Frontiers in ophthalmology最新文献

{"title":"Assessment of the aggregate index of systemic inflammation in dyslipidemia with dry eye disease: a retrospective case-control.","authors":"Amani Y Alhalwani, Asma Altasan, Nawaf Alasmari, Asma Almutiri, Mustafa Sunbul, Razan Khalifa, Jumanah Makhtoum, Shatha Jambi","doi":"10.3389/fopht.2026.1762122","DOIUrl":"10.3389/fopht.2026.1762122","url":null,"abstract":"<p><strong>Background: </strong>Dyslipidemia (DLP) is characterized by high rates of occurrence of inflammation. One outcome of DLP development is dry eye disease (DED). The level of inflammation was assessed by identifying clinically relevant parameters in the complete blood count (CBC). In this study, the aim was to evaluate inflammation in DLP-DED patients using the aggregate index of systemic inflammation (AISI) and inflammatory biomarkers, including C-reactive protein (CRP).</p><p><strong>Methods: </strong>A total of 214 patients who had been clinically diagnosed with DLP at King Abdulaziz Medical City between 2016 and 2023 were randomly selected for retrospective analysis. The patients were allocated to one of two groups: DLP only as the control group and DLP with DED as the study group. Blood biomarker tests and demographic data were gathered and analyzed. The means, standard deviations, and medians of the blood results were calculated. Associations with lipid profile and inflammatory indicators were evaluated by Spearman's correlation analysis. Moreover, a multivariable logistic regression analysis was performed to assess the independent association between AISI and DED, controlling for age, gender, and body mass index (BMI).</p><p><strong>Results: </strong>The DLP-DED group demonstrated higher neutrophil and monocyte counts relative to the DLP group. In the DLP-DED group, AISI showed a positive correlation with CRP and a weak negative correlation with HDL and total cholesterol.</p><p><strong>Conclusions: </strong>AISI may indicate components of systemic inflammation in patients with dyslipidemia; however, it was not associated with dry eye disease following adjustment for confounding variables. Additional evaluation of its clinical value requires prospective research.</p><p><strong>Impact statement: </strong>Investigating inflammatory biomarkers in patients with dyslipidemia and dry eye disease may improve understanding of the pathogenesis and pave the way for novel therapeutic approaches to alleviate this debilitating condition.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1762122"},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347442","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":"Outcomes of allogeneic ocular surface stem cell transplantation.","authors":"Albert Y Cheung, Natalia Quiroz-Casian, Enrica Sarnicola, Gautam C Ramanathan, Siddharth Nath, Edward J Holland","doi":"10.3389/fopht.2026.1836045","DOIUrl":"10.3389/fopht.2026.1836045","url":null,"abstract":"<p><p>Allogeneic ocular surface stem cell transplantation (OSST) is an established therapeutic approach for limbal stem cell deficiency, utilizing techniques such as keratolimbal allograft (KLAL), living-related conjunctival limbal allograft (lr-CLAL), allogeneic cultivated limbal epithelial transplantation (allo-CLET), and allogeneic simple limbal epithelial transplantation (allo-SLET). This review synthesizes evidence from 35 studies encompassing 1, 268 eyes with at least 24 months of follow-up to evaluate intermediate- and long-term outcomes. Overall, OSST is associated with improvement in visual acuity and restoration of ocular surface stability, although success rates vary widely by technique, ranging from 13% to 87%. Outcomes appear to be influenced by the intensity of systemic immunosuppression, with triple-agent regimens demonstrating higher rates of long-term success compared with single- or dual-agent approaches. Among techniques, lr-CLAL may offer advantages over KLAL due to lower rejection rates. Despite encouraging results, long-term data remain limited for newer approaches such as allo-CLET and allo-SLET. Careful postoperative monitoring and management of complications, including rejection, glaucoma, and microbial keratitis, remain essential to optimize outcomes.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1836045"},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347489","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":"Combined phacoemulsification and angle filtering procedures versus phacoemulsification with clinical outcomes in primary glaucoma coexisting with cataracts: a meta-analysis of randomized controlled trials.","authors":"Tangshou Xie, Wenrong Rao, Xi Liu, Yuanyi Li, Jie Zhu","doi":"10.3389/fopht.2026.1787044","DOIUrl":"10.3389/fopht.2026.1787044","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the clinical outcomes of combined phacoemulsification and angle filtering procedures versus phacoemulsification alone in patients with primary glaucoma coexisting with cataracts.</p><p><strong>Methods: </strong>Randomized controlled trials comparing combined phacoemulsification and angle filtering procedures with phacoemulsification published before September 24, 2025, were identified through PubMed/Medline, Embase, and Cochrane Library. Intraocular pressure (IOP), anti-glaucoma medications (AGMs), best-corrected visual acuity (BCVA), perimetry, and complications were analyzed in this meta-analysis. Subgroup analyses were conducted based on follow-up duration, angle status, use of mitomycin C (MMC), and surgical approach.