Frontiers in ophthalmology最新文献

{"title":"Myocardial infarction following fluorescein angiography: a case report and review of the literature.","authors":"Maram El-Geneidy, Akhila Alapati, Radwan S Ajlan","doi":"10.3389/fopht.2026.1823249","DOIUrl":"10.3389/fopht.2026.1823249","url":null,"abstract":"<p><strong>Introduction: </strong>Fluorescein angiography (FA) is a commonly utilized procedure to evaluate retinal vasculature. Although relatively safe, the procedure carries a small risk of serious life-threatening adverse reactions. The purpose of this report is to describe a case of a non-ST-elevation myocardial infarction (NSTEMI) after fluorescein angiography.</p><p><strong>Case presentation: </strong>A 76-year-old woman with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to the clinic with subacute-onset bilateral vision and hearing loss. Ophthalmic exam demonstrated neovascularization of the optic disc and iris in the left eye. A recent brain magnetic resonance imaging (MRI) suggested systemic vasculitis. FA was obtained to rule out Susac syndrome and evaluate for possible vasculitic etiology of her vision loss. Approximately 10 min after the procedure, she developed acute central chest pain and hypertension. She was sent to the emergency department (ED), and workup revealed a non-ST-elevation myocardial infarction for which she was admitted. Cardiac catheterization confirmed an occlusion of the right coronary artery. She was managed medically and subsequently discharged upon stabilization.</p><p><strong>Conclusion: </strong>This case reports the extremely rare and life-threatening complication of acute myocardial infarction following FA. Possible underlying mechanisms include an allergic-mediated coronary vasospasm (aka Kounis syndrome) or anxiety-related catecholamine release in pre-existing diseased myocardium. This event underscores the critical importance of thorough patient counseling, clinical vigilance, and institutional readiness to manage acute systemic emergencies associated with this common procedure.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1823249"},"PeriodicalIF":2.4,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152367","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":"Peripheral retinal degenerations: multimodal imaging-guided risk stratification and clinical decision-making.","authors":"Siniša Babović, Nemanja Maletin, Nikola Denda","doi":"10.3389/fopht.2026.1814997","DOIUrl":"10.3389/fopht.2026.1814997","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral retinal degenerations (PRD) encompass a broad spectrum of peripheral retinal alterations, ranging from benign atrophic changes to tractional lesions associated with retinal tears (RT) and rhegmatogenous retinal detachment (RRD). Despite increasing detection with modern peripheral imaging, the clinical relevance and management of many PRD remain controversial. This review aims to provide an imaging guided, risk based framework for PRD evaluation and management, emphasizing the role of posterior vitreous detachment (PVD), selective prophylactic intervention, and emerging AI-assisted risk stratification and decision support concepts.</p><p><strong>Methods: </strong>A narrative literature search was conducted in PubMed, Scopus, and Web of Science (January 2000 to September 2025) using predefined terms related to PRD, vitreoretinal traction, RT, RRD, PVD, ultra widefield (UWF) imaging, and peripheral OCT. Of 842 records identified, 29 studies met inclusion criteria and were qualitatively synthesized.</p><p><strong>Results: </strong>PRD can be functionally stratified into low risk atrophic lesions (paving stone degeneration, WWOP), intermediate entities (degenerative retinoschisis), and high risk tractional lesions (lattice degeneration, snail track degeneration, retinal tufts). PVD represents the key biomechanical event linking PRD with RT and RRD, particularly during acute symptomatic stages. UWF imaging and SS-OCT improve visualization of peripheral morphology and vitreoretinal interface abnormalities, enabling differentiation between benign lesions, tractionally unstable configurations, and subclinical RRD. Current evidence supports selective prophylactic laser photocoagulation in eyes with symptomatic RT, fellow eye RRD, or OCT confirmed tractional instability, while routine treatment of asymptomatic low risk PRD is not justified. AI-assisted decision support may help standardize risk interpretation by integrating multimodal imaging features with clinical risk modifiers within a human in the loop model.</p><p><strong>Conclusion: </strong>PRD management should be individualized using integrated clinical assessment and multimodal imaging, with intervention targeted to tractional instability and meaningful risk modifiers.