p><strong>Results: </strong>A total of 194 patients met the inclusion criteria (mean age, 67.7 years). Past medical history and skin cancer risk factors were evaluated. The most common periocular malignancy was basal cell carcinoma (70.6%), the location was lower lid (56.7%), and the reconstruction type was Modified Hughes tarsoconjunctival flap (24.7%). There were no intraoperative complications. The most common post-operative complications were healing issues (6.7%) or ectropion (6.2%). Patients reported post-operative symptoms such as eye irritation (23.2%) or pain (20.1%). Most patients had full eyelid function after surgery (93.3%) and acceptable cosmetic appearance (94.8%). Some correlations were found. For example, post-Mohs defect size was associated with variables such as cure rate (p = 0.01834) and general eyelid reconstruction (p = 0.0230). Adjuvant chemotherapy was associated with decreased cure rates (p = 0.0010) and recurrence (p = 0.0174).</p><p><strong>Conclusions: </strong>This study found associations between health history, periocular cutaneous malignancy features, and post-Mohs reconstruction outcomes. Features such as location, defect size, and staged reconstruction techniques in particular had an association with numerous outcomes.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1777608"},"PeriodicalIF":2.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Manuka honey eye drops in managing dry eye disease after cataract surgery: a prospective controlled study.","authors":"Javier García-Bardera, Javier García-Bella, Fiorella K Cuba-Sulluchuco, Bárbara Burgos-Blasco, Pedro Arriola-Villalobos, Jose Manuel Benítez-Del-Castillo","doi":"10.3389/fopht.2026.1812914","DOIUrl":"10.3389/fopht.2026.1812914","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the efficacy of Leptospermum spp (Manuka) honey eye drops in improving dry eye symptoms and reducing ocular inflammation after cataract surgery, compared to sodium hyaluronate eye drops.</p><p><strong>Methods: </strong>A prospective controlled study including 53 eyes undergoing cataract surgery was conducted. Patients were consecutively allocated to Manuka eye drops (n = 25) or sodium hyaluronate (n = 28). Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI) and CATQUEST-SF9 questionnaires. Objective parameters included non-invasive tear break-up time (NIBUT) and conjunctival redness measured with the Keratograph^® 5M. Assessments were performed preoperatively and at 1 day, 1 week, and 1 month.</p><p><strong>Results: </strong>A total of 53 eyes from 53 patients (18 males and 35 females) were analyzed, with a mean age of 72.1 ± 7.6 years. At 1 month, the Manuka group showed a greater reduction in OSDI score compared to the control group (-27.3 ± 20.3 vs -4.3 ± 17.4). After adjustment for baseline OSDI and sex, OSDI remained significantly lower in the Manuka group (adjusted mean difference: -18.7; 95% CI: -28.8 to -8.7; p = 0.007). Conjunctival redness was also lower in the Manuka group at 1 month (adjusted mean difference: -0.56; 95% CI: -0.91 to -0.21; p = 0.014). No significant differences were observed in NIBUT between groups.</p><p><strong>Conclusion: </strong>Manuka eye drops were associated with greater improvement in postoperative dry eye symptoms and reducing ocular surface inflammation compared to sodium hyaluronate. These findings should be interpreted with caution and considered hypothesis-generating.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1812914"},"PeriodicalIF":2.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal vascular occlusions during COVID-19: an epidemiological survey.","authors":"Andrea Montesel, Yan Guex-Crosier, Chiara M Eandi","doi":"10.3389/fopht.2026.1804194","DOIUrl":"10.3389/fopht.2026.1804194","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether the COVID-19 pandemic was associated with changes in the incidence of retinal vascular occlusions.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at the Jules-Gonin Eye Hospital (Lausanne). All new diagnoses of central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), central retinal artery occlusion (CRAO), and branch retinal artery occlusion (BRAO) between January 1, 2019 and December 31, 2020 were included. Regional COVID-19 case counts were obtained from public health records. Incidence rate ratios (IRR) comparing 2019 cases versus 2020 were calculated using official population data. Pearson correlation was used to explore temporal associations between monthly COVID-19 cases and retinal vascular events. The study period largely reflects natural infection exposure, as COVID-19 vaccination in Switzerland began on December 23, 2020.