</p><p><strong>Results: </strong>Fourteen randomized controlled trials were pooled for analysis. Combined phacoemulsification and angle filtering procedures had a smaller effect on BCVA than phacoemulsification alone without MMC [mean difference (MD) = 0.07, confidence interval (CI): 0.01 to 0.13, I² = 49%, p = 0.03]. Combined phacoemulsification and angle filtering procedures were significantly more effective in reducing IOP (MD = -1.98, CI: -2.71 to -1.25, I² = 90%, p < 0.0001) and need of AGMs (MD = -0.69, CI: -0.87 to -0.52, I² = 73%, p < 0.0001) but associated with a significantly higher rate of complications [risk ratio (RR) = 2.66, CI: 1.82 to 3.89, I² = 13%, p < 0.00001].</p><p><strong>Conclusions: </strong>Combined phacoemulsification and angle filtering procedures are superior in reducing IOP and need for AGMs. In the subgroup without MMC use, combined angle filtering procedures were associated with a statistically significant difference in BCVA compared with phacoemulsification alone.</p><p><strong>Systematic review registration: </strong>https://inplasy.com/inplasy-2026-5-0081/, identifier INPLASY202650081.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1787044"},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310801","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":"Incidence and clinical characterization of retinal detachment in acute retinal necrosis: a global federated database analysis.","authors":"Donovin Thompson, Sidra Zafar, Meghan Berkenstock","doi":"10.3389/fopht.2026.1829400","DOIUrl":"10.3389/fopht.2026.1829400","url":null,"abstract":"<p><strong>Background: </strong>To determine the incidence of retinal detachment (RD) following acute retinal necrosis (ARN) and to evaluate demographic and treatment-related associations using a large, multi-institutional database. Design: Retrospective cohort study.</p><p><strong>Methods: </strong>Setting: TriNetX Research Network. Study population: Patients diagnosed with ARN between January 1, 2014, and January 1, 2024. Procedures: ARN and RD were identified using ICD and CPT codes. Chi-square tests, risk ratio analyses, and logistic regression models were used to evaluate demographic and treatment-related associations of RD. Main outcome measures: Incidence and associations for RD at 3, 6, and 12 months post-diagnosis of ARN.</p><p><strong>Results: </strong>Among 1,785 patients with ARN, the overall incidence of RD was 12.49% (n=223), with 135 cases (60.5%) occurring within the first 3 months of diagnosis and 88 cases (39.5%) occurring thereafter. Although aggressive combination therapy consisting of systemic corticosteroids, oral valacyclovir, and/or intravitreal foscarnet was primarily used in severe cases, RD still occurred frequently. No significant differences were observed in RD incidence based on age, sex, diabetes status, or immunosuppression.</p><p><strong>Conclusions: </strong>In this large EHR-based cohort, RD following ARN occurred most commonly within the first 3 months after diagnosis. Treatment exposures (corticosteroids, valacyclovir, intravitreal foscarnet) should be interpreted strictly as proxies of disease severity, not independent risk factors for RD. These findings underscore the importance of close ophthalmic monitoring during the first 3 months after ARN diagnosis, when the risk of RD is highest.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1829400"},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310744","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":"Case Report: Tube perforation after bleb reformation after PreserFlo MicroShunt implantation.","authors":"Masashi Nishigaki, Atsuya Miki, Chiaki Nogawa, Motohiro Kamei","doi":"10.3389/fopht.2026.1749614","DOIUrl":"10.3389/fopht.2026.1749614","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a rare case of tube perforation after PreserFlo MicroShunt (PMS) implantation and subsequent bleb revision, emphasizing the potential mechanisms involved and the strategies employed for clinical management.</p><p><strong>Observations: </strong>An 84-year-old woman with bilateral exfoliation glaucoma underwent PMS implantation in her left eye due to uncontrolled intraocular pressure (IOP) despite receiving maximum medical therapy. The patient had a history of multiple ocular surgeries and long-term use of glaucoma eye drops. The initial surgery was uneventful; however, the patient developed hypotony and choroidal detachment after stent removal, prompting a second procedure for stent reinsertion. Subsequently, a postoperative conjunctival leak developed, and petrolatum-based ophthalmic ointment was used; however, the leakage did not improve, leading to a third surgery. During this procedure, a conjunctival defect and a 0.5-mm tear posterior to the fin of the PMS tube were identified. The device was removed, and a new PMS tube was implanted in a different quadrant. The IOP stabilized postoperatively, with no recurrent leakage or hypotony.