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1814997"},"PeriodicalIF":2.4,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058766","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":"Clinical evaluation of corneal elasticity and true IOP using a dual-applanation tonometer.","authors":"Ciro Caruso, Gaetano Barbaro, Mario Troisi, Francesco Matarazzo, Ciro Costagliola","doi":"10.3389/fopht.2026.1811004","DOIUrl":"10.3389/fopht.2026.1811004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical feasibility of a modified Goldmann applanation system capable of estimating true intraocular pressure and corneal elasticity <i>in vivo</i>.</p><p><strong>Methods: </strong>A dual-applanation prism was developed, allowing two sequential IOP readings under identical optical conditions. A mathematical model was applied to compute true intraocular pressure and the corneal Young's modulus measured applanation forces, corneal thickness and curvature. Fifty-three healthy eyes were examined. Model-derived true intraocular pressure values were compared with standard GAT, Pascal dynamic contour tonometry and corneal Young's modulus.</p><p><strong>Results: </strong>Mean IOPT was 15.72 ± 2.44 mmHg, significantly higher than GAT measurements (14.86 ± 2.71 mmHg; mean difference +0.86 ± 1.82 mmHg, p = 0.0012). IOPT showed strong agreement with Pascal DCT (15.60 ± 2.35 mmHg), with minimal bias (+0.15 ± 1.63 mmHg, p = 0.499) and high correlation (r = 0.93, p < 0.0001). Measurement variance was lower for IOPT than for GAT, indicating improved precision. The mean <i>in vivo</i> corneal Young's modulus was 0.18 ± 0.04 MPa (range 0.057 MPa to 0.296 MPa.), consistent with physiological values. Young's modulus showed significant age-related variation (p < 0.001) and a moderate inverse correlation with IOPT (r = -0.53, p < 0.001), while no significant sex-related differences were observed.</p><p><strong>Conclusion: </strong>This dual-applanation system enables real-time <i>in vivo</i> estimation of both true intraocular pressure and corneal elasticity. The model provides a physically grounded correction to Goldmann tonometry and introduces a new clinically accessible method to assess corneal biomechanics.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1811004"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019170","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":"Injectable corneal endothelial cell therapy: recent progress, translational barriers, and future directions.","authors":"Ghadeer Mohammed, Muhammad Abbas Tayyab, Jaffer Hussain, Renad AlDhib, Mifrah Rahat Khan Sherwani, Johar Abbas, Zahra Arsalan, Carolina Mercado","doi":"10.3389/fopht.2026.1799892","DOIUrl":"10.3389/fopht.2026.1799892","url":null,"abstract":"<p><strong>Introduction: </strong>Corneal endothelial dysfunction, most commonly caused by Fuchs endothelial corneal dystrophy (FECD) or pseudophakic bullous keratopathy (PBK), leads to stromal edema and corneal decompensation when endothelial cell density (ECD) falls below 500-700cells/mm². Standard treatment via corneal transplantation, including Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), is limited by the need to standardize corneal endothelial cell culture, donor shortages, immune rejection, and technical complications.This review aims to summarize recent advances in injectable corneal endothelial cell (CEC) therapy, critically appraise translational challenges, and discuss future directions for establishing this regenerative approach as a global treatment.</p><p><strong>Design: </strong>Narrative review of pre-clinical and clinical studies examining CEC injection therapy.</p><p><strong>Methods: </strong>Relevant literature was analyzed to evaluate innovations in Human corneal endothelial cells (HCEC) preparation, culture techniques, delivery methods, and strategies to enhance cell adhesion and survival. Studies reporting preclinical models and human clinical trials were included to assess safety, efficacy, and translational feasibility.</p><p><strong>Results: </strong>Corneal endothelial cells (CEC) injections have achieved significant advancement since their development. Simple cultured CEC injections showed poor efficacy due to limited cell adhesion and survival, but the introduction of ROCK inhibitors along with cultured CECs demonstrated improvement in corneal transparency up to 5 years. Advancements in cell delivery techniques like hydrogel, carrier-assisted injections, magnetically guided injections, as well as alternative cell sources have shown promising results in pre-clinical studies, but human studies are still ongoing. Despite advancements, persisting challenges include phenotypic stability, and longterm safety and efficacy.</p><p><strong>Discussion: </strong>Injectable CEC therapy is a promising minimally invasive alternative to corneal transplantation. While early clinical outcomes are encouraging, further work is required to optimize cell preparation, delivery, and long-term safety, and to establish the therapy as a scalable, globally applicable treatment for endothelial failure.