</p><p><strong>Results: </strong>In 2019, 66 retinal vein occlusions (38 CRVO, 28 BRVO) and 20 arterial occlusions (9 CRAO, 11 BRAO) were recorded. In 2020, 49 retinal vein occlusions (34 CRVO, 15 BRVO) and 21 arterial occlusions (14 CRAO, 7 BRAO) were recorded. The IRR for 2020 versus 2019 was 0.73 for vein occlusions (95% CI 0.51-1.05; <i>p</i>=.093) and 1.04 for arterial occlusions (95% CI 0.57-1.90; <i>p</i>=.896). Monthly analysis showed no significant temporal association between COVID-19 incidence and retinal vascular events (<i>p</i>=.08).</p><p><strong>Conclusions: </strong>In this regional study, we did not observe an increase in retinal vascular occlusive events during the early phase of the COVID-19 pandemic. While biologically plausible mechanisms have been proposed, these population-level trends do not support a strong association.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1804194"},"PeriodicalIF":2.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted diagnosis of ocular caruncle oncocytoma: a proof- of-concept case report of two cases.","authors":"Matteo Sacchi, Clara Ellecosta, Sara Sechi, Stefano Dore, Antonio Pinna","doi":"10.3389/fopht.2026.1772378","DOIUrl":"10.3389/fopht.2026.1772378","url":null,"abstract":"<p><strong>Background: </strong>Oncocytomas of the ocular caruncle are rare benign epithelial tumors. Their clinical diagnosis is challenging, as they can mimic other benign or malignant lesions such as papilloma, nevus, squamous cell carcinoma, melanoma, or oncocytic carcinoma. For this reason, histopathological confirmation remains indispensable. The aim of this study was to test the ability of a multimodal large language model (ChatGPT, GPT-5, 2025 version) to generate diagnostic hypotheses directly from slit-lamp images, supported by brief clinical summaries.</p><p><strong>Case presentation: </strong>We retrospectively analyzed two cases of caruncular oncocytoma that had undergone surgical excision with subsequent histopathological confirmation. For each case, ChatGPT was provided only with slit-lamp photographs of the lesion and a concise clinical summary including age, sex, and the site of the lesion (caruncle). No histopathological data or additional clinical details were supplied. In both cases, ChatGPT proposed oncocytoma as the primary diagnostic hypothesis. The model also generated differential diagnoses including papilloma, nevus, as well as the possibility of a malignant lesion such as squamous cell carcinoma or melanoma.</p><p><strong>Conclusions: </strong>This proof-of-concept demonstrates, for the first time to our knowledge, that a general- purpose multimodal AI system can correctly recognize a rare ocular surface tumor from slit-lamp images. While preliminary and limited by the very small sample size, these findings suggest that large language models may assist clinicians in considering rare adnexal tumors during differential diagnosis. Further research on larger datasets is required, and histopathology will remain the gold standard for definitive diagnosis.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1772378"},"PeriodicalIF":2.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workforce challenges to implementation of myopia management in Europe: an electronic/telephone expert survey.","authors":"Annegret Dahlmann-Noor, Line Kessel, Wolf A Lagrèze, Susana Noval, Jan Roelof Polling, Edoardo Villani, Dominique Brémond-Gignac","doi":"10.3389/fopht.2026.1812277","DOIUrl":"10.3389/fopht.2026.1812277","url":null,"abstract":"<p><p>The European Medicines Agency and the UK Medicines and Healthcare products Regulatory Agency recently approved the first commercial preparation of low-concentration atropine, Ryjunea, for use in children aged 3 years and older to slow the progression of myopia. Whilst optical approaches have been available for several years, the addition of a pharmacological option will increase the involvement of ophthalmologists in paediatric myopia management. However, little information is available about implementation strategies in different European countries. We conducted an electronic/telephone survey with key opinion leaders in myopia management in Germany, the Netherlands, Denmark, the UK, France, Italy, and