</p><p><strong>Conclusions and importance: </strong>This is a rare case report of PMS tube perforation with a conjunctival hole. Potential contributing factors included chronic conjunctival inflammation from long-term use of glaucoma eye drops, previous ocular surgeries, and prostaglandin-associated periorbitopathy. These conditions may have resulted in tissue thinning and mechanical stress, leading to tube exposure and perforation. In addition, loss of the conjunctival barrier and subsequent exposure to petrolatum-based ophthalmic ointment may have compromised the structural integrity of the PMS, potentially leading to perforation due to continued eyelid friction. A careful preoperative assessment of the ocular surface and periocular anatomy is essential for identifying high-risk patients. Furthermore, if the PMS becomes exposed postoperatively, the use of petrolatum-based ophthalmic ointment should be avoided.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1749614"},"PeriodicalIF":2.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280081","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":"Neuro-ophthalmic complications of tuberculosis and its treatment: a systematic review and meta-analysis.","authors":"Ahmed A Alessa, Ahmed Zuhier Awan, Abdulkarim B Almutairi, Ibrahim Ghassan Ajabnoor, Mohammed Marouf M Jan, Ahmed Y Azzam, Nooran Badeeb","doi":"10.3389/fopht.2026.1818640","DOIUrl":"10.3389/fopht.2026.1818640","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) and its treatment have been associated with significant neuro-ophthalmic morbidity; however, the magnitude and determinants of these complications remain incompletely characterized. This systematic review and meta-analysis aimed to evaluate the incidence and risk factors of ethambutol optic neuropathy (EON), neuro-ophthalmic manifestations of tuberculous meningitis (TBM), and prognostic biomarkers for visual outcomes.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar up to the 30th of September 2025. Studies reporting EON incidence, TBM neuro-ophthalmic complications, or subclinical neurotoxicity biomarkers were included. Random-effects meta-analysis with generalized linear mixed models was performed.</p><p><strong>Results: </strong>Twenty-two studies (N = 260,430) were included. Pooled EON incidence was 1.54% (95% CI: 0.81-2.49%, I²=98.2%). Renal impairment (OR 3.73, 95% CI: 1.78-7.83) and hypertension (OR 2.37, 95% CI: 1.46-3.84) were significant risk factors. TBM neuro-ophthalmic manifestations included cranial nerve III palsy (17.4%), papilledema (12.5%), and optic atrophy (16.7%), with pediatric patients demonstrated significantly higher hydrocephalus rates (72.5% vs 13.0%, RR 5.56). Visual evoked potential (VEP) demonstrated better detection of subclinical changes over optical coherence tomography (OCT) (Hedges' g difference: 0.686, P-value = 0.001). Visual recovery occurred in 52.4% of clinical EON cases. Factors associated with improved recovery included younger age (MD= -3.8 years, P-value= 0.095) and earlier ethambutol discontinuation.</p><p><strong>Conclusions: </strong>TB-related neuro-ophthalmic complications represent significant morbidity with identifiable risk factors. Visual evoked potentials offer superior subclinical detection and early intervention improves visual outcomes. Screening protocols targeting high-risk populations are recommended.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251141453.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1818640"},"PeriodicalIF":2.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254786","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":"Editorial: Diagnostic burdens in high myopia.","authors":"Hitomi Saito, Linda Zangwill, Jasmin Rezapour, Hongli Yang","doi":"10.3389/fopht.2026.1870549","DOIUrl":"https://doi.org/10.3389/fopht.2026.1870549","url":null,"abstract":"","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1870549"},"PeriodicalIF":0.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201371","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":"Case Report: Neuro-ophthalmic manifestations of petroclival meningioma.","authors":"Natalie Lanners, Ritu Sampige, Safa Ibrahim, Dina Abdelsalam, Andrew G Lee","doi":"10.3389/fopht.2026.1841667","DOIUrl":"10.3389/fopht.2026.1841667","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the neuro-ophthalmic manifestations of petroclival meningioma including multiple cranial neuropathies (e.g., trigeminal (V), abducens (VI), facial (VII), vestibulocochlear (VIII), glossopharyngeal (IX), vagus (X), accessory (XI), and hypoglossal (XII) dysfunction).</p><p><strong>Background: </strong>Petroclival meningiomas (PCM) are uncommon, benign skull base tumors that often present gradually but can lead to significant morbidity and mortality due to brainstem and lower cranial nerve involvement.</p><p><strong>Case presentation: </strong>A 42-year-old woman presented with gradual and progressive neck pain, headaches, and dysphagia. Neuroimaging showed a large petroclival meningioma with secondary obstructive hydrocephalus. She underwent staged surgical resections with near-gross total tumor resection. The patient subsequently developed new cranial nerve VI and VIII deficits. We also include a patient perspective of her condition as a unique aspect of the evaluation of PCM.