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1799892"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019135","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":"Bag-in-the-lens technique.","authors":"Shervine Ameli, Iva Krolo, Silke Oellerich, Luc Van Os, Marie-José Tassignon, Sorcha Ní Dhubhghaill","doi":"10.3389/fopht.2026.1813018","DOIUrl":"10.3389/fopht.2026.1813018","url":null,"abstract":"<p><p>Optimal centration of an intraocular lens (IOL) is important for obtaining its intended visual properties. The bag-in-the-lens (BIL) approach is a surgical technique that optimizes centration by centring the lens using both an anterior and a posterior capsulorhexis. The BIL is a monofocal hydrophilic IOL with a biconvex optic and two elliptical plane haptics. The space between the haptics creates an equatorial groove. The IOL is then suspended by placing both anterior and posterior capsular bag rhexis openings into this equatorial IOL groove. As a result, the BIL IOL captures residual lens epithelial cells and therefore additionally seals its position avoiding opacification of the visual axis. In this review, we offer an overview of current literature on the BIL technique.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1813018"},"PeriodicalIF":2.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019165","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":"Poroid hidradenoma of the eyelid: a case report.","authors":"Christian Nieves-Rios, José J López-Fontanet, Juan Serrano-Olmo, Joseph Campbell","doi":"10.3389/fopht.2026.1806872","DOIUrl":"10.3389/fopht.2026.1806872","url":null,"abstract":"<p><strong>Background: </strong>Poroid hidradenoma (PH) is a rare, benign tumor arising from eccrine sweat glands. It typically presents as a painless and slow-growing subcutaneous lesion in individuals in their sixth to seventh decades of life. Histologically, PH demonstrates neoplastic poroid cells with solid and cystic structures confined to the dermal layer, distinguishing it from other types of eccrine tumors such as eccrine poroma, hidroacanthoma simplex, and dermal duct tumor. It predominantly involves regions abundant in eccrine glands, yet reports involving the eyelids are scarce.</p><p><strong>Case presentation: </strong>We report a case of an 88-year-old woman with a 2-year history of a non-painful, enlarging mass on her left upper eyelid, associated with irritation and itchiness. Examination revealed a skin-colored, cystic lesion with associated madarosis and minimal telangiectasia. The patient underwent excisional biopsy of the lesion. Histopathological analysis confirmed the diagnosis of PH, characterized by well-circumscribed solid and cystic components with a pseudocapsule. There was no evidence of recurrence at the 3-month follow-up visit.</p><p><strong>Conclusion: </strong>This case highlights the rare occurrence of PH in the eyelids, emphasizing the diagnostic challenges associated with adnexal tumors in atypical locations. Surgical excision remains the standard treatment, and awareness of ocular manifestations of PH is essential for accurate diagnosis and management by ophthalmologists.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1806872"},"PeriodicalIF":2.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019140","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":"Advanced bilateral glaucoma decades after first-generation Fyodorov 'collar-button' anterior-posterior phakic intraocular lens implantation: a case report and clinical management considerations.","authors":"Monika Sarnat-Kucharczyk, Anna Hitnarowicz, Aleksandra Ziemba, Dorota Pojda-Wilczek, Ewa Mrukwa-Kominek, Sudi Patel","doi":"10.3389/fopht.2026.1677323","DOIUrl":"10.3389/fopht.2026.1677323","url":null,"abstract":"<p><strong>Background: </strong>Phakic intraocular lenses (pIOLs), used to correct high refractive errors, have since been associated with long-term complications including glaucoma and cataract formation. Elevated intraocular pressure (IOP) in these patients can be challenging to manage, often requiring surgical intervention. Micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) offers a less invasive option for IOP control in refractory cases. This report describes a patient with advanced glaucomatous optic neuropathy decades after undergoing pIOL implantation and the successful use of MP-TSCPC.