Spain. We complemented the survey with figures on population size reported by the World Bank and UNICEF, and workforce numbers reported by the International Council of Ophthalmology, the International Orthoptic Association, and national associations, where available. We collated data in categories reflecting the current provision of eye care for children and workforce availability. Prescribing rights for medicines, spectacles, and contact lenses for children, as well as workforce numbers, including paediatric ophthalmologists, optometrists, and orthoptists, vary significantly across European countries. In general, workforce numbers appear low compared with the number of children and young people in each country. Policies and implementation pathways for myopia management in children are required to ensure equitable access. European guidelines for training in myopia management and national pathways and standards of care should be developed and endorsed by professional organisations to enable children and young people at risk of myopia progression to access appropriate interventions in a timely and economical fashion.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1812277"},"PeriodicalIF":2.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser doppler holography for choroidal blood flow assessment: a systematic review of technical capabilities, validation studies, and clinical applications.","authors":"Manfredi Marco Giammanco, Ginevra Genziana Bazan Russo, Marco Giammanco","doi":"10.3389/fopht.2026.1763171","DOIUrl":"10.3389/fopht.2026.1763171","url":null,"abstract":"<p><strong>Introduction: </strong>Quantitative choroidal blood flow assessment is important for understanding chorioretinal diseases. Laser Doppler Holography (LDH) is a new non-invasive imaging technique that provides full-field, high-temporal-resolution assessments of ocular hemodynamics. This systematic review synthesizes evidence on LDH's technical capabilities, clinical applications, and provides normative reference values for choroidal vascular anatomy.</p><p><strong>Methods: </strong>A systematic search of the literature was undertaken in accordance with PRISMA guidelines. Studies that evaluated choroidal blood flow in humans using LDH were identified. Data on technical specifications, hemodynamic parameters, and vascular anatomy were extracted for narrative synthesis.</p><p><strong>Results: </strong>The comprehensive literature search resulted in 347 records, with 8 studies that met the inclusion criteria for qualitative synthesis, as well as 2 studies that could be included in the meta-analysis. The pooled mean diameter of the choroidal arteries was derived to be 134.2 μm (95% CI: 128.3 to 140.1 μm) based on the meta-analysis and demonstrated low levels of heterogeneity (I² = 0).</p><p><strong>Discussion: </strong>The narrative synthesis found that LDH could assess choroidal vasculature, differentiate arteries from veins using both flow waveforms and spectral data, deliver quantitative data for hemodynamic parameters, and assess blood flow directionality. LDH is a promising and versatile technique to study choroidal blood flow quickly and non-invasively.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1763171"},"PeriodicalIF":2.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TREM2 in age-related macular degeneration: a microglia-centered perspective in the retinal myeloid landscape.","authors":"Shengyu Zhu, Taoshuo Yang, Limei Sheng, Lei Shi","doi":"10.3389/fopht.2026.1804578","DOIUrl":"10.3389/fopht.2026.1804578","url":null,"abstract":"<p><p>Age-related macular degeneration (AMD) is a leading cause of irreversible central vision loss in older adults. Advanced AMD comprises an atrophic (\"dry\") form characterized by retinal pigment epithelium (RPE) and photoreceptor degeneration and a neovascular (\"wet\") form driven by choroidal neovascularization (CNV). Beyond genetic predisposition and environmental stressors, chronic dysregulation of innate immunity is increasingly recognized as a convergent mechanism linking drusen/Bruch's membrane alterations to outer retinal cell death and pathological angiogenesis. Retinal myeloid cells-including resident microglia and, in specific disease contexts, recruited monocyte-derived macrophages-can support homeostasis by clearing lipids and cellular debris, yet may also exacerbate inflammation, matrix remodeling, and neovascularization. Triggering receptor expressed