</p><p><strong>Conclusion: </strong>PCM can present with multiple progressive cranial neuropathies due to tumor effects or as a consequence of surgical or radiation therapy. We believe that including a patient perspective in clinical reports might improve physician empathy and understanding of the patient's condition and course beyond the traditional evaluation and management paradigms for brain tumors including PCM.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1841667"},"PeriodicalIF":2.4,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13233223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201380","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":"Prevalence of visual impairment and associated risk factors: a cross-sectional community-based study among children and adolescents in Ghana.","authors":"Josephine Ampomah Boateng, Werner Eisenbarth, Sylvester Kyeremeh, Albert Kwadjo Amoah Andoh, Isaiah Osei Duah Junior, Debora Abena Baidoo, Sylvia Agyekum, Daniel Boateng, Emmanuel Antwi, Kwadwo Owusu Akuffo","doi":"10.3389/fopht.2026.1829462","DOIUrl":"10.3389/fopht.2026.1829462","url":null,"abstract":"<p><strong>Objective: </strong>Contrary to hospital-based estimates of visual impairment, which are influenced by care-seeking behavior and clinical referral patterns, community-based studies provide a more accurate reflection of the true population burden. There is limited evidence on childhood visual impairment in Ghana; this study therefore reports the prevalence and determinants of visual impairment in a community-based sample from the Ashanti Region of Ghana.</p><p><strong>Methods: </strong>A total of 622 participants, all aged 0-20 years, 332 of whom were females, underwent comprehensive ocular examinations, including age-appropriate visual acuity assessment, refraction, anterior segment and fundus evaluations. Visual impairment was defined as visual acuity worse than 0.3 logMAR (6/12 Snellen) in the better-seeing eye. Univariate and multivariable logistic regression analyses were used to assess factors associated with visual impairment (p ≤ 0.05).</p><p><strong>Results: </strong>Of the 622 participants recruited, 571 were included in the analysis after 51 were excluded due to incomplete visual assessment. These participants ranged from 3 months to 20 years (mean ± SD: 8.88 ± 4.11 years), comprising 53.6% females. The prevalence of presenting distance visual impairment was 6.1% (95% CI: 4.3-8.4), while near visual impairment was 10.9% (95% CI: 8.3-13.9). In the multivariable analysis, age (AOR = 0.68, 95% CI: 0.57-0.82, p < 0.001) and ethnicity (AOR = 0.10, 95% CI: 0.03-0.37, p < 0.001) were significantly associated with lower odds of distance visual impairment.</p><p><strong>Conclusion: </strong>Childhood visual impairment remains relatively high in this community-based population in Ghana. Age and ethnicity were significant determinants of distance visual impairment, highlighting important demographic influences on visual health among children and adolescents. These findings underscore the need for strengthened early detection and improved access to pediatric eye care services to reduce avoidable vision loss. Longitudinal studies are warranted to further clarify risk patterns and inform targeted intervention strategies.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1829462"},"PeriodicalIF":2.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165895","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":"Ultrasound-guided preseptal hydrodissection with 5% dextrose in water for persistent botulinum toxin-associated ptosis: a technical protocol.","authors":"King Hei Stanley Lam, Yonghyun Yoon, Jihyo Hwang, Hyemi Yu, Seungbeom Kim, Daniel Chiung-Jui Su","doi":"10.3389/fopht.2026.1792644","DOIUrl":"10.3389/fopht.2026.1792644","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin type A (BoNT-A) injections for glabellar rhytides can rarely lead to persistent blepharoptosis. Current management, including observation and α-adrenergic agonists, is often temporary, highlighting a need for definitive minimally invasive interventions.</p><p><strong>Methods: </strong>This article presents a novel, systematic protocol for ultrasound-guided preseptal hydrodissection. The technique utilizes high-frequency ultrasound with color Doppler to access the sub-orbicularis plane superficial to the orbital septum, where 20 mL of 5% dextrose in water (D5W) is delivered as low-pressure irrigational hydrodissection to establish a confined fluid layer.</p><p><strong>Results: </strong>Application of this protocol in two patients with persistent BoNT-A ptosis refractory to conventional care resulted in progressive improvement. The Marginal Reflex Distance 1 (MRD1) increased from 0 to 4 mm in one patient and normalized in the other, with gains maintained at 3-6 months without additional treatment and no adverse events.</p><p><strong>Conclusion: </strong>This work standardizes a technical protocol for a potential adjunctive intervention in persistent BoNT-A-associated ptosis. The findings are descriptive and hypothesis-generating, positioning the technique for consideration only after standard measures fail. Prospective controlled trials are required to establish efficacy and safety.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1792644"},"PeriodicalIF":2.4,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152451","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}