</p><p><strong>Case presentation: </strong>A 45-year-old male presented in June 2023 with advanced glaucomatous optic neuropathy following bilateral implantation of a first-generation Fyodorov \"collar-button\" phakic intraocular lens (pIOL) performed 25 years earlier. The patient experienced worsening vision in both eyes. Visual acuity testing, slit-lamp examination, static visual field (VF) assessment, anterior and posterior segment optical coherence tomography (AS-OCT, PS-OCT), pattern and flash visual evoked potentials (PVEP/FVEP) were performed. Corrected distance visual acuity (CDVA) was 0.9 in the RE and 1.0 in the left eye LE on the Snellen chart. Corrected near visual acuity (CNVA) was 0.5 on the Jaeger chart in both eyes. IOP was 26 mmHg in the RE and 24 mmHg in the LE. Slit-lamp examination revealed the presence of pIOLs with anterior capsular cataracts in both eyes. Fundoscopy showed severe glaucomatous optic neuropathy. Gonioscopy indicated a 30-degree angle width with grade 3 trabecular pigmentation. Visual field testing revealed advanced scotomata. PS-OCT confirmed severe ganglion cell and retinal nerve fiber loss. Performed examinations confirmed bilateral glaucomatous optic nerve atrophy. Despite the use of antiglaucoma medications, IOP remained elevated 3 weeks later measuring 23 mmHg in the RE and 21 mmHg in the LE. Due to persistently elevated intraocular pressure (IOP) despite pharmacological treatment, micropulse transscleral cyclophotocoagulation (MP-TSCPC) was performed in the right eye (RE). Following MP-TSCPC in the RE, the IOP decreased to 16 mmHg. The LE was managed pharmacologically, achieving favorable outcomes.</p><p><strong>Conclusion: </strong>Long-term follow-up is essential in patients with anterior chamber phakic IOLs due to the risk of progressive complications such as cataract formation and secondary glaucoma. Early diagnosis of glaucoma could have prevented advanced optic nerve damage in the presented patient. In complex cases with multiple potential causes of visual impairment, electrophysiological examinations may serve as a supportive tool in the differential diagnosis of optic neuropathies.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1677323"},"PeriodicalIF":2.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977632","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 in ophthalmology: from innovation to clinical integration.","authors":"Bharat Gurnani, Kirandeep Kaur","doi":"10.3389/fopht.2026.1839194","DOIUrl":"10.3389/fopht.2026.1839194","url":null,"abstract":"<p><p>Artificial intelligence (AI) has emerged as a transformative force in modern ophthalmology, enabling rapid advances in disease detection, clinical decision support, workflow optimization, and tele-ophthalmology. Ophthalmology is particularly suited for AI integration because of its reliance on imaging modalities such as fundus photography, optical coherence tomography (OCT), and visual field testing. Over the past decade, deep learning algorithms have demonstrated high diagnostic accuracy in identifying retinal diseases including diabetic retinopathy, age-related macular degeneration, and glaucoma. The approval of autonomous AI diagnostic systems for diabetic retinopathy screening marked a significant milestone in clinical adoption. Beyond diagnostics, AI is increasingly influencing surgical planning, predictive analytics, education, and patient engagement. Despite these promising advances, significant challenges remain regarding algorithm generalizability, ethical considerations, regulatory approval, data privacy, and integration into routine clinical practice. This perspective article reviews current innovations in AI applications within ophthalmology and discusses their clinical impact while outlining future directions for research and implementation. We argue that the next phase of AI in ophthalmology will involve multimodal learning systems, integration with large language models, and deployment in global eye-care networks to address disparities in access to care. A collaborative approach involving clinicians, data scientists, regulators, and industry will be essential to ensure safe, ethical, and effective adoption of AI technologies in ophthalmic practice.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1839194"},"PeriodicalIF":2.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965564","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":"Application of imaging studies for orbital tumors: a practical review and representative cases.","authors":"César Fernández, J Matthew Debnam, Bita Esmaeli","doi":"10.3389/fopht.2026.1822331","DOIUrl":"10.3389/fopht.2026.1822331","url":null,"abstract":"<p><p>Orbital imaging has undergone a significant transformation over the past few decades, evolving from basic radiographic techniques to sophisticated cross-sectional imaging modalities. Historically, conventional radiography was limited to visualizing only the bony structures of the orbit or radiodense foreign bodies, making it inadequate for detecting soft tissue pathology. Advances in imaging over the last several decades-first with computed tomography (CT) in the 1970s