on myeloid cells 2 (TREM2) is an innate immune receptor expressed by microglia and other myeloid cells that regulates phagocytosis, lipid handling, migration, survival, immunometabolism, and inflammatory tone. Recent retinal studies suggest that TREM2-associated programs can restrain lesion expansion in outer retinal degeneration models and modulate CNV severity in experimental neovascularization; however, interpretation remains limited by disease stage, anatomical niche, and the difficulty of cleanly separating microglia from infiltrating macrophages <i>in vivo</i>. Here, we synthesize current evidence on retinal myeloid contributions to dry and neovascular AMD, provide an updated mechanistic framework for TREM2 signaling, and discuss therapeutic strategies and translational challenges for targeting TREM2 in AMD.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1804578"},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding perceptions of ophthalmology residents on pursuing a uveitis fellowship.","authors":"Lorenzo Bosque, John Gonzales, Shilpa Kodati, Meghan Berkenstock","doi":"10.3389/fopht.2026.1824816","DOIUrl":"10.3389/fopht.2026.1824816","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate factors influencing the decision of ophthalmology residents in the United States to pursue a uveitis fellowship.</p><p><strong>Methods: </strong>A cross-sectional survey, with prospective data collection, study. From December 2023 to July 2024, an anonymous survey was distributed via the Association of University Professors of Ophthalmology (AUPO) to all United States ophthalmology residents. The survey was distributed a second time, between May 2024 and July 2024, through the American Uveitis Society listserv to distribute to residents. The primary outcome was to determine factors influencing ophthalmology residents' decisions to pursue or forgo a uveitis fellowship.</p><p><strong>Results: </strong>Of 115 ophthalmology resident respondents, 14 (12.2%) chose to pursue a uveitis fellowship. Key factors influencing the decision to pursue a uveitis fellowship included the perceived complexity of the field (21.6%), job market perceptions (19.6%), and mentor influence (15.7%). Conversely, the main reasons for not choosing a uveitis fellowship were perceptions regarding surgical opportunities (17.6%), beliefs about the field's complexity (15.1%), and salary expectations (13.2%). Residents not pursuing uveitis subspecialization were more likely to decide before their PGY3 year (26.7% vs. 14.3%, P = 0.041) and 43.6% indicated they would reconsider if the fellowship were combined with another subspecialty. Additionally, 75% (N = 87) felt their uveitis rotation time was inferior compared to other subspecialties. Residents pursuing uveitis subspecialization had more surgical exposure with uveitis-trained faculty than those who did not (64.3% vs. 56.4%, P = 0.018). Residents not pursuing a uveitis fellowship had a higher number of uveitis-trained faculty at their program compared to residents who pursued a fellowship in uveitis (1.90 vs. 1.14, P = 0.002).</p><p><strong>Conclusions: </strong>Improving recruitment into uveitis fellowship may require residency curriculum adjustments that emphasize earlier rotations and increased surgical exposure with uveitis faculty. While didactic and research opportunities are valuable, other factors may play a more determinative role in a resident's decision to pursue a uveitis fellowship. Strengthening mentorship programs can address concerns compensation along with surgical and research opportunities to foster an interest in current residents.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1824816"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-dimensional ultrasound versus torsional ultrasound phacoemulsification in cataracta nigra: a single-nucleus <i>ex vivo</i> bench pilot.","authors":"Rosa Giglio, Daniele Tognetto","doi":"10.3389/fopht.2026.1795898","DOIUrl":"10.3389/fopht.2026.1795898","url":null,"abstract":"<p><p>Cataracta nigra, an extremely dense nuclear cataract, often requires prolonged ultrasound use during phacoemulsification, increasing the risk of corneal endothelial injury and incision-site thermal damage. We compared the Alcon UNITY Cataract System using 4-dimensional (4D) ultrasound with the Alcon CENTURION Vision System with torsional ultrasound in an ex vivo cataracta nigra bench model. A single human cataracta nigra nucleus was divided