and later with magnetic resonance imaging (MRI) in the 1980s-have revolutionized orbital diagnostics by enabling detailed visualization of both osseous and soft tissue structures. Magnetic resonance imaging (MRI) has emerged as the preferred modality for evaluating orbital tumors and other soft tissue lesions. Its superior soft tissue resolution, multiplanar imaging capability, and ability to characterize lesion morphology and extent make it crucial in clinical practice. MRI is especially valuable in differentiating benign from malignant lesions, evaluating involvement of critical structures such as the globe, optic nerve, extraocular muscles, and vascular components, and assessing disease at the orbital apex or with suspected intracranial extension. Advanced MRI techniques, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, further enhance diagnostic accuracy. In pediatric populations, MRI holds particular importance due to its lack of ionizing radiation and its effectiveness. In contrast, while CT offers superior resolution of bony anatomy and is useful for detecting calcifications and fractures, it is somewhat limited in soft tissue differentiation and involves exposure to ionizing radiation. While CT examination can be tailored to evaluate bone or soft tissues, orbital CT is typically reserved for cases requiring detailed osseous assessment, acute trauma settings, or for patients who cannot undergo an MRI. MRI creates high-resolution images by detecting signals emitted by hydrogen nuclei when exposed to a strong magnetic field and radiofrequency pulses. Differences in signal based on tissue composition and water content are captured and converted into high-resolution images. Interpreting orbital lesions requires standardized terminology.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1822331"},"PeriodicalIF":2.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965537","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":"Ocular manifestations of vitamin A deficiency in gastrointestinal and hepatobiliary disease.","authors":"Eric W Lai, Timothy Lee, George Chen, Shih-Chung Lai, Paul Kang, Sidney A Schechet","doi":"10.3389/fopht.2026.1779060","DOIUrl":"10.3389/fopht.2026.1779060","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize clinical features, risk factors, and outcomes of vitamin A deficiency (VAD) among patients with gastrointestinal (GI) and/or hepatobiliary comorbidities.</p><p><strong>Methods: </strong>This retrospective study examined patients with GI or hepatobiliary disease who presented with ocular manifestations of VAD. Extracted data included patient demographics, underlying GI or hepatobiliary diagnoses, serum vitamin A levels, ophthalmic symptoms and examination findings, imaging features, and response to vitamin A repletion.</p><p><strong>Results: </strong>26 eyes from 13 patients were included. The most common systemic comorbidities were fatty liver disease (38.5%), prior gastric bypass surgery (23.1%), and cirrhosis (23.1%). Median serum vitamin A level at diagnosis was 19.1 mcg/dL (range, 2.5-36.1 mcg/dL, reference range 38-72 mcg/dL). Median presenting best visual corrected acuity (BCVA) was 20/50 (logmar 0.44, range, 20/20-light perception). Twenty-two eyes (84.6%) demonstrated anterior segment manifestations of VAD, including four eyes (15.4%) who presented with bilateral corneal ulceration and perforation. Posterior segment findings were present in 16 eyes (61.5%), including subretinal drusenoid deposits, RPE mottling, placoid macular changes, optic neuropathy, and a full-thickness macular hole. All patients reported bilateral vision loss, with 63.6% endorsing nyctalopia. All patients who underwent vitamin A repletion experienced subjective visual improvement and partial or complete resolution of ophthalmic findings, including regression of anterior and posterior segment pathology.</p><p><strong>Conclusions: </strong>Vitamin A deficiency occurs across a wide spectrum of GI and hepatobiliary diseases and is associated with diverse anterior and posterior segment ocular findings, ranging from subtle surface disease to severe, vision-threatening pathology. Visual symptoms and ocular findings improved following vitamin A repletion, highlighting the preventable and reversible nature of this condition when identified early. Given the risk of irreversible ocular sequelae with delayed diagnosis, serum vitamin A assessment with timely repletion should be considered in patients with at-risk gastrointestinal and hepatobiliary conditions. Early identification through multidisciplinary care may prevent avoidable, vision-threatening ocular complications.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"6 ","pages":"1779060"},"PeriodicalIF":2.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944136","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}