into four fragments; two fragments were emulsified with UNITY and two with CENTURION under identical user-selected console settings (35% power; IOP 36 mmHg; vacuum 450 mmHg; aspiration flow 30 mL/min). Endpoints included emulsification time, effective phaco time (EPT), cumulative dissipated energy (CDE), and qualitative video assessment of fragments behavior. In this single-specimen model, compared with CENTURION, UNITY showed shorter emulsification time (mean 12.0 s vs 43.5 s) and lower console-reported energy indices (mean EPT 4.2 s vs 15.2 s; mean CDE 1.12 percent-seconds vs 15.01 percent-seconds). Video review suggested more continuous fragment engagement with minimal chatter using UNITY, whereas CENTURION more often showed initial fragment repulsion and turbulence. Because EPT and CDE are console-derived, these findings should be interpreted as relative performance under matched user-selected settings rather than equivalent physical energy delivery. These preliminary findings suggest that the 4D ultrasound mode might be associated with improved emulsification efficiency compared to torsional mode in ultra-dense nuclear material. Further studies using additional specimens and clinical cohorts are needed to determine whether these bench findings translate into meaningful surgical benefit.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1795898"},"PeriodicalIF":2.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative clinical outcomes of SMILE, femtosecond LASIK, and transepithelial PRK: a multicenter Iraqi study.","authors":"Hassan A Aljaberi, Saeed Rahmani, Humam H Alrikabi","doi":"10.3389/fopht.2026.1787176","DOIUrl":"10.3389/fopht.2026.1787176","url":null,"abstract":"<p><strong>Purpose: </strong>To compare refractive predictability, long-term stability, visual quality, ocular surface outcomes, and safety of small incision lenticule extraction (SMILE), femtosecond laser-assisted laser <i>in situ</i> keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (Trans-PRK) for myopia correction in an Iraqi population.</p><p><strong>Methods: </strong>This retrospective multicenter comparative cohort study included 919 eyes of 919 patients who underwent SMILE (388 eyes), FS-LASIK (344 eyes), or Trans-PRK (187 eyes) between January 2023 and December 2025. Postoperative outcomes were evaluated at 6 months, 1 year, and 1.5 years. Primary outcome measures included refractive predictability and stability of spherical equivalent (SE). Secondary outcomes included uncorrected and corrected distance visual acuity (UDVA and CDVA), absolute refractive error, induced corneal higher-order aberrations (HOAs) at 6 months, Ocular Surface Disease Index (OSDI) scores, and safety outcomes. Multivariable linear regression analysis was performed to identify factors associated with residual SE at 1.5 years.</p><p><strong>Results: </strong>SMILE demonstrated the highest refractive predictability and long-term stability, with postoperative SE values closest to emmetropia and the narrowest distribution of residual refractive error at all follow-up intervals. FS-LASIK showed intermediate outcomes, whereas Trans-PRK was associated with greater residual myopia and increased refractive regression over time. Induced corneal HOAs were lowest following SMILE and highest following Trans-PRK. OSDI scores were consistently lower after SMILE, intermediate after FS-LASIK, and highest after Trans-PRK throughout follow-up. Multivariable analysis identified surgical technique as the primary independent predictor of residual SE at 1.5 years, with FS-LASIK and Trans-PRK associated with significantly greater myopic residual error than SMILE. All three procedures demonstrated a high safety profile, with low rates of CDVA loss and infrequent enhancement procedures.</p><p><strong>Conclusions: </strong>In this large multicenter Iraqi cohort, SMILE provided superior refractive predictability, long-term stability, visual quality, and ocular surface outcomes compared with FS-LASIK and Trans-PRK. FS-LASIK remained an effective and safe alternative, while Trans-PRK was associated with greater refractive regression and higher enhancement rates, particularly in eyes with higher degrees of myopia. These findings support procedure-specific patient selection to optimize refractive outcomes and postoperative comfort.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1787176"},"PeriodicalIF":2.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}